Several studies have recently been released looking at the use of dry mannitol powder in an inhalation device for the management of cystic fibrosis. One study, entitled “Optimising inhaled mannitol for cystic fibrosis in an adult population,” published in Breathe, explored the safety and effectiveness of inhaled mannitol versus a placebo and found that those who took mannitol had improvement in their cystic fibrosis symptoms.
Cystic fibrosis is an autosomal recessive genetic disease in which there are thick secretions in the lungs and other body areas. The secretions are so thick that they cannot easily be coughed up. Treatment is designed to increase the fluidity of the secretions so they can be removed from the body through coughing.
Mannitol is an osmotic agent that, when dry and inhaled, draws fluid into the bronchial tree. This loosens the mucus in the bronchial tree so it can be more easily coughed up. Mannitol has been found to be safe in cystic fibrosis patients and effective in improving the removal of respiratory secretions, even in those patients who were maximally treated on other cystic fibrosis therapies.
The studies were conducted on adults, but researchers point out that there is no reason to believe that the results won’t be applicable to children. A total of 390 people with cystic fibrosis were enrolled in the study, some of whom used inhaled mannitol and some of whom used placebo. This was a double blind study so none of the participants knew who was taking the mannitol and who was receiving the placebo.
The study participants who used dry mannitol by inhalation had improvements in their spirometry readings, including the FEV1 and forced vital capacity. These measures of lung function gradually improved over 26 weeks and remained improved for an additional 26 weeks in those study participants who chose to use inhaled mannitol after the 26 week study was completed. By the end of 52 weeks, the study participants who took mannitol at 400 mg twice daily had an increase in FEV1 of nearly 75 milliliters.
Inhaled mannitol also decreased the number of disease exacerbations in those with cystic fibrosis who responded to therapy. Not everyone responded to mannitol therapy initially but with improvements in teaching the participants how best to use the inhaled mannitol device, more people responded to this form of therapy. It is anticipated that, once the inhaler is used properly, that respiratory therapists can monitor the use of the inhaler, teaching patients what to expect while taking this form of treatment.
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