Inhaled mannitol for the treatment of cystic fibrosis

Abstract

Inhaled dry powder mannitol is well established for use in bronchial provocation testing. Inhaled mannitol also increases mucociliary clearance, and therefore could have a role in treating chronic suppurative lung disease. There have been a number of studies in cystic fibrosis and bronchiectasis. An international Phase III trial has just been published that suggests the use of regular inhaled mannitol increases lung function and reduces exacerbation frequency in cystic fibrosis. Inhaled mannitol exerts its effects in a number of ways, most importantly like hypertonic saline, setting up an osmotic gradient so water flows into the airway lumen, increasing mucus hydration and mucociliary clearance. Its formulation as a dry powder makes it quick and convenient to take.

Keywords::

• cystic fibrosis
• hyperosmolar
• inhaled therapy
• mannitol
• mucociliary clearance
• mucolytic hypertonic saline
• rhDNase

Financial & competing interests disclosure

D Bilton is the first author of the ‘Inhaled dry powder mannitol in cystic fibrosis: an efficacy and safety study’ published in the European Respiratory Journal in 2011. She has received fees of up to GB£5000 for advisory boards from Pharmaxis Ltd (Frenchs Forest, Australia). The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

No writing assistance was utilized in the production of this manuscript.