NICE recommends inhaled mucolytic in cystic fibrosis

28 November 2012

New guidance from NICE approves the use of the dry powder mannitol inhaler, Bronchitol, in patients with rapidly deteriorating disease who are unable to take rhDNase or other osmotic agents.

The build-up of mucus in the lungs (as pictured in this X-ray) is broken down by the influx of water into the airway following inhalation of hyperosmotic mannitol | SCIENCE PHOTO LIBRARY

Adult patients with cystic fibrosis are set to benefit from the approval of the Pharmaxis product Bronchitol following the publication of the latest technology appraisals from NICE. However, use is restricted to patients:

who cannot receive recombinant human deoxyribonuclease (rhDNase) owing to ineligibility, intolerance or who have not adequately responded to rhDNase and
whose forced expiratory volume in 1 second (FEV₁) has declined by >2% annually and
for whom other osmotic agents are inappropriate.

Initiation and dosage recommendations

Before starting dosing with the inhaler, patients must be assessed for bronchial hyperresponsiveness to inhaled mannitol according to the SPC. Following initial dose assessment, the recommended dosage is 400mg (contents of 10 capsules) inhaled using the provided inhaler twice daily.

NICE guidance on mannitol dry powder inhalation for cystic fibrosis

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