Effect of increasing doses of mannitol on mucus clearance in patients with bronchiectasis

¹ Depts of Respiratory & Sleep
² PET & Nuclear Medicine, Royal Prince Alfred Hospital, Camperdown, NSW 2050, Australia

	Abstract

Bronchiectasis is characterised by hypersecretion of mucus and impaired clearance. Inhaled mannitol (400 mg) improves mucus clearance, however, the effect of other doses is unknown.

Fourteen patients, age: 63.3±5.7 yr, were studied on 5 visits. Mucus clearance was measured using ^99mTc-sulphur colloid and imaging with a gamma camera at baseline and with mannitol (160, 320 and 480 mg), over 45 minutes and over a further 30 minutes involving 100 voluntary coughs. A control study assessed the effect of cough provoked by mannitol during the intervention.

Whole right lung clearance over 45 minutes was 4.7±1.2% and 10.6±2.6% on baseline and control days and increased to 16.7±4.2%, 22.8±4.2% and 31±4.7% with mannitol 160, 320 and 480 mg respectively. Clearance over 45 min with 480 mg mannitol was greater than clearance with 320 and 160 mg. Total clearance over 75 min, after mannitol and voluntary coughs, was 36.1±5.5%, 40.9±5.6% and 46.0±5.2% with 160, 320 and 480 mg mannitol respectively, all significantly different to baseline (24.1±6.0%) and control (13.1±3.0%). Total clearance over 75 min with 480 mg mannitol was greater compared to 160 mg.

Mucus clearance increases with increasing doses of mannitol and it can be further increased by cough in patients with bronchiectasis.

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