Optimising inhaled mannitol for cystic fibrosis in an adult

There has been remarkable progress in the treatment of cystic fibrosis(CF) patients over the past 20 years. However, limitations of standard therapies have highlighted the need for a convenient alternative treatment to effectively target the pathophysiologic basis of CF-related disease by improving mucociliary clearanceof airway secretions and consequently improve lung function and reduce respiratory exacerbations. Mannitolis an osmotic agent available as a dry powder, dispensed in a convenient disposable inhalerdevice for the treatment of adult patients with CF. Inhalationof mannitolas a dry powder is thought to change the viscoelastic properties of airway secretions, increase the hydration of the airway surface liquid and contribute to increased mucociliary and cough clearance of retained secretions. In two large phase 3 studies [1, 2], long-term use of inhaled mannitolresulted in a significant and clinically meaningful improvement in lung function relative to control in adult CF subjects and had an acceptable safety profile. Clinical experience with inhaled mannitolconfirms that it is safe and effective. A minority of patients are unable to tolerate the medication. However, through training in proper inhalertechnique and setting clear expectations regarding therapeutic effects, both the tolerance and adherence necessary for long term efficacy can be positively influenced. Educational aims ● ● To discuss the importance of airway clearance treatments in the management of cystic fibrosis. ● ● To describe the clinical data that supports the use of mannitolin adult patients with cystic fibrosis. ● ● To highlight the role of mannitoltolerance testing in screening for hyperresponsiveness. ● ● To provide practical considerations for patient education in use of mannitol inhaler.