WS08.4/1 Inhaled mannitol (IM) in adults with cystic fibrosis – Part I: Clinical effects

Introduction In 2012 IM (Bronchitol®) gained healthcare approval as an add-on to best standard care in adults with CF. Aim To assess the ‘real world' experience and clinical effectiveness of IM in adults with CF. Method Prospective, questionnaire-based, study. Patients successfully passing the Bronchitol Initiation Dose Assessment were consecutively recruited. Questionnaires were completed including answers graded on a visual analogue scale (VAS) and closed questions, which were repeated after 6–8 weeks. Results 23 patients were recruited, 16 patients (63% female, n=10) completed the study; patient drop-out was due to stopping IM (n = 1), or loss to follow up (n = 6). The median age (range) was 29 (17–44) years and median FEV1 (IQR) 1.76L (1.29–2.11L), 54% (39–66%) predicted. VAS scores were obtained at baseline and follow-up (scale 1 [low/least effective] to10 [high/most effective]): the median score for sputum clearance overall was 6.6 (range 1–9). There was a significant improvement in ease of clearance with physiotherapy from median 5.78 to 4.13 (p = 0.01) and an improvement in daytime cough from median 5.09 to 3.88 (p = 0.09). There was no change in length of physiotherapy sessions, with a median of 20 (14–30) minutes and there was no haemoptysis reported. 15 patients (94%) reported completing all 10 capsules at each dose and FEV1 did not significantly change in this group. Conclusion This small study shows IM was associated with an improvement in ease of sputum clearance in adults with CF. There was no evidence of increased incidence of haemoptysis, cough or length of physiotherapy sessions. Larger studies are needed to evaluate the long term clinical effects.