The 24-h effect of mannitol on the clearance of mucus in patients with bronchiectasis.
OBJECTIVE
To investigate the acute effect of mannitol on the clearance of mucus, and (1) the 24-h mucus retention, and (2) the mucus clearance rate and lung function 24 h after inhalation of a single dose of mannitol.


METHODS
Clearance of mucus was measured on 3 consecutive days using (99m)Tc-sulfur colloid radioaerosol and a gamma camera.


METHODS
Mannitol, 330 +/- 68 mg (mean+/- SD), was inhaled using a dry powder inhaler only on day 2.


METHODS
Eight patients with bronchiectasis (age range, 29 to 70 years).


RESULTS
On each day, lung images were collected over 2 h and at 24 h. Key findings of the study are as follows: (1) the 24-h retention of mucus was reduced the day after mannitol had been inhaled, compared to the day without mannitol (day 1) in the whole right lung (57.6 +/- 6.2% vs 68.1 +/- 5.9%), central (47.5 +/- 6.7% vs 56.9 +/- 6.5%), intermediate (61.7 +/- 5.6% vs 73.8 +/- 5.5%), and peripheral regions (70.9 +/- 4.3% vs 86.6 +/- 4.6%)(p < 0.02); and (2) mannitol helped patients clear mucus within 2 h that might otherwise take up to 24 h, from the whole right lung and defined regions. However, clearance over 60 min measured 24 h after mannitol inhalation was not significantly different to baseline clearance without mannitol (8.7 +/- 1.9% on day 1 vs 9.7 +/- 3.7% 24 h after mannitol; p > 0.8). The patients maintained the same lung function the day before and after mannitol had been inhaled: FEV(1) (percent predicted), 79 +/- 5 on day 1 vs 80 +/- 5 on day 3; and forced expiratory flow, midexpiratory phase (percent predicted), 50 +/- 6 on day 1 vs 51 +/- 6 on day 3; p > 0.6).


CONCLUSIONS
Mannitol inhalation acutely increases clearance of mucus, and this effect extends beyond the acute study period, resulting in decreased mucus retention at 24 h.
Daviskas
E
E
Department of Respiratory Medicine, Royal Prince Alfred Hospital, Camperdown, Australia. lily@nucmed.rpa.cs.nsw.gov.au
Anderson
S D
SD
Eberl
S
S
Chan
H K
HK
Young
I H
IH
D000328:Adult; D000368:Aged; D001987:Bronchiectasis / Q000503:physiopathology*; D004234:Diuretics, Osmotic / Q000494:pharmacology*; D005260:Female; D006801:Humans; D008297:Male; D008353:Mannitol / Q000494:pharmacology*; D008875:Middle Aged; D009079:Mucociliary Clearance / Q000187:drug effects*
D004234:Diuretics, Osmotic; D008353:Mannitol