Recombinant human DNase in children with airway malacia and lower respiratory tract infection.
BACKGROUND
Children with airway malacia often have protracted courses of airway infections, because dynamic airway collapse during coughing results in impaired mucociliary clearance. The aim of this study was to determine the effect of the mucolytic drug recombinant human deoxyribonuclease (rhDNase) on the recovery of respiratory symptoms in children with airway malacia and lower respiratory tract infection (LRTI).


METHODS
In a randomized double-blind controlled clinical trial, 40 children with airway malacia and LRTI were randomly assigned to receive either 2.5 mg nebulized rhDNase or placebo twice daily for 2 weeks. The primary endpoint was the change in the cough diary score (CDS) (scale 0-5) from baseline to the second week of treatment. Secondary endpoints were VAS symptom scores for cough, dyspnea, and difficulty in expectorating sputum, need for an antibiotic course, and lung function data (FVC, FEV(1), FEF(75), R(int(e))).


RESULTS
There was no significant difference in the mean change in CDSs from baseline between the rhDNase group and the placebo group (mean difference for daytime 0.19 (95% CI -0.53 to 0.90); for nighttime 0.38 (95% CI -0.30 to 1.05). Proportions of patients requiring antibiotics, and the mean changes in symptom scores and lung function from baseline did not significantly differ between both groups.


CONCLUSIONS
Treatment with 2 weeks of nebulized rhDNase does not enhance recovery or reduce the need for antibiotics in children with airway malacia and LRTI. (Controlled-trials.com number, ISRCTN85366144).
Boogaard
Ruben
R
Division of Pulmonology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Erasmus University Medical Centre, Rotterdam, The Netherlands. r.boogaard@erasmusmc.nl
de Jongste
Johan C
JC
Vaessen-Verberne
Anja A P H
AA
Hop
Wim C J
WC
Merkus
Peter J F M
PJ
D000280:Administration, Inhalation; D000293:Adolescent; D000402:Airway Obstruction / Q000150:complications / Q000188:drug therapy* / Q000473:pathology*; D055091:Bronchomalacia / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D003850:Deoxyribonuclease I / Q000008:administration & dosage*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005500:Follow-Up Studies; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011014:Pneumonia / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D011336:Probability; D011446:Prospective Studies; D011994:Recombinant Proteins / Q000008:administration & dosage; D012129:Respiratory Function Tests; D012141:Respiratory Tract Infections / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014797:Vital Capacity
D011994:Recombinant Proteins; C085693:DNASE1 protein, human; D003850:Deoxyribonuclease I