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* From the Departments of Respiratory Medicine (Drs. Daviskas, Anderson, and Young) and PET & Nuclear Medicine (Mr. Eberl), Royal Prince Alfred Hospital, Camperdown; and Department of Pharmacy (Dr. Chan), University of Sydney, Sydney, Australia.
Correspondence to: Evangelia Daviskas, MBiomedE, PhD, Department of Respiratory Medicine, Level 9, Page Chest Pavilion, Royal Prince Alfred Hospital, Missenden Rd, Camperdown, NSW 2050, Australia; e-mail: lily{at}nucmed.rpa.cs.nsw.gov.au
Study 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.
Design: Clearance of mucus was measured on 3 consecutive days using 99mTc-sulfur colloid radioaerosol and a gamma camera.
Interventions: Mannitol, 330 ± 68 mg (mean± SD), was inhaled using a dry powder inhaler only on day 2.
Patients: Eight patients with bronchiectasis (age range, 29 to 70 years).
Measurements and 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: FEV1 (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.
Key Words: bronchiectasis • hyperosmolarity • mannitol • mucus clearance
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