DORNASE ALFA - A PRACTICAL GUIDE TO PATIENT SELECTION AND DRUG-USE INCYSTIC-FIBROSIS

Cystic fibrosis is characterised by chronic bronchopulmonary sepsis, V arious therapeutic modalities attempt to enhance the clearance of airw ay secretions, Dornase alfa (recombinant human deoxyribonuclease) redu ces the viscoelasticity of sputum from patients with cystic fibrosis b y depolymerising extracellular DNA, The drug is administered as an aer osol using a jet nebuliser at a dosage of 2.5mg once daily, It improve s pulmonary function and reduces the risk of respiratory exacerbations requiring parenteral antibacterials. Various clinical trials have dem onstrated a heterogeneous response to dornase alfa and have been unabl e to predict which groups of patients benefit from treatment, Patient selection is further complicated because some individuals do not exhib it improvements in lung function, but benefit in terms of a decrease i n infective exacerbations, All patients with cystic fibrosis who produ ce purulent sputum are potential candidates for dornase alfa therapy, We suggest that compliant patients be considered for treatment with do rnase alfa, irrespective of disease severity, but should be closely mo nitored and be assessed at regular intervals to monitor treatment resp onse.