Inhalation of dry powder mannitol improves clearance of mucus in patients with bronchiectasis

Bronchiectasis is a disease characterized by hypersecretion and retention o f mucus requiring physical and pharmacologic treatment. Recently we reporte d that inhalation of dry powder mannitol markedly increases mucociliary cle arance (MCC) in asthmatic and in healthy subjects (Daviskas, E., S. D. Ande rson, J. D. Brannan, H. K. Chan, S. Eberl, and G. Bautovich. 1997. Inhalati on of dry-powder mannitol increases mucociliary clearance. Eur. Respir. J. 10:2449-2454). In this study we investigated the effect of mannitol on MCC in patients with bronchiectasis. Eleven patients 40 to 62 yr of age inhaled mannitol (approximately 300 mg) from a Dinkihaler. MCC was measured over 9 0 min, in the supine position, on three occasions involving: mannitol or co ntrol or baseline, using a radioaerosol technique. On the control day patie nts reproduced the breathing maneuvers and the number of coughs induced by the mannitol. Mannitol significantly increased MCC over the 75 min from the start of the intervention compared with control and baseline in the whole right lung, central, and intermediate region. Mean (+/- SEM) clearance with mannitol was 34.0 +/- 5.0% versus 17.4 +/- 3.8% with control and 11.7 +/- 4.4% with baseline in the whole right lung (p < 0.0001). The mean number of coughs induced by mannitol was 49 +/- 11. In conclusion, inhalation of dry powder mannitol increased clearance of mucus and thus has the potential to benefit patients with bronchiectasis.