Bronchoscopically administered recombinant human DNase for lobar atelectasis in cystic fibrosis

Lobar atelectasis is a common complication of cystic fibrosis. The majority of cases respond to intravenous antibiotics and chest physiotherapy. In a subgroup of patients, atelectasis is resistant to medical therapy, and its persistence in the pediatric population is associated with a poor prognosis . Bronchoscopic instillation of human recombinant DNase expanded atelectatic lobes in three children resistant to at least 2 weeks of medical therapy. T his method of administration of DNase has been successful in resistant case s of lobar atelectasis in patients with chronic obstructive pulmonary disea se, quadriplegia, and status asthmaticus. Purulent cystic fibrosis sputum h as a very high DNA content, and DNA has been shown to become more pourable in vitro when treated with rhDNase. Bronchoscopic instillation of rhDNase should be considered in cases of pers istent lobar atelectasis unresponsive to medical therapy. (C) 2001 Wiley-Li ss, Inc.