Inhalation

Question

Is it a good idea to combine amiloride with the salty Vincentka mineral water or physiological solution in the course of one day? The interval between amiloride inhalations should supposedly be at least 3 hours, but we cannot keep to this schedule, as it differs from our daughter´s needs. She inhales at the following intervals: 8:30 a.m. – 11:00 a.m.– 5:30 p.m.

Is it normal that our daughter has a strong coughing attack after she starts inhaling amiloride? The cough subsides after about a minute and then the inhalation continues without any problems.

Answer

Hello,

Amiloride inhalation can certainly be combined with the inhalation of other medicines during the day. The three-hour interval is based on amiloride´s self life, which means that the effect of an inhalation still lasts after 2 ½ hours. If other solutions are used for inhalation, it is important to bear in mind that a new bottle of Vincentka mineral water or physiological solution must be opened every other day. Once a bottle is opened, it might get infected with Pseudomonas. I presume that you have amiloride in 20ml bottles (which are safe from bacteria) and that you keep it in a dark place, but not in the refrigerator. In the refrigerator, the solution might crystallize and become turbid. Light, on the other hand, ruins it.
To comment on the mentioned mineral water: it is a special type of salty mineral water – Vincentka® –that is often used for inhalation. This kind of mineral water, however, is a hypotonic solution with a NaCl content of 0.24%. Furthermore, it is not a sterile solution (as is the prescribed 0.9% NaCl solution, which is a well controlled medical product). Admittedly there has been a microbiological investigation (laboratory report 2007) which did not show any harmful germs such as E. coli and Pseudomonas; however, one cannot be sure how often those controls are performed on this water. There are no studies about the safety and efficacy in CF patients. Therefore it cannot be recommended as a standard inhalative therapy.
I cannot explain why your daughter starts coughing after she starts inhaling amiloride. Maybe the thick vapour fills her airways and causes irritation. It would be a good idea to consult this problem with physiotherapists, who will assert if you are using a suitable inhaler type and if your daughter uses a suitable inhalation technique.
Dr. Jitka Brázová

22.11.2011