Inhalation of sodium bicarbonate

Question

Dear expert team,

I would like to know in which cases it is recommended in CF to inhale NaHCO3 (sodium bicarbonate), how this is done (amount/frequency/dosage/kg or age) and if this inhalation is done in addition to the inhalation with NaCl-solution or instead of it (i.e. in addition with Atrovent® (Ipratropium bromide) and Sultanol® (Salbutamol)).

Thank you.

Answer

Hello,

Thank you for your question. After having reviewed the literature I would like to inform you as follows. In 2002 they started to plan a study about a children's therapy with sodium bicarbonate at the Children's Hospital of Pittsburgh. In the meantime, the recruitment of the patients is completed and all patients have run through the study protocol. Unfortunately, no results have been published so far. Other studies in CF patients are not known.
In July 2012 (5 J U L Y 2 0 1 2 | V O L 4 8 7 | N A T U R E | 1 0 9) the results of a research with CF pigs were published. The authors were able to show that the ph value of the bronchial secretion was lower in CF pigs than in healthy pigs and that the bacterial killing was reduced.

By raising the ph level into a normal range this defence function could be normalised. The authors see these results as a proof that raising the ph value in the bronchial secretion (e.g. by inhaling sodium bicarbonate) might be helpful for fighting pulmonary infections in CF. As there is currently no scientifically validated knowledge about the inhalation of sodium bicarbonate in human beings and no knowledge about the adequate dosage of such an inhalation, it has to be strongly advised against testing the therapy with sodium bicarbonate. Hopefully, the results of the Pittsburgh study will be published soon.

Best regards,
Dr. H.-G. Posselt

15.05.2013