Pulmozyme®

Question

Dear experts,
you write in an answer to a question from january 2013 that Pulmozyme® (rh-DNAse) has to be broguht to room temperature before inhaling, therefore should not be inhaled directly when taken from the fridge. May I ask where this information comes from and why it is not written in the leaflet nor in the drug brochure of the Roche Company, and why the CF Center does not point this out, either?
Our son inhales Pulmozyme® for 5 months and is at the moment very hoarse for the second time. Even if I know that hoarseness is one of the frequent side effects of Pulmozyme®, I understood your answer from last year like this, that one can probably avoid this side effect by bringing it to room temperature.
Would you enlighten me on this?
Many thanks!

Answer

Hello,
you ask, if hoarseness as a side effect of inhalation of Pulmozyme® does probably not occur if the drug is not inhaled too cold (directly taken from the fridge). I can answer the question with "yes, however not always".
In my answer from 21.01.13 on the question "hoarseness with Pulmozyme® - what to do" (you have read this, it can be found unter:
ecorn-cf.eu/index.php?id=65&L=0&tx_expertadvice_pi1%5Bshowitem%5D=2243&tx_expertadvice_pi1%5Bsearch%5D=hoarseness) I recommend as a "tip" to inhale the drug at room temperature and not directly from the fridge in order to avoid hoarseness. This recommendation can indeed not be found in the leaflet nor in the drug brochure as it represents an experience and expert recommendation. There are no focused studies on this, that have been conducted during testing of the drug and would provide proves for the theory, therefore you will not find this recommendation in the drug brochure. Pulmozyme® is already on the market for many years and is used frequently in CF patients therefore in the meantime expert opinions could emerge due to experiences in everyday life. Drug prescribing informations are in general not amended by expert opinions.
It seems very natural, that "cooling of the voice cords" can lead to hoarseness in some patients. It is known from everyday life, that too fast drinking of a too cold beverage or the "gulping down" of a very cold portion of icecream can lead to hoarseness. These experiences have pointed at the inhalation of a too cold fulid as a possible hoarseness reason. This is however not the case in all patients.
It would certainly make sense for your son, to test the recommendation. At first, you should however pause your son's inhalation with Pulmozyme® for a few days (until the voice has recovered) and then start another try with adherence to the above mentioned recommendation. Probably it works also with your son?!
I hope that I have answered your question with this and send you my best regards,
Yours,
Dr. med. Christina Smaczny

03.02.2014