Impairment of ventilation

Question

At a routine x-ray in december an impairment of ventilation on the right side of the lung has been found in my 2.5-year-old daughter. She had been given an antibiotic, jumped a lot and inhaled a lot, because she had an underlying infection. Now, after about 6 weeks, a control x-ray had been done, the impairment of ventilation is still there. 2 therapeutic possibilities have been discussed:
1. bronchoscopy with rinsing of the affected side,
2. inhalation with Pulmozyme® (until now 2 ml Mucoclear® 3% (hypertonic saline) with 5 drops of salbutamol),
These alternatives will be discussed next week by the CF team and we will be informed about the decision.
Now my question here, what is the more reasonable approach in your opinion? Are there any other alternatives how one could try to get rid of the impariment of ventilation? Is Pulmozyme® be paid by all (also private ones) insurances at that age?
Many thanks!

Answer

Hello,
the re-opening of this less-ventilated lung area is an important aim for CF patients, that can not always be achieved.
I agree with the recommendations of the concerned center.
In general, one can at first try a therapeutical attempt with inhalative Pulmozyme® (rh-DNAse). It is covered regularly by the insurances from 6 years on, before that age, they are not obliged to cover the costs (however, they do it more and more on request according to our experiences).
The problem is, that non-ventilated areas are not sufficiently reached when drugs are inhaled. Therefore the bronchoscopy - in part also with application of Pulmozyme® in the affected brochus - is a reasonable step in case other therapeutic strategies withhold. On this, there are articles available, also in case of non-CF patients.
All the best,
PD Dr. jochen Mainz

24.02.2014