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Pulmozyme® 2 times daily more effective?
- Question
- Dear expert team,
my daughter (nearly 2 years old) inhales for some time once daily with Pulmozyme® (rh-DNAse) in the mornings, before this and in the evenings with hypertonic saline 3% with 7 drops salbutamol. She has an impaired ventilation of the right upper part of the lung (near the "location of the thymus"). If the impaired ventilation area is not getting smaller/disappearing by the inhalation of Pulmozyme® once daily, could probably, according to your opinion, the twice daily inhalation (in the mornings and additionally in the middle of the day) with Pulmozyme be helpful? Or can the twice daily inhalation of Pulmozyme® be harmful?
Many thanks! - Answer
- Hello,
you report, that your nearly 2-year-old daughter has an impaired ventilation of the right upper lung lobe and that your daughter inhales for some time in the mornings and evenings with hypertonic saline 3% plus 7 drops of salbutamol and inhales additionally in the mornings with Pulmozyme®. You ask, if an additional inhalation with Pulmozyme® in the middle of the day could be helpful, in case the impaired area of ventilation will not disappear.
Concerning the impaired area of ventilation, it deals with high probability with an obstruction of the smaller airways by older, viscous bronchial secretions. In this situation it seems to be more sensible to me, to inhale primarily twice daily with Pulmozyme®, as such a mucus plug can hardly be liquidated by inhalation with hypertonic saline 3%.
An additional inhalation with hypertonic saline 3% is however sensible in order to aviod further accumulation of mucus.
In case of a 2-year-old child it should be questioned critically, if this child is able at all to inhale as effective that a liquidation of a supposed mucus plug is possible at all.
I think, it has to be discussed with the treating physicians of your CF center, if one should not make an early trial to restore normal ventilation by endoscopic suction.
We wish you and your daughter all the best.
Yours sincerely,
Dr. H.-G. Posselt - 02.06.2014
