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Inhalation with 3% NaCl solution

Question
Dear expert team,
at first, many thanks for your always quick and competent answers!!

My daughter (23 moths, CF) has been prescribed Mucoclear® (3% NaCl) for inhalation. Before, she inhaled always with 0,9% NaCl and Berodualin® (fenoterol and ipratropiumbromide, both bronchial widening substances). At first, I did "mixtures" and after a few weeks I took only 3% (also with Berodualin®).
From one moment to another, she got sleeping problems since she started the sole 3% solution (during the day, she could nearly not sleep at all, besides fatigue) and she had instead of 1-2 times stool per day 3-4 times stool per day, and that was partly massy. Other things, like getting teeth, getting to cold i.a. can be excluded. Reportedly such side effects are not the custom concerning Mucoclear®.
Can it be, that she reacts simply different to it than others do (like it is in general often the case with drugs)? We stopped it after about a week and now everything is normal again.
Many thanks for your answer,
Best regards,
G.M.
Answer
Hello,
this time, we had to get some additional information at first, in order to be able to answer your question.
You reported, that your 2-year-old daughter, who inhaled before NaCl 0,9% with Berodualin® for a longer time, reacted with sleeping problems especially during the day after switching to Mucoclear® 3%. At the same time, the frequency of having stool increased and the stool had been partly massy.
In your question, you talk about "mixtures" of inhalation solutions. I am not sure if this concerns only NaCl 0,9% and NaCl 3% or also Berodualin®.
After addressing the university hospital in Mainz, Germany, pharmaceutical departement, we were told, that until now, there is no data about an uncritical mixture of Berodualin® and NaCl soultions for inhalation. In case you should indeed have mixed both solutions, you should stop this immediately. The company Boehringer Ingelheim (manufacturer of Berodualin®) informed us, that until now they have not been aware of similar complaints.
A possible explanation for the observed phenomenon would probably be the effectiveness of Mucoclear® 3%. It is known, that Mucoclear® has a markedly increased mucolytic effect in comparison to NaCl 0,9%. Therefore, the sleep of your child could probably be impaired because of an increased tendency to cough. This however, would be obvious to you. Another explanation could be a markedy increased absorption of Berodualin®, as via the better coughing up of mucus from the lungs, Berodualin® comes increasingly into contact with the bronchial mucosa. Hereby it has to be mentioned, that for the substance fenoterol, that is one active agent in Berodualin®, only a slowing down of the bowel passage is known as a side effect. Probably a trial with a reduction of the Berodualin® dosage should be made?
You should discuss with your treating physician, which kind of therapeutic change would make sense in this situation.
Best regards,
Dr. H.-G. Posselt
13.10.2014