Mucus Thinners

Overview

If you use a bronchodilator, use it before inhaling hypertonic saline. If your care team has prescribed mannitol (Bronchitol®), use a bronchodilator before taking it. Then, if you use dornase alfa (Pulmozyme®), use it next, before doing your airway clearance techniques. Following this order will make the time you spend doing your airway clearance techniques more efficient and your cough more productive. The mucus will be easier to move from your smaller airways into your larger ones if your airways are already widened and your mucus is thinner and less sticky.

See how mucus thinners work to make the thick, sticky mucus in your lungs easier to clear out of your lungs.

Hypertonic Saline

Hypertonic saline is a sterile saline solution of different concentrations, 3 percent, 3.5 percent, and 7 percent. It works by increasing the amount of sodium (salt) in the airways.

Salt attracts water into the airways, which thins the mucus, making it easier to cough out. Research has shown that inhaling hypertonic saline twice a day helps people with cystic fibrosis experience fewer lung infections.

Who Should Take It? 

People who are 6 years and older, or who have a forced expiratory volume (FEV1) greater than or equal to 40 percent predicted might be able to take hypertonic saline, but it has been studied in younger children. Before it can be prescribed, your CF care team may do some tests to see if hypertonic saline is right for you. 

How Do I Take It?

Although hypertonic saline can be given at the care center to make you cough, you will most often inhale hypertonic saline as a mist twice a day through a nebulizer. However, everyone is different, so your CF care team will prescribe how much and how often you should take hypertonic saline based on your specific health needs. To ensure that hypertonic saline does not cause problems, your care team may ask you to take your first dose while at the care center. Ask your care team whether you can use your nebulizer and compressor or if you need different equipment.

For complete instructions on how to take hypertonic saline, visit DailyMed, a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects.

To take hypertonic saline:

  • Wash and dry your hands.
  • Empty a single-use vial of hypertonic saline into a clean nebulizer cup.
  • Sit upright in a chair.
  • Place the mouthpiece of the nebulizer between your teeth and on top of your tongue.
  • Inhale and exhale normally through your mouth, making sure you don't breathe through your nose.
  • Remember to take a couple of deep breaths every minute or two to ensure the saline reaches your smaller airways.
  • When you hear a sound similar to spitting, it means the hypertonic saline is almost used up. Tap on the nebulizer cup. Keep breathing the medication in until it is entirely used.
  • Remember to use the full dose. If you need to cough or stop your treatment for some reason, turn the compressor off. When you are ready to restart your treatment, turn the compressor back on and resume treatment. 

Do not take hypertonic saline and other medications at the same time.

Hypertonic saline can damage electrical equipment, such as computers, if you take it too close to electronics. Make sure you take your hypertonic saline in a well-ventilated area away from electronics.

What Should I Expect After Taking it?

Unlike medications, such as antibiotics, hypertonic saline does not remain in your system, so the benefits of thinned mucus are temporary. Therefore, it is important to perform your airway clearance techniques right after taking hypertonic saline, or dornase alfa if you take it, while your mucus is still thin and easier to move out of your airways.

You may experience side effects when you take any medication, including hypertonic saline. Common side effects of hypertonic saline include:

  • Increased cough.
  • Sore throat.
  • Chest tightness.

When discussing any new medications or changes in dosages for medications you are already taking, be sure to ask your care team about:

  • Any potential side effects.
  • Which side effects might be more serious than others.
  • How long they might last.
  • When to talk to your care team if side effects don't go away or if they interfere with your quality of life.

Let your care team know if you feel any side effect that makes it hard for you to continue taking this medication as prescribed. Your care team can work with you to help you manage side effects or to adjust your treatment plan.

Mannitol

Mannitol is an inhaled powder that makes it easier to cough up mucus. It is unknown how it works.

Who Should Take It? 
People who are 18 years and older can take mannitol. Before it can be prescribed, your CF care team will have you use mannitol as a test, the Bronchitol tolerance test, to see if it is right for you. 

How Do I Take It?
You will take mannitol twice a day, once in the morning and once in the evening about 2 to 3 hours before bedtime. 

Mannitol comes with a handheld inhaler and a blister pack of tablets (typically 10).

For complete instructions on how to take mannitol, visit DailyMed, a service from the National Library of Medicine that provides information about drugs, including dosages and possible side effects.

To take mannitol:

  • Wash and dry your hands.
  • Take the cap off the inhaler.
  • Twist the mouthpiece to open the inhaler.
  • Put one capsule in the inhaler.
  • Replace the mouthpiece until it locks in place.
  • Push the two buttons on the sides of the inhaler at the same time, then release.
  • Exhale.
  • Take a deep, steady breath in from the mouthpiece.
  • Hold your breath for 5 seconds, then exhale.
  • Open the inhaler to make sure there is no powder left. If there is, repeat the inhalation process until there is no powder left.
  • Throw the empty capsule away.
  • Take a sip of water.
  • Repeat this process until you have used all the capsules.


What Should I Expect After Taking it?

Unlike medications, such as antibiotics, mannitol does not remain in your system, so the benefits of thinned mucus are temporary. Therefore, it is important to perform your airway clearance techniques right after taking mannitol, or dornase alfa if you take it, while your mucus is still thin and easier to move out of your airways.

You may experience side effects when you take any medication, including mannitol. Serious side effects of mannitol include:

  • Sudden breathing problems immediately after inhaling your medication. Use a short-acting inhaler or rescue medication if you have sudden breathing problems. Get emergency medical care if your bronchodilator or rescue medication does not relieve your symptoms.
  • Coughing up a large amount of blood. Although coughing up blood in your mucus can happen when you use mannitol, you should call your health care provider or get emergency medical care if you cough up a large amount of blood. Ask your care team how to judge this.

Common side effects of mannitol include:

  • Cough.
  • Coughing up blood.
  • Pain or irritation in the back of your mouth and throat and discomfort when swallowing.
  • Vomiting.
  • Fever.
  • Joint pain.
  • Bacteria in your sputum.

When discussing any new medications or changes in dosages for medications you are already taking, be sure to ask your care team about:

  • Any potential side effects.
  • Which side effects might be more serious than others.
  • How long they might last.
  • When to talk to your care team if side effects don't go away or if they interfere with your quality of life.

Let your care team know if you feel any side effect that makes it hard for you to continue taking this medication as prescribed. Your care team can work with you to help you manage side effects or to adjust your treatment plan.

Dornase Alfa

Dornase alfa (Pulmozyme®) is an inhaled medication that thins mucus. Sometimes referred to as a mucolytic or DNase, dornase alfa acts like scissors by cutting up the long DNA strands contained in white blood cells. By cutting these strands into shorter pieces, dornase alfa helps to break up the thick, sticky mucus that often leads to lung infections.

Who Should Take It?

The Cystic Fibrosis Foundation's guidelines, "Chronic Medications for Maintenance of Lung Health," recommend the use of dornase alfa in people with CF ages 6 years and older to improve lung function and reduce exacerbations, or lung infections. It is approved for people ages 5 years and older, but has been studied in younger children.

You should not take dornase alfa if you are allergic to any of the following ingredients: 

  • Dornase alfa.
  • Calcium chloride.
  • Sodium chloride (salt).

How Do I Take It?

Keep dornase alfa refrigerated until you are ready to use it. Dornase alfa is taken through a nebulizer once or twice daily as prescribed by your physician. 

For complete instructions on how to take dornase alfa, visit DailyMed, a service from the U.S. National Library of Medicine that provides FDA label information on marketed drugs.

Dornase alfa comes in single-dose ampules or vials.

To take dornase alfa: 

  • Wash and dry your hands.
  • Pour the contents of an ampule into the nebulizer cup.
  • Sit upright in a chair. Place the mouthpiece of the nebulizer between your teeth and on top of your tongue.
  • Inhale and exhale normally through your mouth, making sure you don't breathe through your nose.
  • Remember to take a couple of deep breaths every minute or two to ensure medication reaches your smaller airways.
  • When you hear a sound similar to spitting, it means the medication is almost used up. Tap on the nebulizer cup. Keep breathing the medication in until it is entirely used.
  • Remember to use the full dose. If you need to cough or stop your treatment for some reason, turn the compressor off. When you are ready to restart your treatment, turn the compressor back on and resume treatment.

What Should I Expect After Taking It?

Unlike medications like antibiotics, dornase alfa does not remain in your system, so the benefits of thinned mucus are temporary. Therefore, it is important to perform your airway clearance techniques right after taking dornase alfa, while your mucus is still thin and easier to move out of your airways.

You may experience side effects when you take any medication. Common side effects of dornase alfa include:

  • Change in or loss of voice.
  • Throat discomfort.
  • Red, watery eyes.
  • Rash.
  • Dizziness.
  • Fever.
  • Runny nose.

When discussing any new medications or changes in dosages for medications you are already taking, be sure to ask your care team about: 

  • Any potential side effects.
  • Which side effects might be more serious than others.
  • How long they might last.
  • When to talk to your care team if side effects don't go away or if they interfere with your quality of life.

Let your care team know if you feel any side effect that makes it hard for you to continue taking this medication as prescribed. Your care team can work with you to help you manage side effects or to adjust your treatment plan.

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Airway Clearance