Rational use of mucoactive medications to treat pediatric airway disease

Abstract

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Use of dornase alfa in the paediatric intensive care unit: current literature and a national cross-sectional survey

“…While several retrospective and case studies suggest beneficial effects of dornase alfa on resolution of atelectasis and/or clinical indices were identified, there is only one RCT of good quality which showed shortening of duration of mechanical ventilation (primary outcome in this systematic review), but only in a specific age and disease population. This paucity of data in critically-ill children, who are in general highly prone to develop respiratory failure following airway mucus obstruction related to their small airway diameter, [1][2][3] underscores the need for further randomised controlled testing in superiority or noninferiority trials. Interestingly, while airway mucus obstruction has been identified as one of the major challenges in the management of critically-ill patients, 33 the adult ICU literature shows a similar lack of evidence-based recommendations on mucoactive agents, including dornase alfa.…”

“…Airway obstruction resulting from a combination of mucus hypersecretion, increased mucus viscosity and decreased mucociliary clearance poses a major challenge in the care for critically-ill children with respiratory disease in the paediatric intensive care unit (PICU). 1 The presence of mucus plugs carries the risk of atelectasis and nosocomial (eg, ventilator-associated) pneumonia, as well as prolonged need for respiratory support. 2 3 This is particularly true in young children due to small sized airways in combination with limited respiratory muscle strength and possibilities for collateral ventilation.…”

Prevention and Treatment Strategies for Respiratory Syncytial Virus (RSV)

“…This complex interplay between the viral genome and host immune system can result in a type-2 immune response and the release of pro-inflammatory cytokines that, in turn, activate mucus metaplasia and mucin secretion, further exaggerating airway obstruction [ 29 , 30 , 31 ]. An understanding of these potential mechanisms has led to various therapeutic approaches that can be applied to reverse airway obstruction, most notably mucolytics [ 32 ], bronchodilators [ 33 ], and anti-inflammatory agents [ 34 ], and they are summarized in Table 1 . Interestingly, despite the mechanistic links, the evidence does not support the notion that these approaches are of universal benefit for RSV infections.…”

Hipertoniczne roztwory soli w nebulizacji

“…HRS podawane dooskrzelowo (w nebulizacji) działają jako leki mukoaktywne, należące do grupy leków wykrztuśnych [7]. Mechanizm ich działania opiera się na pobudzeniu sekrecji gruczołowej, zwiększeniu zawartości wody w wydzielinie oskrzelowej oraz zmniejszeniu lepkości wydzieliny zalegającej w drogach oddechowych [8]. Dzieje się tak, gdyż po podaniu dooskrzelowym HRS tworzą wewnątrzoskrzelowy gradient osmotyczny prowadzący do zwiększonego biernego wydzielania wody do dróg oddechowych przez wierzchołkowe kanały akwaporynowe [9].…”