The use of intrapleural thrombolytic and/or fibrinolytic therapy via indwelling tunneled pleural catheters with or without concurrent anticoagulation usage
We report a relatively low incidence of complications and in particular, bleeding complications in patients receiving intrapleural alteplase for non-draining IPCs. Bleeding episodes occurred in 5/94 (5.3%) patients with no apparent increased risk of bleeding complication, whether receiving anticoagulation or not. Additional study is warranted to identify risk factors for complications, in particular bleeding complications in this patient population.PMID:33745991 | DOI:10.1016/j.chest.2021.03.023 (Source: Chest)
Source: Chest - March 22, 2021 Category: Respiratory Medicine Authors: Christopher R Gilbert Candice L Wilshire Shu-Ching Chang Jed A Gorden Source Type: research

Dornase alfa for cystic fibrosis
CONCLUSIONS: There is evidence to show that, compared with placebo, therapy with dornase alfa may improve lung function in people with cystic fibrosis in trials lasting from one month to two years. There was a decrease in pulmonary exacerbations in trials of six months or longer, probably due to treatment. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials. There is not enough evidence to firmly conclude if dornase alfa is superior to other hyperosmolar agents in improving lung function.PMID:33735508 | DOI:10.1002/14651858.CD001127.pub5 (Source: ...
Source: Cochrane Database of Systematic Reviews - March 18, 2021 Category: General Medicine Authors: Connie Yang Mark Montgomery Source Type: research

Dornase alfa for cystic fibrosis
CONCLUSIONS: There is evidence to show that, compared with placebo, therapy with dornase alfa may improve lung function in people with cystic fibrosis in trials lasting from one month to two years. There was a decrease in pulmonary exacerbations in trials of six months or longer, probably due to treatment. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials. There is not enough evidence to firmly conclude if dornase alfa is superior to other hyperosmolar agents in improving lung function.PMID:33735508 | DOI:10.1002/14651858.CD001127.pub5 (Source: ...
Source: Cochrane Database of Systematic Reviews - March 18, 2021 Category: General Medicine Authors: Connie Yang Mark Montgomery Source Type: research

Dornase alfa for cystic fibrosis
CONCLUSIONS: There is evidence to show that, compared with placebo, therapy with dornase alfa may improve lung function in people with cystic fibrosis in trials lasting from one month to two years. There was a decrease in pulmonary exacerbations in trials of six months or longer, probably due to treatment. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials. There is not enough evidence to firmly conclude if dornase alfa is superior to other hyperosmolar agents in improving lung function.PMID:33735508 | DOI:10.1002/14651858.CD001127.pub5 (Source: ...
Source: Cochrane Database of Systematic Reviews - March 18, 2021 Category: General Medicine Authors: Connie Yang Mark Montgomery Source Type: research

Dornase alfa for cystic fibrosis
CONCLUSIONS: There is evidence to show that, compared with placebo, therapy with dornase alfa may improve lung function in people with cystic fibrosis in trials lasting from one month to two years. There was a decrease in pulmonary exacerbations in trials of six months or longer, probably due to treatment. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials. There is not enough evidence to firmly conclude if dornase alfa is superior to other hyperosmolar agents in improving lung function.PMID:33735508 | DOI:10.1002/14651858.CD001127.pub5 (Source: ...
Source: Cochrane Database of Systematic Reviews - March 18, 2021 Category: General Medicine Authors: Connie Yang Mark Montgomery Source Type: research

Timing of dornase alfa inhalation for cystic fibrosis
CONCLUSIONS: The current evidence derived from a small number of participants does not indicate that inhalation of dornase alfa after airway clearance techniques is more or less effective than the traditional recommendation to inhale nebulised dornase alfa 30 minutes prior to airway clearance techniques, for most outcomes. For children with well-preserved lung function, inhalation before airway clearance may be more beneficial for small airway function than inhalation after. However, this result relied on a measure with high variability and trials with variable follow-up. In the absence of strong evidence to indicate that ...
Source: Cochrane Database of Systematic Reviews - March 9, 2021 Category: General Medicine Authors: Ruth Dentice Mark Elkins Source Type: research

Timing of dornase alfa inhalation for cystic fibrosis
CONCLUSIONS: The current evidence derived from a small number of participants does not indicate that inhalation of dornase alfa after airway clearance techniques is more or less effective than the traditional recommendation to inhale nebulised dornase alfa 30 minutes prior to airway clearance techniques, for most outcomes. For children with well-preserved lung function, inhalation before airway clearance may be more beneficial for small airway function than inhalation after. However, this result relied on a measure with high variability and trials with variable follow-up. In the absence of strong evidence to indicate that ...
Source: Cochrane Database of Systematic Reviews - March 9, 2021 Category: General Medicine Authors: Ruth Dentice Mark Elkins Source Type: research

Timing of dornase alfa inhalation for cystic fibrosis
CONCLUSIONS: The current evidence derived from a small number of participants does not indicate that inhalation of dornase alfa after airway clearance techniques is more or less effective than the traditional recommendation to inhale nebulised dornase alfa 30 minutes prior to airway clearance techniques, for most outcomes. For children with well-preserved lung function, inhalation before airway clearance may be more beneficial for small airway function than inhalation after. However, this result relied on a measure with high variability and trials with variable follow-up. In the absence of strong evidence to indicate that ...
Source: Cochrane Database of Systematic Reviews - March 9, 2021 Category: General Medicine Authors: Ruth Dentice Mark Elkins Source Type: research

Withdrawal of dornase alfa increases ventilation inhomogeneity in children with cystic fibrosis
The lung clearance index (LCI) measured by multiple breath washout (MBW) is a sensitive marker of lung disease even early in life in patients with cystic fibrosis (CF) [1 –3]. Conventionally, pulmonary function in patients with CF is monitored by spirometry from school-age, using the forced expired volume in 1 second (FEV1) as primary outcome [4]. Due to advancements in clinical care, an increasing proportion of school-age children with CF have retained FEV1 withi n the normal or near-normal range over the last decades [5]. (Source: Journal of Cystic Fibrosis)
Source: Journal of Cystic Fibrosis - February 19, 2021 Category: Respiratory Medicine Authors: Christian Voldby, Kent Green, Lue Philipsen, Rikke Mulvad Sandvik, Marianne Skov, Frederik Buchvald, Tacjana Pressler, Kim Gjerum Nielsen Tags: Original Article Source Type: research

Inspiration and Exasperation: The Challenges of Inhaled Biologics.
Abstract The delivery of biotherapeutic molecules (antibodies, proteins, peptides) and nucleic acids via the respiratory route has presented challenges for regulatory approval, due in part to a lack of understanding of the expected pathology, mechanisms of toxicity, and immunogenicity induced by the inhalation route. Although the first inhaled biotherapeutic was approved some time ago (Dornase Alfa, Pulmozyme; Genetech, 1993), no other inhaled biotherapeutics have been marketed for the treatment of human disease other than the inhaled insulins (Exubera; Pfizer, 2006 and Afrezza; Mannkind Corporation, 2014). As a r...
Source: Toxicologic Pathology - January 5, 2021 Category: Pathology Authors: Hall P, Vahle JL, Colman K Tags: Toxicol Pathol Source Type: research

Polysulfated Hyaluronan GM-1111 Inhibits Elastase and Improves Rheology in CF Sputum.
Abstract Cystic fibrosis (CF) lung disease is marked by high concentrations of neutrophil elastase (NE) and DNA polymers; both factors contribute to airway disease. Although inhaled recombinant human dornase alfa reduces the frequency of CF pulmonary exacerbations, it also increases free NE activity in the sputum. There are no approved anti-NE therapies for patients with CF. We investigated whether synthetic, low molecular weight polysulfated hyaluronan (GM-1111) would be effective as an anti-NE drug using ex vivo CF sputum. Anti-NE activity of GM-1111 was tested in CF sputum in the presence or absence of dornase ...
Source: Am J Respir Cell Mol... - December 2, 2020 Category: Respiratory Medicine Authors: Kummarapurugu AB, Zheng S, Pulsipher A, Savage JR, Ma J, Rubin BK, Kennedy TP, Voynow JA Tags: Am J Respir Cell Mol Biol Source Type: research

Predictors of eradication failure at first isolation of MRSA in cystic fibrosis patients
Conclusions: There is limited data investigating morbidity and mortality of chronic MRSA infection. This study has shown that pancreatic insufficiency is one of the predictors of eradication failure. Further prospective studies should be done to determine the best treatment option and impact of MRSA on disease progress. (Source: European Respiratory Journal)
Source: European Respiratory Journal - October 28, 2020 Category: Respiratory Medicine Authors: Mursaloglu, H. H., Akin, C., Yilmaz, C., Ergenekon, P., Gokdemir, Y., Erdem Eralp, E., Karakoc, F., Karahasan, A., Karadag, B. Tags: Cystic fibrosis Source Type: research

A review of treatment regimens at first isolation of PA in a single cystic fibrosis center
Conclusions: This retrospective review of PA eradication protocols revealed a lower success rate compared to other studies. Although oral ciprofloxacin + inhaled tobramycin regimen seems to be more effective, due to the limited number of patients it did not reach statistical significance. Randomized controlled studies are needed to determine an optimal treatment regimen. (Source: European Respiratory Journal)
Source: European Respiratory Journal - October 28, 2020 Category: Respiratory Medicine Authors: Mursaloglu, H. H., Akin, C., Yilmaz, C., Ergenekon, P., Gokdemir, Y., Erdem Eralp, E., Karakoc, F., Karahasan, A., Karadag, B. Tags: Cystic fibrosis Source Type: research

Launch of a novel intrapleural fibrinolytic service for empyema at a district general hospital in London
This study has led to the development of a procedure checklist to further enhance patient safety. Small sample size warrants further audit once our service has been expanded. (Source: European Respiratory Journal)
Source: European Respiratory Journal - October 28, 2020 Category: Respiratory Medicine Authors: Mackay, E., Sasikumar, S. Tags: Respiratory infections Source Type: research

Neutrophil Extracellular Traps (NETs) increase mucus viscoelasticity
Conclusion: We show that exposing airway mucus to NETs increases the viscoelasticity of airway mucus and that this may be due, in part, to oxidative stress. This implicates a role for NETs formation in the airways as an underlying mechanism in airway mucus obstruction. (Source: European Respiratory Journal)
Source: European Respiratory Journal - October 28, 2020 Category: Respiratory Medicine Authors: Linssen, R. S. N., Chai, G., Ma, J., Kummarapurugu, A., Van Woensel, J. B. M., Bem, R. A., Kaler, L., Duncan, G., Zhou, L., Rubin, B. K., Xu, Q. Tags: Paediatric respiratory infection and immun. Source Type: research

Neutrophil Extracellular Traps Increase Airway Mucus Viscoelasticity and Slow Mucus Particle Transit.
Abstract Mucus obstruction is a key feature of many inflammatory airway diseases. Neutrophil extracellular traps (NETs) are released upon neutrophil stimulation and consist of extracellular chromatin networks studded with cytotoxic proteins. When released in the airways, these NETs can become part of the airway mucus. We hypothesized that the extracellular DNA and/or oxidative stress e.g. by the release of reactive oxygen species (ROS) and myeloperoxidase (MPO) during NETs formation in the airways would increase mucus viscoelasticity. We collected human mucus from endotracheal tubes of healthy patients admitted fo...
Source: Am J Respir Cell Mol... - October 23, 2020 Category: Respiratory Medicine Authors: Linssen RS, Chai G, Ma J, Kummarapurugu AB, van Woensel JBM, Bem RA, Kaler L, Duncan GA, Zhou L, Rubin BK, Xu Q Tags: Am J Respir Cell Mol Biol Source Type: research

Dornase alfa and rate of lung function decline in European patients with cystic fibrosis: A retrospective registry cohort study
Dornase alfa, a treatment that hydrolyses DNA, is approved as a therapy for patients with Cystic Fibrosis (CF). This mucolytic effect was shown in a pivotal clinical trial to improve lung function and reduce the frequency of CF pulmonary exacerbations [1]. Subsequent longitudinal studies of the impact of dornase alfa on lung function in United States ’ and United Kingdom cohorts have shown additional long-term benefits including reductions in lung function decline, although these findings vary owing to differences in study design [2–4]. (Source: Journal of Cystic Fibrosis)
Source: Journal of Cystic Fibrosis - August 20, 2020 Category: Respiratory Medicine Authors: Edward F. McKone, Abaigeal D. Jackson, Godfrey Fletcher, Laura Kirwan Tags: Letter to the Editor Source Type: research

Short-course modified regimen intrapleural alteplase and pulmozyme (DNase) in pleural infection
Publication date: Available online 17 July 2020Source: Respiratory Medicine Case ReportsAuthor(s): M. Faisal, R. Farhan, X.K. Cheong, B.H. Ng, N. Nuratiqah, Ban Andrea YL (Source: Respiratory Medicine Case Reports)
Source: Respiratory Medicine Case Reports - July 18, 2020 Category: Respiratory Medicine Source Type: research

Efficacy and safety of aerosolized intra-tracheal dornase alfa administration in patients with SARS-CoV-2-induced acute respiratory distress syndrome (ARDS): a structured summary of a study protocol for a randomised controlled trial
Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) may trigger severe pneumonia in coronavirus disease of 2019 (COVID-19) patients through release of damage-associated molecular patterns (DAMPs) and ... (Source: Trials)
Source: Trials - June 19, 2020 Category: General Medicine Authors: J. P. Desilles, C. Gregoire, C. Le Cossec, J. Lambert, O. Mophawe, M. R. Losser, F. Lambiotte, S. Le Tacon, M. Cantier, N. Engrand, P. Trouiller and J. Pottecher Tags: Letter Source Type: research

Treatment adherence among children and adolescents in a cystic fibrosis reference center
Conclusions: The TAI was high particularly among children younger than 14 years. There was a positive correlation between the self-referenced TA and the one presumed by the Psychology (p=0.032) and the nutrition (p=0.012) professionals.RESUMO Objetivo: Avaliar o grau de ades ão ao tratamento (AT) autorreferida e pesquisar sua associação com variáveis clínicas e sociodemográficas em pacientes com fibrose cística (FC) de um centro de referência e comparar o grau de AT autorreferida com o presumido pela equipe multidisciplinar. Métodos: Estudo transversal, inclu in...
Source: Revista Paulista de Pediatria - June 5, 2020 Category: Pediatrics Source Type: research

Low dose intrapleural alteplase and pulmozyme (DNase) in two post-surgical patients with pleural sepsis
Publication date: Available online 29 May 2020Source: Respiratory Medicine Case ReportsAuthor(s): M. Faisal, M. Fazlin, B.H. Ng, N. Nuratiqah, YL. Ban Andrea (Source: Respiratory Medicine Case Reports)
Source: Respiratory Medicine Case Reports - May 29, 2020 Category: Respiratory Medicine Source Type: research

Inhaled mannitol for cystic fibrosis.
CONCLUSIONS: There is moderate-quality evidence to show that treatment with mannitol over a six-month period is associated with an improvement in some measures of lung function in people with cystic fibrosis compared to control. There is low to very low-quality evidence suggesting no difference in quality of life for participants taking mannitol compared to control. This review provides very low-quality evidence suggesting no difference in lung function or quality of life comparing mannitol to dornase alfa alone and to mannitol plus dornase alfa. The clinical implications from this review suggest that mannitol could be con...
Source: Cochrane Database of Systematic Reviews - April 30, 2020 Category: General Medicine Authors: Nevitt SJ, Thornton J, Murray CS, Dwyer T Tags: Cochrane Database Syst Rev Source Type: research

Protocol for TRAUMADORNASE: a prospective, randomized, multicentre, double-blinded, placebo-controlled clinical trial of aerosolized dornase alfa to reduce the incidence of moderate-to-severe hypoxaemia in ventilated trauma patients
Acute respiratory distress syndrome continues to drive significant morbidity and mortality after severe trauma. The incidence of trauma-induced, moderate-to-severe hypoxaemia, according to the Berlin definitio... (Source: Trials)
Source: Trials - March 18, 2020 Category: General Medicine Authors: Julien Pottecher, Eric Noll, Marie Borel, G érard Audibert, Sébastien Gette, Christian Meyer, Elisabeth Gaertner, Vincent Legros, Raphaël Carapito, Béatrice Uring-Lambert, Erik Sauleau, Walter G. Land, Seiamak Bahram, Alain Meyer, Bernard Geny and Pie Tags: Study protocol Source Type: research

Addition of Dornase to Intrapleural Fibrinolytic Therapy for Otherwise Healthy Children Hospitalized With Empyema
In this issue of JAMA Pediatrics, Livingston et al address the important question of whether a therapy demonstrated to improve the care of adult patients with empyema, the addition of dornase alfa (DNase) to tissue plasminogen activator (tPA) intrapleural therapy, has similar benefits in children. The utility of DNase in adults requiring pleural drainage for empyema has been established in a prior randomized clinical trial by Rahman et al. In that study, adult patients who received a combination of intrapleural DNase and tPA had improved pleural effusion size compared with patients receiving DNase alone, tPA alone, and dou...
Source: JAMA Pediatrics - February 3, 2020 Category: Pediatrics Source Type: research

Intrapleural Tissue Plasminogen Activator and Dornase Alfa in Pediatric Empyema
This randomized clinical trial investigates if intrapleural tissue plasminogen activator and dornase alfa is more effective than intrapleural tissue plasminogen activator alone at reducing hospital length of stay in children with pleural empyema. (Source: JAMA Pediatrics)
Source: JAMA Pediatrics - February 3, 2020 Category: Pediatrics Source Type: research

Sequential intrapleural administration of fibrinolytic drugs and dornase alfa for empyema management. Treatment protocol based on its physicochemical stability.
CONCLUSIONS: The physicochemical stability data obtained does not allow to ensure a simultaneous administration of both drugs in a  safe and effective way, thus a sequential administration protocol is  proposed. PMID: 31901057 [PubMed - in process] (Source: Farmacia Hospitalaria)
Source: Farmacia Hospitalaria - December 25, 2019 Category: Drugs & Pharmacology Authors: Bastida C, Salazar-Santander C, Soy D, Sánchez D, Díez C, Badia JR Tags: Farm Hosp Source Type: research

A combined intrapleural administration of dornase alfa and tissue plasminogen activator is safe in children with empyema - a pilot study.
Conclusions: The intrapleural treatment of dornase alfa and tissue plasminogen activator as treatment of empyema was safe in ten children with empyema. If confirmed in further studies, this combination of intrapleural therapy may improve the management of paediatric empyema. PMID: 31750793 [PubMed - as supplied by publisher] (Source: Acta Chirurgica Belgica)
Source: Acta Chirurgica Belgica - November 22, 2019 Category: Surgery Tags: Acta Chir Belg Source Type: research

Medical interventions for chronic rhinosinusitis in cystic fibrosis.
CONCLUSIONS: We identified no eligible trials assessing the medical interventions in people with cystic fibrosis and chronic rhinosinusitis. High-quality trials are needed which should assess the efficacy of different treatment options detailed above for managing chronic rhinosinusitis, preventing pulmonary exacerbations and improving quality of life in people with cystic fibrosis. PMID: 31642064 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - October 22, 2019 Category: General Medicine Authors: Karanth TK, Karanth VKLK, Ward BK, Woodworth BA, Karanth L Tags: Cochrane Database Syst Rev Source Type: research

P352 “Mind the Gap”; variation in advice given to cystic fibrosis patients regarding the gap between inhalation of Dornase Alfa and inhaled antibiotics across the UK
(Source: Journal of Cystic Fibrosis)
Source: Journal of Cystic Fibrosis - May 27, 2019 Category: Respiratory Medicine Authors: C. Brown, M. Archer, L. Carson, T. Daniels, A. Gates, Z. Johnstone, R. Rashid, J.L. Whitehouse, E.F. Nash Tags: Posters Sessions Source Type: research

Exercising our options: comparing effects of exercise and positive expiratory pressure on mucociliary clearance
Cystic fibrosis (CF) lung disease is characterised by defective clearance of airway secretions that are hyperconcentrated, viscous, and serve as the nidus of chronic polymicrobial infection. The pathophysiological events that link CFTR channel dysfunction to mucus obstruction of airways are multifactorial, complex and an ongoing source of debate [1, 2]. Despite the availability of multiple "symptomatic therapies" that target mucus retention (hypertonic saline, mannitol, dornase alfa and mucolytics), mechanical clearance of airway secretions has continued to be a cornerstone of treatment across patient populations...
Source: European Respiratory Journal - April 17, 2019 Category: Respiratory Medicine Authors: Donaldson, S. H. Tags: Editorials Source Type: research

Cost Effectiveness of Inhaled Mannitol (Bronchitol ® ) in Patients with Cystic Fibrosis
ConclusionBenchmarked against an implicit Australian willingness-to-pay threshold for life-threatening diseases, our model suggests inhaled mannitol provides a cost-effective addition to best supportive care in patients with cystic fibrosis, irrespective of concomitant dornase alfa use. (Source: PharmacoEconomics)
Source: PharmacoEconomics - January 22, 2019 Category: Health Management Source Type: research

Safety and efficacy of reduced dose intrapleural alteplase and DNAase for pleural infection
Conclusions: Our data suggest that 2.5mg alteplase and 5mg DNase is safe and effective even in high risk patients. A larger prospective study will be needed to confirm this. 90% of patients received 3 doses or less.References:1) Popowicz N et al. Dose De-escalation of Intrapleural Tissue Plasminogen Activator Therapy for Pleural Infection. Ann Am Thorac Soc. 2017 Jun;14(6):929-936. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Ip, H., West, A., Wallace, D., Noorzad, F., Ahmed, L. Tags: Respiratory infections Source Type: research

Intrapleural use of dornase alfa and tissue plasminogen activator are successful as treatment in pediatric empyema: a pilot study
Conclusions: This pilot study investigated the efficacy and safety of dornase alfa and tissue plasminogen activator as treatment of empyema in ten children with parapneumonic empyema. With this study, we can conclude that intrapleural fibrinolysis with dornase alfa and tissue plasminogen activator is safe and successful as demonstrated in adults. Therefore, the series will be expanded in preparation of comparative studies. (Source: European Respiratory Journal)
Source: European Respiratory Journal - November 19, 2018 Category: Respiratory Medicine Authors: Slaats, M., De Dooy, J., Lauwers, P., Van Schil, P., Verhulst, S., Hendriks, J. Tags: Paediatric respiratory infection and immun. Source Type: research

Timing of dornase alfa inhalation for cystic fibrosis.
CONCLUSIONS: The current evidence derived from a small number of participants does not indicate that inhalation of dornase alfa after airway clearance techniques is more or less effective than the traditional recommendation to inhale nebulised dornase alfa 30 minutes prior to airway clearance techniques, for most outcomes. For children with well-preserved lung function, inhalation before airway clearance may be more beneficial for small airway function than inhalation after. However, this result relied on a measure with high variability and trials with variable follow-up. In the absence of strong evidence to indicate that ...
Source: Cochrane Database of Systematic Reviews - November 12, 2018 Category: General Medicine Authors: Dentice R, Elkins M Tags: Cochrane Database Syst Rev Source Type: research

Mucoactive agents for adults with acute lung conditions: A systematic review
ConclusionDornase alfa, hypertonic saline and NAC were ineffective for atelectasis/mucus plugging while intubated. More data are required to support using NAC, ambroxol and heparin during acute illness. (Source: Heart and Lung: The Journal of Acute and Critical Care)
Source: Heart and Lung: The Journal of Acute and Critical Care - November 6, 2018 Category: Respiratory Medicine Source Type: research

Dornase alfa for cystic fibrosis.
CONCLUSIONS: There is evidence to show that, compared with placebo, therapy with dornase alfa improves lung function in people with cystic fibrosis in trials lasting from one month to two years. There was a decrease in pulmonary exacerbations in trials of six months or longer. Voice alteration and rash appear to be the only adverse events reported with increased frequency in randomised controlled trials. There is not enough evidence to firmly conclude if dornase alfa is superior to other hyperosmolar agents in improving lung function. PMID: 30187450 [PubMed - as supplied by publisher] (Source: Cochrane Database of Systematic Reviews)
Source: Cochrane Database of Systematic Reviews - September 6, 2018 Category: General Medicine Authors: Yang C, Montgomery M Tags: Cochrane Database Syst Rev Source Type: research

Investigating the effects of long-term dornase alfa use on lung function using registry data
Dornase alfa (DNase) is one of the commonest cystic fibrosis (CF) treatments and is often used for many years. However, studies have not evaluated the effectiveness of its long-term use. We aimed to use UK CF Registry data to investigate the effects of one-, two-, three-, four- and five-years of DNase use on lung function to see if the benefits of short-term treatment use are sustained long term. (Source: Journal of Cystic Fibrosis)
Source: Journal of Cystic Fibrosis - August 29, 2018 Category: Respiratory Medicine Authors: S.J. Newsome, R.M. Daniel, S.B. Carr, D. Bilton, R.H. Keogh Tags: Original Article Source Type: research

Dornase Alfa Ototoxic Effects in Animals and Efficacy for Clogged Tympanostomy Tubes in Children
This pilot study investigates the ototoxic effects of dornase alfa in a chinchilla model and its efficacy vs ofloxacin in a randomized clinical trial of children with clogged tympanostomy tubes. (Source: JAMA Otolaryngology - Head and Neck Surgery)
Source: JAMA Otolaryngology - Head and Neck Surgery - August 2, 2018 Category: ENT & OMF Source Type: research

P029 Upper airway symptoms in CF - is dornase alfa administered by pulsating aerosol a treatment option?
(Source: Journal of Cystic Fibrosis)
Source: Journal of Cystic Fibrosis - June 1, 2018 Category: Respiratory Medicine Authors: F. Haynes, R. Ledermueller, H. Mentzel Tags: Poster Sessions Source Type: research

Outcome evaluation of a pharmacy ‐based therapy management program for patients with cystic fibrosis
Abstract ObjectiveTo compare medication adherence, pulmonary exacerbations, healthcare utilization, and costs for patients with cystic fibrosis (CF) who utilized a pharmacy‐based therapy management program to a matched control group. We hypothesized that patient management services would be associated with better medication adherence, and thus require fewer visits to the emergency room or hospitalizations. MethodsThis retrospective, observational cohort study used claims data from the MORE2 claims Registry®. The sample consisted of CF patients, aged 6+, who had ≥1 pharmacy claim for inhaled tobramycin, inhaled azt...
Source: Pediatric Pulmonology - March 1, 2018 Category: Respiratory Medicine Authors: Heather S. Kirkham, Francis Staskon, Nishita Hira, Darren McLane, Karl M. Kilgore, Alexis Parente, Seung Kim, Gregory S. Sawicki Tags: ORIGINAL ARTICLE: CYSTIC FIBROSIS Source Type: research

Endonuclease from Gram-Negative Bacteria Serratia marcescens Is as Effective as Pulmozyme in the Hydrolysis of DNA in Sputum
Gulnaz Vafina, Elmira Zainutdinova, Emil Bulatov, Maria N. Filimonova (Source: Frontiers in Pharmacology)
Source: Frontiers in Pharmacology - February 16, 2018 Category: Drugs & Pharmacology Source Type: research

Inhaled mannitol for cystic fibrosis.
CONCLUSIONS: There is moderate-quality evidence to show that treatment with mannitol over a six-month period is associated with an improvement in some measures of lung function in people with cystic fibrosis compared to control. There is low to very low-quality evidence suggesting no difference in quality of life for participants taking mannitol compared to control. This review provides very low-quality evidence suggesting no difference in lung function or quality of life comparing mannitol to dornase alfa alone and to mannitol plus dornase alfa.The clinical implications from this review suggest that mannitol could be cons...
Source: Cochrane Database of Systematic Reviews - February 9, 2018 Category: General Medicine Authors: Nevitt SJ, Thornton J, Murray CS, Dwyer T Tags: Cochrane Database Syst Rev Source Type: research

Health Insurance and Use of Recommended Routine Care in Adults with Cystic Fibrosis.
Abstract BACKGROUND: Low socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis. Whether insurance status impacts adherence to care in this population is unknown. METHODS: Patients ≥18 years old in the CF Foundation Patient Registry (2005-2013) were grouped based on reported annual insurance as private, public (Medicaid, Medicare, or state medical assistance program), other, or no insurance. Random effects logistic regression evaluated association between change in insurance status and annual use of recommended routine care. RESULTS: A total of 18,358 patients contribu...
Source: Respiratory Care - January 22, 2018 Category: Respiratory Medicine Authors: Li SS, Hayes D, Tobias JD, Morgan WJ, Tumin D Tags: Clin Respir J Source Type: research

Health Insurance and Use of Recommended Routine Care in Adults with Cystic Fibrosis
ABSTRACT Background. Low socioeconomic status is correlated with worse outcomes in patients with cystic fibrosis. Whether insurance status impacts adherence to care in this population is unknown. Methods. Patients ≥18 years old in the CF Foundation Patient Registry (2005‐2013) were grouped based on reported annual insurance as private, public (Medicaid, Medicare, or state medical assistance program), other, or no insurance. Random effects logistic regression evaluated association between change in insurance status and annual use of recommended routine care. Results. A total of 18,358 patients contributed 94,690 years ...
Source: The Clinical Respiratory Journal - January 22, 2018 Category: Respiratory Medicine Authors: Susan S. Li, Don Hayes, Joseph D. Tobias, Wayne J. Morgan, Dmitry Tumin Tags: Original Article Source Type: research

Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review
International Forum of Allergy&Rhinology, EarlyView. (Source: International Forum of Allergy and Rhinology)
Source: International Forum of Allergy and Rhinology - January 11, 2018 Category: Allergy & Immunology Authors: Gopi B.ShahMD, MPH , LindeDe KeyzerMD , Joy A.RussellPhD, MLS , AshleighHaldermanMD Source Type: research

Treatment of chronic rhinosinusitis with dornase alfa in patients with cystic fibrosis: a systematic review
ConclusionTopical intranasal dornase appears to improve sinonasal symptoms in CF patients to a greater degree than saline alone. The impact on other outcomes is less clear. Larger studies are needed to fully elucidate the true efficacy of dornase alfa in the treatment of CRS in CF patients. (Source: International Forum of Allergy and Rhinology)
Source: International Forum of Allergy and Rhinology - January 11, 2018 Category: Allergy & Immunology Authors: Gopi B. Shah, Linde Keyzer, Joy A. Russell, Ashleigh Halderman Tags: ORIGINAL ARTICLE Source Type: research

Cystic fibrosis clinical characteristics associated with dornase alfa treatment regimen change
ConclusionsWe have studied populations of patients with CF receiving dornase alfa who were switched between regimens to characterize clinical course. Our results suggest that the most common clinical attribute associated with switching from QD to BID dornase alfa was a marked deterioration in stability characterized by increased incidence and frequency of pulmonary exacerbation. For this population, deterioration in lung function did not appear to be a driver for this switch. In contrast, patients receiving BID dornase alfa who were ultimately switched to QD appeared to be clinically stable, on average, suggesting that tre...
Source: Pediatric Pulmonology - October 24, 2017 Category: Respiratory Medicine Authors: Donald R. VanDevanter, Marcia L. Craib, David J. Pasta, Stefanie J. Millar, Wayne J. Morgan, Michael W. Konstan, Tags: ORIGINAL ARTICLE: CYSTIC FIBROSIS Source Type: research

Inhalation delivery of complex drugs-the next steps.
Abstract Oral inhalation offers the opportunity of targeting drugs locally to different regions of the respiratory tract or alternatively, using the high surface area of the alveoli for systemic delivery. Pulmozyme and the inhaled insulins (i.e. Exubera and Afrezza) are examples of the scope of pulmonary drug delivery of biopharmaceuticals-albeit with strikingly different commercial success. Particularly, the failure of Exubera and the subsequent overreactions (e.g. the unsubstantiated lung cancer fear), lastingly stunned the field of systemically inhaled protein and peptide drugs. Building on the lessons learned ...
Source: Current Opinion in Pharmacology - August 25, 2017 Category: Drugs & Pharmacology Authors: de Kruijf W, Ehrhardt C Tags: Curr Opin Pharmacol Source Type: research

Comparison of FEV1 reference equations for evaluating a cystic fibrosis therapeutic intervention
ConclusionsAlthough individual patient results are impacted by the choice of reference equations, the study conclusions from this evaluation of a therapeutic intervention were minimally affected. GLI equations are recommended for future studies, but prior results based on other equations should be accepted as reliable. (Source: Pediatric Pulmonology)
Source: Pediatric Pulmonology - July 1, 2017 Category: Respiratory Medicine Authors: Michael W. Konstan, Jeffrey S. Wagener, Donald R. VanDevanter, David J. Pasta, Stefanie J. Millar, Wayne J. Morgan, Tags: ORIGINAL ARTICLE: CYSTIC FIBROSIS Source Type: research