Inhaled dry powder mannitol in cystic fibrosis

Introduction: Inhaled dry powder mannitol facilitates mucociliary clearance in individuals with cystic fibrosis (CF). It does not require nebulization, and is more convenient to use than dornase alfa and hypertonic saline. There is evidence that inhaled mannitol can improve forced expiratory volume in one second in individuals with CF. Patients must be assessed for hyperresponsiveness to inhaled mannitol before they are prescribed the drug. Areas covered: In this article, the characteristics of inhaled mannitol, dornase alfa, and hypertonic saline are reviewed. An overview of the evidence on inhaled mannitol, including its clinical efficacy and safety, is provided. Expert opinion: Given the burden of treatment that individuals with CF face, inhaled mannitol's ease of use is advantageous. In addition, the drug leads to a modest improvement in lung function. Potential areas of future research for inhaled mannitol are discussed. As the number of treatment options for CF increase, the authors suggest that comparative effectiveness studies can help guide clinical decision-making.