Mannitol (Inhaled)

How it works

As an inhaled osmotic agent it draws water onto the airway surface liquid, hydrating secretions and improving mucociliary and cough clearance.

Prescribing in practice

• A bronchial provocation (initiation) test under supervision is mandatory before regular use, as inhalation can provoke bronchospasm and the product is contraindicated in those who react.
• Pre-treatment with a bronchodilator before each dose is advised to reduce the risk of cough and bronchospasm.
• Use as an adjunct to airway clearance techniques rather than a substitute, and avoid in haemoptysis until the cause is established.

Monitoring

Monitor lung function and for cough, wheeze or haemoptysis, particularly after the initiation test and on dose escalation.

Counselling the patient

• Take your reliever inhaler first as directed before each dose.
• Report worsening cough, wheeze or any blood in your sputum.
• Always swallow from the capsules via the supplied inhaler only and never by mouth.

Evidence & guidelines

NICE and the SPC support inhaled mannitol as an add-on mucoactive option in cystic fibrosis where other treatments are unsuitable or inadequate.