Mucolytic therapy reduces bronchial hypersecretions and improves the capability of sputum drainage. In obstructive disease, mucous hypersecretions and plugging play important role in the development of atelectasis and increase in artificial airway resistance. Mesna dissolves the disulfite bonds of the sputum mucoproteins. Despite their potential effectiveness, mesna has been largely overlooked because of its uncertain risks of bronchospasm. This study aimed to test the clinical and respiratory mechanics safety of this therapy in obstructive patients.
Forty obstructive patients admitted to a university hospital were randomized in a crossover design to receive two nebulized strategies. Treatment group (T) received one session of a combination of 1 ml of Mesna and 0.5 ml of salbutamol. Control group (C) received one session of 0.5 ml of salbutamol. Respiratory mechanics and clinical symptoms and signs are recorded at baseline and after 15 (T1), 30 (T2), 60 (T3) and 120 minutes (T4) in each group. Primary outcome was the forced expiratory volume in one second (FEV1) at T2. Secondary outcomes were the progression overtime of the Vital capacity (VC), FEV1, Tiffeneau, DEM 25–75%, cough, dyspnea, wheezing, sputum, blood pressure (BP) and heart rate (HR).
30 COPD and 10 asthmatic patients were studied. Washout period between treatments were 13.9 ± 6.8 hours. No significant difference in FEV1 at T2 is noted (77.7 ± 15.9% and 77.6 ± 15.8% for T and C respectively). Two-ways ANOVA were comparable for pulmonary mechanics and clinical parameters. Diastolic BP is higher in T-group compared to C-group (67.2 ± 6.9 and 63.8 ± 7.2 mm Hg respectively, p < 0.04). HR is lower in T-group compared to C-group (82.4 ± 11.3 and 84.7 ± 12 per minute respectively, p < 0.04).
Nebulized mesna with salbutamol is well tolerated and does not alter respiratory mechanics neither clinical parameters compared to salbutamol alone in moderate obstructive patients.
Mesna can be safely used in combination therapy with betaagonists in obstructive patients likely to benefit from this therapeutic modality.
Moussa Riachy, University grant monies Faculty of Medecine -Saint Joseph Univesrsity -Beirut - Lebanon; No Product/Research Disclosure Information