2 The technology
2.1 Mannitol (Bronchitol, Pharmaxis) is a mucoactive agent that causes water to enter the airway lumen and hydrate airway secretions. This reduces the viscosity of secretions and stimulates cough, thereby increasing the clearance of secretions and pathogenic bacteria. Mannitol dry powder is inhaled from a hand-held, breath-activated device. Mannitol has a marketing authorisation as an add-on therapy to best standard of care in adults with cystic fibrosis. The summary of product characteristics states that the recommended dose is 400 mg twice a day.
2.2 The most common and important adverse reactions associated with mannitol as stated in the summary of product characteristics are hyperresponsiveness to mannitol, cough, bronchospasm, exacerbation of cystic fibrosis, chest discomfort, wheezing, throat irritation, vomiting, headache and pharyngolaryngeal pain. The most clinically significant adverse reaction associated with mannitol use is haemoptysis (coughing up of blood).
2.3 Mannitol is available as a 40 mg powder capsule for inhalation. The list price for a 14-day pack of 280 capsules and 2 inhalers is £231.66 (excluding VAT; 'Monthly Index of Medical Specialities' [MIMS] September 2012). This equates to £0.83 per 40 mg capsule, or an average cost of £16.55 per day, including the cost of the inhaler. These prices do not include VAT. Costs may vary in different settings because of negotiated procurement discounts.