Notes for: MucolyticsLast edited [22/08/2013 16:16:16]
1. NICE recommends a trial of mucolytic in patients with a chronic cough productive of sputum. Mucolytic therapy should be continued if there is symptomatic improvement (for example, reduction in frequency of cough and sputum production). Patients should receive a one month trial of carbocisteine (750 mg TDS). If there has not been a symptomatic improvement the mucolytic should be stopped. Where there has been symptomatic improvement the dose should be reduced to 1.5 g daily in divided doses.
2. Dornase alfa should only be initiated within hospital for the treatment of cystic fibrosis.
3. A Jet Nebuliser used exclusively for dornase alfa is required to administer dornase alfa.
Last edited [02/10/2013 12:10:27] The 'Flutter' device can be prescribed by a GP on an FP10 if recommended by a
specialist respiratory physiotherapist. It is listed in Part IXA (appliances) of
the Drug tariff as 'oscillating positive expiratory pressure device' at a cost
of £40.50.
However, the evidence for effectiveness of the device is limited. The
following link to a recent UKMi information sheet about the device discusses a
Cochrane evaluation which did not find any significant differences in effect
between oscillating devices and other methods of airway clearance:
http://www.midlandsmedicines.nhs.uk/filestore/Flutter_device.pdf.
However, if a specialist respiratory physiotherapist has assessed an
individual patient and thinks they could benefit from the use of a Flutter
device then the GP may wish to prescribe it.