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Question 3: Inhaled mannitol improves lung function in patients with cystic fibrosis
  1. Lucinda C Winckworth1,
  2. Harriet Holme2
  1. 1Paediatric Department, Chelsea and Westminster Hospital, London, UK
  2. 2Paediatric Department, Whittington Health, London, UK
  1. Correspondence to Dr Lucinda C Winckworth, Paediatric Department, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH, UK; lucinda.w{at}

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As the paediatric registrar in clinic, you see a child with cystic fibrosis (CF). Her mother mentions reading about newer treatments available to help improve lung function and mucus clearance. You have heard of inhaled mannitol being used in this context and wonder how effective it is and how it compares to the established treatments.

Structured clinical question

In children with CF [population] does inhaled mannitol [intervention] significantly improve respiratory function [outcome]?

Search strategy and outcome

Medline via PubMed was the primary source of articles. The search was through ‘Clinical queries’ using the broad, sensitive filter and search terms: ‘inhaled mannitol AND CF’. Limits were ‘humans’. No age or language limits were used due to the small number of studies. Dates included 1966 to March 2012.

Secondary searches were performed on the Cochrane database, Clinical Evidence and SUMSearch.

A total of 29 papers were found via PubMed, five of which included the relevant population and outcome measures (table 1). The references of the these papers were scanned, along with the linked articles, but no further articles were found. No additional articles were found via secondary sources.

View this table:

Inhaled mannitol improves lung function in patients with cystic fibrosis


Inhaled mannitol acts as a hyperosmolar expectorant, increasing tracheobronchial clearance in a range of conditions, including bronchiectasis and asthma.6 Multiple mechanisms of action are proposed, including a …

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  • Contributors LW and HH reviewed the clinical evidence and wrote the article.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.