Safety, Tolerability, and Effects of Sodium Bicarbonate Inhalation in Cystic Fibrosis

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Souza Gomez, Carla Cristina ; Francisco Parazzi, Paloma Lopes ; Clinckspoor, Karl Jan ; Mauch, Renan Marrichi ; Teixeira Pessine, Francisco Benedito ; Levy, Carlos Emilio ; Peixoto, Andressa Oliveira ; Goncalves Oliveira Ribeiro, Maria Angela ; Ribeiro, Antonio Fernando ; Conrad, Douglas ; Quinton, Paul Marquis ; Lima Marson, Fernando Augusto ; Ribeiro, Jose Dirceu

• Document type: Journal article
• Source: CLINICAL DRUG INVESTIGATION; v. 40, n. 2, p. 13-pg., 2019-11-13.

Abstract

Background Among the many consequences of loss of CFTR protein function, a significant reduction of the secretion of bicarbonate (HCO3-) in cystic fibrosis (CF) is a major pathogenic feature. Loss of HCO3- leads to abnormally low pH and impaired mucus clearance in airways and other exocrine organs, which suggests that NaHCO3 inhalation may be a low-cost, easily accessible therapy for CF. Objective To evaluate the safety, tolerability, and effects of inhaled aerosols of NaHCO3 solutions (4.2% and 8.4%). Methods An experimental, prospective, open-label, pilot, clinical study was conducted with 12 CF volunteer participants over 18 years of age with bronchiectasis and pulmonary functions classified as mildly to severely depressed. Sputum rheology, pH, and microbiology were examined as well as spirometry, exercise performance, quality-of-life assessments, dyspnea, blood count, and venous blood gas levels. Results Sputum pH increased immediately after inhalation of NaHCO3 at each clinical visit and was inversely correlated with rheology when all parameters were evaluated: [G ' (elasticity of the mucus) = - 0.241; G '' (viscosity of the mucus) = - 0.287; G* (viscoelasticity of the mucus) = - 0.275]. G* and G ' were slightly correlated with peak flow, forced expiratory volume in 1 s (FEV1), and quality of life; G '' was correlated with quality of life; sputum pH was correlated with oxygen consumption (VO2) and vitality score in quality of life. No changes were observed in blood count, venous blood gas, respiratory rate, heart rate, peripheral oxygen saturation of hemoglobin (SpO(2)), body temperature, or incidence of dyspnea. No adverse events associated with the study were observed. Conclusion Nebulized NaHCO3 inhalation appears to be a safe and well tolerated potential therapeutic agent in the management of CF. Nebulized NaHCO3 inhalation temporarily elevates airway liquid pH and reduces sputum viscosity and viscoelasticity. (AU)

• FAPESP's process: 15/12858-5 - Identification of prevalent mutations and clinical and functional characterization of children and adults with primary ciliary dyskinesia
• Grantee: Fernando Augusto de Lima Marson
• Support Opportunities: Scholarships in Brazil - Post-Doctoral
• FAPESP's process: 11/18845-1 - Association between polymorphisms in modifier genes in children and adolescent with allergic and non-allergic mild, moderate and severe asthma
• Grantee: Jose Dirceu Ribeiro
• Support Opportunities: Regular Research Grants
• FAPESP's process: 15/12183-8 - Identification of prevalent mutations and clinical and functional characterization of children and adults with primary ciliary dyskinesia
• Grantee: Jose Dirceu Ribeiro
• Support Opportunities: Regular Research Grants
• FAPESP's process: 11/12939-4 - Association between polymorphisms in modifier genes in children and adolescent with allergic and non-allergic: mild, moderate and severe asthma
• Grantee: Fernando Augusto de Lima Marson
• Support Opportunities: Scholarships in Brazil - Doctorate