Aerosolized Amiloride for the Treatment of Lung Disease in Cystic Fibrosis

To the Editor: The April 26 issue of the Journal presented encouraging results by Knowles et al. regarding the beneficial effects of aerosolized amiloride in the treatment of cystic fibrosis.1 The introduction and discussion sections of this article described the function of amiloride as an inhibitor of sodium transport in the airway epithelium, and the authors suggested that the beneficial effects observed were exerted “at least in part by increasing the clearance of secretions.” Although the results of this investigation were promising in terms of the improvement in the decline of forced vital capacity in patients with cystic fibrosis, this

A Pilot Study of Aerosolized Amiloride for the Treatment of Lung Disease in Cystic Fibrosis

Excessive active absorption of sodium is a unique abnormality of the airway epithelium in patients with cystic fibrosis. This defect is associated with thickened mucus and poor clearance of airway secretions and may contribute to the pulmonary disease in these patients. To study whether the inhibition of excessive absorption of sodium might affect the course of lung disease in cystic fibrosis, we performed a double-blind, crossover trial comparing aerosolized amiloride (5 mmol per liter; 3.5 ml four times daily), a sodium-channel blocker, with vehicle alone. Fourteen of the 18 adult patients initially enrolled in the study completed the one-year trial (25 weeks for each treatment). The mean (±SEM) loss of forced vital capacity (FVC) was reduced from 3.39±1.13 ml per day during treatment with vehicle alone to 1.44±0.67 ml per day during treatment with amiloride (P<0.04). A measured index of sputum viscosity and elasticity was abnormal during treatment with vehicle alone and improved during treatment with amiloride. Calculated indexes of mucociliary and cough clearance also improved during amiloride treatment. No systemic, respiratory, or subjective toxic effects of amiloride were noted. We conclude from this preliminary study that aerosolized amiloride can be safely administered to adults with cystic fibrosis. The slowing of the loss of FVC and the improvement in sputum viscosity and elasticity suggest a beneficial clinical effect. Aerosolized amiloride deserves further evaluation in the treatment of lung disease in patients with cystic fibrosis