Basically, for those of you who have issues with Dnase, they studies are out there you just have to research.
And this is a study from 1998, that apparently every cf doctor has never seen.
This is an excerpt from a study on Dnase and cf...
"<b>Within the first hour following rhDNase, not only did the CF sputum's elastase activity markedly increase, but its potential to induce hemorrhage in murine lungs was also clearly increased. Several investigators have previously demonstrated that elastase induces lung hemorrhage within minutes of intratracheal instillation, and the maximal amount of hemorrhage is observed at 1 h."
</b>
<b>"Although the effect of rhDNase aerosol therapy on CF sputum elastase activity was transient, it was observed consistently on each day of therapy. Since aerosolized rhDNase is usually taken daily for indefinite periods by patients with CF, one should be concerned about the potential long term adverse effects of daily, albeit temporary, spikes in neutrophil elastase activity at the airway epithelial surface. It is notable that each of the subjects in the current study had been receiving rhDNase therapy for at least 2 mo prior to sputum collection. The acute increases in post-rhDNase sputum elastase activity therefore were not restricted to the first days following initiation of rhDNase therapy as previously observed at the 8- 12 h post-rhDNase time period."</b>
"<b>In summary, the DNase I-mediated increase in CF sputum elastase activity is associated with an increase in the potential of the airway secretions to induce lung hemorrhage. The effect of DNase I on elastase activity in airway secretions is relevant to CF patients receiving aerosolized rhDNase since a marked increase in sputum elastase activity was consistently observed within 1 h of treatment in all of the study subjects. Mucolytic therapy of selected CF patients with rhDNase has proven to be safe and effective in short-term studies. However, based on observations from the current study it would appear reasonable to suggest that elastase-mediated lung hemorrhage should be considered as a potential contributing factor in patients with CF presenting with hemoptysis while receiving rhDNase therapy."</b>
<a target=_blank class=ftalternatingbarlinklarge href="http://ajrccm.atsjournals.org/.../full/157/2/464
">"><a target=_blank class=ftalternatingbarlinklarge href="http://ajrccm.atsjournals.org/cgi/content/full/157/2/464
<br ">http://ajrccm.atsjournals.org/...l/157/2/464
</a></a>
I have another article which is about pulmozyme causing hemorrhage in a premie... I can't get the link to work, but I have the article if anybody wants it.
Interesting if you compare it to our population because:
premies have low lung surfactant...cfers have liitle to none
premies have oxidative damage in lungs...cfers do too
premies have low glutathione in BAL....cfers do too
premies suffer from pulmonary arterial hypertension...cfers do as they get sicker
premies have mucoid secretions....cfers...duh.
premies have low airway nitric oxide...cfers do too.
And this is a study from 1998, that apparently every cf doctor has never seen.
This is an excerpt from a study on Dnase and cf...
"<b>Within the first hour following rhDNase, not only did the CF sputum's elastase activity markedly increase, but its potential to induce hemorrhage in murine lungs was also clearly increased. Several investigators have previously demonstrated that elastase induces lung hemorrhage within minutes of intratracheal instillation, and the maximal amount of hemorrhage is observed at 1 h."
</b>
<b>"Although the effect of rhDNase aerosol therapy on CF sputum elastase activity was transient, it was observed consistently on each day of therapy. Since aerosolized rhDNase is usually taken daily for indefinite periods by patients with CF, one should be concerned about the potential long term adverse effects of daily, albeit temporary, spikes in neutrophil elastase activity at the airway epithelial surface. It is notable that each of the subjects in the current study had been receiving rhDNase therapy for at least 2 mo prior to sputum collection. The acute increases in post-rhDNase sputum elastase activity therefore were not restricted to the first days following initiation of rhDNase therapy as previously observed at the 8- 12 h post-rhDNase time period."</b>
"<b>In summary, the DNase I-mediated increase in CF sputum elastase activity is associated with an increase in the potential of the airway secretions to induce lung hemorrhage. The effect of DNase I on elastase activity in airway secretions is relevant to CF patients receiving aerosolized rhDNase since a marked increase in sputum elastase activity was consistently observed within 1 h of treatment in all of the study subjects. Mucolytic therapy of selected CF patients with rhDNase has proven to be safe and effective in short-term studies. However, based on observations from the current study it would appear reasonable to suggest that elastase-mediated lung hemorrhage should be considered as a potential contributing factor in patients with CF presenting with hemoptysis while receiving rhDNase therapy."</b>
<a target=_blank class=ftalternatingbarlinklarge href="http://ajrccm.atsjournals.org/.../full/157/2/464
">"><a target=_blank class=ftalternatingbarlinklarge href="http://ajrccm.atsjournals.org/cgi/content/full/157/2/464
<br ">http://ajrccm.atsjournals.org/...l/157/2/464
</a></a>
I have another article which is about pulmozyme causing hemorrhage in a premie... I can't get the link to work, but I have the article if anybody wants it.
Interesting if you compare it to our population because:
premies have low lung surfactant...cfers have liitle to none
premies have oxidative damage in lungs...cfers do too
premies have low glutathione in BAL....cfers do too
premies suffer from pulmonary arterial hypertension...cfers do as they get sicker
premies have mucoid secretions....cfers...duh.
premies have low airway nitric oxide...cfers do too.