Statement 5: The main criteria for guiding the choice between the different mucoactive agents should be the patient’s age; the mechanism of action of mucoactive agent and the patient’s clinical conditions.
The expert panel reached consensus on the main criteria for choosing between different mucoactive therapies. Experts did agree that different mucoactive drugs are characterized by different mechanisms of action and intervene at various levels of the pathogenetic cascade of CF. Therefore, the mechanism of action of the mucoactive agent together with the age and the patient’s clinical conditions are key factors in the decision making in CF (Figure 3A ). In final consensus meeting, there was unanimous response to this statement.
Mucoactive drugs are able to modify the properties of mucus and promote the muco-ciliary clearance which is impaired both by mucus viscoelasticity and by mucus adhesiveness30.
A European consensus document reviewed in detail therapies for CF, concluding that modes of action of hypertonic saline and dornase alfa differ and therefore the two drugs cannot replace each other. In addition, the use of any mucoactive agent should be recommended for CF patients according to age31.