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3.7 Mucolytics


Carbocisteine should be initiated by secondary care respiratory physicians for chronic cough productive of sputum as outlined in
NICE guidance. Therapy should only be continued if there is symptomatic improvement e.g. reduction in frequency of cough and
sputum production.
GREEN     Carbocisteine
                  capsules 375mg
                  sachets -750mg/10ml sugar-free oral solution in sachet 
                  (2nd line choice for adults with COPD and swallowing difficulties) 
RED           Oral Solution 250mg/5ml (paediatric use only) 
RED           Dornase alfa nebuliser solution 1mg/ml* 
RED           Mannitol, dry powder inhalation 40mg capsules
* Dornase alfa is RED Traffic Light where prescribing has been initiated on or after 1st April 2013.
Where prescribing was initiated prior to April 1st 2013 the traffic light status may remain amber until repatriation of patients has 
been agreed by NHS England, local commissioners and providers.
Hypertonic sodium chloride
Inhaled hypertonic saline is a widely-used and well-accepted therapy for increasing the mucilliary clearance in the lower airways in
patients with cystic fibrosis. Patients especially benefit from sputum expectoration due to osmotic effects of hypertonic saline. 
Different doses and concentrations are used in common therapy. The DTC has supported the use of this product .The efficacy and 
tolerability of hypertonic saline has been demonstrated in several clinical trials.
AMBER      Mucoclear® (Sodium chloride 3% solution for inhalation)   [PRESCRIBE BY BRAND]
AMBER      Resp-Ease® (Sodium chloride 7% solution for inhalation)    [PRESCRIBE BY BRAND]
RED            All other unlicensed products and strengths
 Mucolytic  [Palliative Care, Tracheostomy]
 Breathlessness - See page 8 & 19  Consensus Approach to Managing Palliative Care Symptoms Clinical Practice Summary 
 Tracheostomy use.
 GREEN       Sodium Chloride 0.9% for nebulisation [Respi-Clear® 20 x 2.5ml, Salineb® 20 x 2.ml]
                     PRESCRIBE BY BRAND
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