The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

SAFETY AND THERAPEUTIC POTENTIAL OF INHALED ALKALINE GLYCINE IN OBSTRUCTIVE AIRWAY DISEASE

Alix Paget-Brown2, Scott T. Dwyer1, Bristol Savage1, John F. Hunt1, Michael D. Davis1; 1Division of Pediatric Respiratory Medicine, University of Virginia, Charlottesville, VA; 2Division of Neonatology, University of Virginia, Charlottesville, VA

Background: Airway pH affects lung health on biochemical, cellular, and physiologic levels. Airway acidification, caused by both intrinsic and extrinsic factors, plays a role in disorders of the pulmonary tract. Additionally, most inhaled beta-agonists and anticholinergic therapeutics achieve better active and passive absorption through the airway epithelium to access the smooth muscle targets when airway lining fluid (ALF) is alkaline. The development of an inhaled alkaline glycine buffer could offer therapeutic promise for patients requiring inhaled medications or suffering from airway pH imbalances. Objective: We hypothesized that providing inhaled alkaline therapy would buffer acids in ALF, alkalinize the airway and therefore increase exhaled breath condensate (EBC) pH safely, without lowering pulmonary function. Methods: After obtaining baseline spirometry, EBC pH, and exhaled nitric oxide (eNO) values, we treated 10 stable adult subjects with known obstructive airway disease with a 2.5 mL nebulized solution of isotonic NaCl and 100 mmol/L of alkaline glycine (pH 9.8) over ten minutes. Following the nebulization, we re-obtained spirometry, EBC pH, and eNO. Results: Alkaline glycine inhalation was tolerated by all subjects with no clinically significant change in spirometric parameters and no excessive rise in EBC pH. Airway alkalinization was confirmed by a mean increase in EBC pH of 0.35 (p=0.02). eNO did not change significantly (p=0.38). The only statistically significant change noted in spirometry was a mean decrease in forced vital capacity (FVC) of 3.3% (p=0.035). Conclusion: Alkalinizing ALF increases EBC pH without compromising pulmonary function. This indicates that inhaled alkaline therapy is safe and possibly beneficial for subjects with airway acidification. Sponsored Research - This work was funded by The National Institutes of Health and the University of Virginia Philip Morris Tobacco Research Fund