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50 Years Ago in The Journal of PediatricsA NONTOXIC DETERGENT FOR AEROSOL USE IN DISSOLVING VISCID BRONCHOPULMONARY SECRETIONS

Miller JB, Boyer EH. J Pediatr 1952;40:767-71

Accumulation of thick bronchial secretions in the airway and the risk of airway obstruction and atelectasis isa significant clinical problem. As an experimental approach, these investigators explored the use of the deter-gent Triton A-20 administered as an aerosol mist. Triton A-20 had been studied in patients and in experimen-tal animals. In this paper, the authors reported on the lack of toxicity using Triton A-20 at concentrations ofup to 50% in rats. They also commented on the clinical results they had achieved in volunteers and in patientswith thick viscid sputum where there was a “constant and dependable” thinning effect at concentrations of0.1% to 0.5%. One of the authors had inhaled the detergent for a few minutes at a concentrations as high as50% and commented that there was no irritation or discomfort but that the taste was very unpleasant at con-centrations >10%.

Clinical use of Triton A-20 by aerosol seems to have died out many years ago, although other detergentssuch as tyloxapol are constituents used in some of the surfactant preparations used to treat hyaline membranedisease and acute respiratory distress syndrome. In cystic fibrosis, the mucolytic drug of choice these days isrecombinant dornase alpha (Pulmozyme, Genentech, San Francisco, Calif). In cystic fibrosis, much of the vis-cosity of sputum is because of the presence of host neutrophil-derived DNA in high concentrations, so dor-nase alpha is a rational choice. Another approach to mobilizing secretions is the use of hypertonic salineadministered by nebulizer—a technique that can even be used to induce samples of sputum for laboratorystudies from persons who are not expectorating spontaneously.

This early paper on the experimental and clinical results with the use of Triton A-20 was intriguing and I amstruck by the apparent lack of toxicity even at high concentrations.

Robert W. Wilmott, MDDepartment of Pediatrics

Saint Louis University School of MedicineSt Louis, MO 63104

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