Dawaa Reference

chronic

Cystic Fibrosis

Treatment options, dosing, cautions and Egyptian brands from the shipped Dawaa Reference card.

Evidence status

Checked against the sources named below

Sources5 sources

Cystic Fibrosis - StatPearls (NCBI Bookshelf NBK493206) - https://www.ncbi.nlm.nih.gov/books/NBK493206/ · ICPC-3 (WONCA International Classification of Primary Care, 3rd edition) class RD99.02 - condition scope only, no dose · No dose - referral pathway, no medicine given in primary care · Egyptian National Drug Formulary - Respiratory Medicines 2026 (Ipratropium Bromide monograph) · Egyptian National Drug Formulary - Respiratory Medicines 2026 (Salbutamol monograph)

Verified against1 document
  • No dose - referral pathway, no medicine given in primary care

Verified date2026-08

Presentation reference

Is it this?

Reference only, to read alongside your own examination.

Symptoms — what the patient reports (7)

  • Newborn screening can identify cystic fibrosis before any clinical symptoms appear
  • Some newborns present with meconium ileus, prolonged jaundice, or difficulty thriving [jaundice]
  • Infants and children may show failure to thrive, anemia, undescended testes, and recurrent sinopulmonary infections [anaemia · failure to thrive]
  • Median age at diagnosis is 6 to 8 months, though some are not diagnosed until later
  • Adults may report chronic sinusitis, postnasal drip, and nasal polyps [nasal polyps]
  • Salty-tasting sweat is a classic feature
  • Male infertility from an absent vas deferens; thickened cervical mucus affects female fertility

Signs — what you find (3)

  • Digital clubbing and cyanosis may be seen on exam [cyanosis · finger clubbing]
  • Exaggerated palm wrinkling occurs after brief water immersion (the water immersion test)
  • A pulmonary exacerbation brings breathlessness, tiredness, a productive cough, and fever [breathlessness · cough · fatigue · fever]

Tests (7)

  • Sweat chloride above 60 mEq/L meets the laboratory criterion for cystic fibrosis
  • Finding two disease-causing CFTR mutations confirms the diagnosis
  • Diagnosis starts with sweat chloride testing, repeated if normal but symptoms persist
  • Immunoreactive trypsinogen (IRT) testing improves newborn screening sensitivity for cystic fibrosis
  • Chest x-ray may show hyperinflation, bronchiectasis, abscesses, or atelectasis
  • Bronchoalveolar lavage shows many neutrophils and often grows Pseudomonas or other organisms
  • Low FEV1 with preserved FVC on spirometry indicates obstructive disease with air trapping

If not this — what else fits (3)

  • Asthma is on the differential list
  • Bronchiectasis is a differential to distinguish from cystic fibrosis
  • Primary ciliary dyskinesia is on the differential list

SourceStatPearls "Cystic Fibrosis" - disease-level clinical article

Presentation findings are traced to the source above.

Rx: Main treatment | Short-acting bronchodilator for wheeze | Added to salbutamol when wheeze persists

MAIN TREATMENT

1

REFERRAL & SAFETY-NETTING (NO DRUG THERAPY)

1st line
Adult dose and duration

A genetic disorder causing thick mucus secretions that lead to recurrent lung infections and pancreatic insufficiency; rare but not absent in Egypt given the effect of consanguinity on recessive-disease risk. Management is specialist, at a paediatric respiratory or CF centre, with enzyme replacement and airway clearance, so the GP's role is recognition and referral. - Refer, with advice

Paediatric dose

Children follow the same pathway: recognise and refer. No primary-care medicine is implied.

Dose source

No dose - referral pathway, no medicine given in primary care

Why

A genetic disorder causing thick mucus secretions that lead to recurrent lung infections and pancreatic insufficiency; rare but not absent in Egypt given the effect of consanguinity on recessive-disease risk. Management is specialist, at a paediatric respiratory or CF centre, with enzyme replacement and airway clearance, so the GP's role is recognition and referral.

Cautions
  • Rare in Egyptian primary care.
  • Referral is the pathway; the medicines listed alongside are what primary care can give before or while it happens.
  • RED FLAG - Recurrent chest infections with failure to thrive in an infant, meconium ileus in a newborn, or salty-tasting skin reported by parents: refer for specialist assessment.

SHORT-ACTING BRONCHODILATOR FOR WHEEZE

2

SALBUTAMOL

Short-acting bronchodilator for wheeze

1st line

Formoral.inhalation

Adult dose and duration

One or two inhalations of 100 micrograms up to 4 times a day; no more than 8 inhalations in 24 hours and usually not repeated inside 4 hours

Paediatric dose
Dose by age
Under 12 years:one or two inhalations of 100 micrograms up to 4 times a day, not exceeding 800 micrograms daily and not more than 6 times in 24 hours.
Dose source

Egyptian National Drug Formulary - Respiratory Medicines 2026 (Salbutamol monograph) - verbatim: "Oral inhalation, one inhalation (100 mcg) or two inhalations up to 4 times a day for persistent symptoms."

Why

Cystic-fibrosis airways obstruct and wheeze like asthma, and an inhaler is the one thing a primary-care doctor can hand the patient the same day while specialist care is arranged.

Cautions
  • Tremor and jitteriness are common and dose-related, and children may become noticeably excitable.
  • Palpitations and a fast pulse can occur; check the pulse if the patient is using it often.
  • Needing it more and more often means the disease is worsening - that is a reason to escalate care, not to increase the inhaler.
  • Do not use it in anyone hypersensitive to salbutamol or to any part of the formulation.
Egyptian brands
Egyptian brandManufacturerIndicative price
AEROLIN 100MCG/DOSE INHALEREIPICO > 3M HEALTH CARE-U.K.7.30 EGP
BUTALIN 100MCG/ACTUATION 200 DOSESJULPHAR12.00 EGP
SALBOVENT RESPIRATOR 5MG/ML SOLN. 20 MLALEXANDRIA17.50 EGP
BRONCHOLIN S 0.5% RESPIRATOR SOLN. 30 MLEIPICO37.00 EGP
ALVEOTRACK 5 MG/ML INH. SOLN. 30 MLMDI PHARMA49.00 EGP
VENTAL INHALER 100 MCG/DOSE 200 DOSESARAB DRUG COMPANY (ADCO)72.00 EGP
VENTOLIN DISKUS 200MCG/DOSE ACCUHALERGLAXO SMITHKLINE86.00 EGP
VENTOLIN EVOHALER 100MCG/ACTUATION INHALERGLAXO SMITHKLINE86.00 EGP
OPICHESTAL SYRUP 120ML? strength differs? different route - not oral.inhalationEL-OBOUR2.00 EGP
SALBUTAMOL 2MG/5ML SYRUP 120ML? strength differs? different route - not oral.inhalationSEDICO3.50 EGP

ADDED TO SALBUTAMOL WHEN WHEEZE PERSISTS - give alongside

3

IPRATROPIUM BROMIDE

Added to salbutamol when wheeze persists

add-on - not a substitute

Formoral.inhalation

Adult dose and duration

Nebulised 250 to 500 micrograms 3 to 4 times a day; 500 micrograms for an acute episode

Paediatric dose
Dose by age
6 to 12 years:250 micrograms a dose, up to 1 mg in total each day. No dose under 6 years in the sources opened.
Dose source

Egyptian National Drug Formulary - Respiratory Medicines 2026 (Ipratropium Bromide monograph) - verbatim: "Maintenance therapy: 250 - 500 micrograms 3 to 4 times daily."

Why

Adding an anticholinergic to the beta-2 agonist widens the airway a little further in cystic-fibrosis airway obstruction; it is a supportive measure, not a substitute for specialist care.

Cautions
  • Do not use it in anyone allergic to ipratropium or to atropine.
  • Keep the nebuliser mist out of the eyes - it can blur vision and raise eye pressure in glaucoma.
  • This is symptom relief only. Cystic fibrosis is managed by a specialist centre and the referral still stands.
Egyptian brands
Egyptian brandManufacturerIndicative price
ASMATROPIM 250MCG/ML 20 NEBULIZER VIAL SOLN.GLOBAL ADVANCED PHARMACEUTICALS (GAP) > GLOBAL PHARMACEUTICAL INDUSTRIES70.00 EGP
IPRATROPIUM VIATRIS 0.25MG/ML (CHILDREN) 10 UNIT DOSE VIALLABORATOIRE UNITHER > ONE PHARMA MEDICS74.00 EGP
IPRATROPIUM VIATRIS 0.5MG/2ML (ADULTS) 10 UNIT DOSE VIALLABORATOIRE UNITHER > ONE PHARMA MEDICS80.00 EGP
LUNGOTROPIUM 250MCG/1ML 20 UNIT DOSE VIAL NEBULIZER SOLNEVA PHARMA152.00 EGP
ASMATROPIM 500MCG/2ML 20 NEBULIZER VIAL SOLN.GLOBAL ADVANCED PHARMACEUTICALS (GAP) > GLOBAL PHARMACEUTICAL INDUSTRIES164.00 EGP
LUNGOTROPIUM 500MCG/2ML 20 UNIT DOSE VIAL NEBULIZER SOLNEVA PHARMA164.00 EGP
ATROVENT 250MCG/2ML 20 UNIT DOSE INH. VIAL.BOEHRINGER INGELHEIM286.00 EGP
ATROVENT 500 MCG/2ML 20 UNIT DOSE INH. VIAL.BOEHRINGER INGELHEIM286.00 EGP

Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy.