Dawaa Reference

Clinical reference

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.