Clinical Scorecard: Inhaled Dornase Alfa (DNase I) for Managing Severe Respiratory Failure in COVID-19: Results from a Randomized Controlled Study
At a Glance
Category
Detail
Condition
Severe respiratory failure with hypoxia in acute COVID-19
Key Mechanisms
Neutrophil extracellular traps (NETs) contribute to lung inflammation, increased sputum viscosity, and impaired gas exchange; DNase I degrades NETs
Target Population
Hospitalized adults (≥18 years) with COVID-19 and oxygen saturation ≤90% without supplemental oxygen
Care Setting
Hospital wards and intensive care units
Key Highlights
Randomized placebo-controlled trial of inhaled dornase alfa (2.5 mg twice daily for 5 days) versus placebo in 76 hospitalized COVID-19 patients with hypoxia
No significant difference in primary outcome (time to oxygen cessation or hospital discharge) or secondary outcomes including mortality and length of stay
Subanalysis by age (<65 vs ≥65 years) showed no benefit of dornase alfa; study stopped early due to emergence of Omicron variant
Guideline-Based Recommendations
Diagnosis
Confirm COVID-19 diagnosis by PCR testing
Assess oxygen saturation ≤90% without supplemental oxygen to identify severe respiratory failure
Management
Standard of care oxygen support for hypoxic COVID-19 patients
Inhaled dornase alfa is not recommended for improving hypoxia based on current evidence
Monitoring & Follow-up
Monitor oxygen saturation regularly (at least twice daily) after cessation of supplemental oxygen
Observe for adverse events during inhaled therapy
Risks
Potential allergy to dornase alfa contraindicates use
No significant adverse events observed in trial; however, no clinical benefit demonstrated
Patient & Prescribing Data
Hospitalized adult COVID-19 patients with hypoxia (oxygen saturation ≤90%)
Inhaled dornase alfa administered twice daily for 5 days did not improve oxygenation or clinical outcomes compared to placebo
Clinical Best Practices
Use standard oxygen therapy protocols for hypoxic COVID-19 patients
Avoid off-label use of inhaled dornase alfa for COVID-19 respiratory failure outside clinical trials
Consider heterogeneity of viral variants and vaccination status when interpreting treatment effects
Further research needed to evaluate DNase I effects in other respiratory infections
by Per Åkesson, Lisa Mellhammar, Magnus Rasmussen, Malin Inghammar, Sara Jesperson, Fredrik Månsson, Elin Economou Lundeberg, John Walles, Martin Wallberg, Attila Frigyesi, Adam Linder
Invited narrative review supports early, interprofessional rehabilitation across the ICU recovery continuum while emphasizing heterogeneous evidence and inconsistent implementation worldwide.
