Study Finds No Significant Benefit of Mucoactive Agents in Preventing Lung Flare-Ups in Bronchiectasis Patients

Research led by Queen's University Belfast has investigated the effectiveness of mucoactive therapies—specifically hypertonic saline and carbocisteine—in managing bronchiectasis, a chronic lung condition characterized by persistent cough, sputum production, chest pain, and recurrent exacerbations that can impair quality of life. The multicenter trial, published in the New England Journal of Medicine, involved 288 adults across 20 UK hospitals and aimed to determine whether these treatments could reduce pulmonary flare-ups over a year.

Participants were randomized to receive either hypertonic saline, carbocisteine, both, or standard care without additional mucoactive agents. Hypertonic saline was administered via nebulizer, while carbocisteine was dosed at 750 mg thrice daily for eight weeks, then twice daily. Notably, smokers and recent mucoactive users were excluded to eliminate confounding factors.

The primary outcome measured was the number of pulmonary exacerbations, assessed using standardized criteria. Results revealed no statistically significant difference in exacerbation rates between the groups. The adjusted difference for hypertonic saline versus no saline was -0.25 (95% CI -0.57 to 0.07, P=0.12), and for carbocisteine versus no carbocisteine, it was -0.04 (95% CI -0.36 to 0.28, P=0.81). Secondary measures, such as quality-of-life scores and lung function, showed no notable differences.

The study concludes that adding these mucoactive treatments to standard care does not effectively reduce exacerbation frequency in bronchiectasis. These findings emphasize the need for clinicians and patients to consider treatment burdens, costs, and side effects when choosing management strategies, potentially guiding a shift away from routine use of these agents for exacerbation prevention.

This research supports the ongoing reassessment of mucoactive therapies and underscores the importance of evidence-based treatment choices in respiratory care.

For more detailed information, see the original study: Judy M. Bradley et al, "Hypertonic Saline or Carbocisteine in Bronchiectasis," New England Journal of Medicine (2025). Source: https://medicalxpress.com/news/2025-09-mucoactive-bronchiectasis-treatments-benefit-lung.html