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Mucolytics for bronchiectasis
A J Crockett1, J M Cranston, K M Latimer
1Respiratory Unit, Flinders Medical Centre, Bedford Park, Adelaide, South Australia, AUSTRALIA, 5042. alan.crockett@flinders.edu.au
Background:
Bronchiectasis is predominantly an acquired disease process representing the end stage of a variety of unrelated pulmonary insults. It is defined as a persistent irreversible dilatation and distortion of medium-sized bronchi. Patients diagnosed with bronchiectasis frequently have difficulty exporating the infected sputum. Mucolytic agents target hyper-secretion or changed physiochemical properties of sputum to make it easier to clear. One drug, recombinant human DNase, breaks down the DNA that is released at the site of infection by neutrophils.
Objectives:
The objective of this review was to assess the effects of ingested or inhaled mucolytics in people with bronchiectasis.
Search Strategy:
We searched the Cochrane Airways Group trials register, reference lists of relevant articles. We also contacted experts in the field and drug companies.
Selection Criteria:
Randomised trials of mucolytic treatment in people with bronchiectasis but not cystic fibrosis.
Data Collection And Analysis:
Data extraction was performed independently by two reviewers. Study authors were contacted for confirmation.
Main Results:
Three trials were included, but none of their data could be aggregated in a meta analysis. Compared to placebo, high doses of bromhexine with antibiotics eased difficulty in expectoration (weighted mean difference -0.53, 95% confidence interval -0.81 to -0.25 at 16 days). There was also a reduction in sputum production with bromhexine (weighted mean difference -21.5%, 95% confidence interval -38.9 to -4.1 % at day 16). Compared to placebo, recombinant human DNase showed no difference in forced expiratory volume or forced vital capacity in one study and was reported to have a significant negative effect on forced expiratory volume in another study. Adverse effects, including influenza-like symptoms, were more common in the group receiving recombinant human DNase.
Reviewer'S Conclusions:
There is not enough evidence to evaluate the routine use of mucolytics for bronchiectasis. High doses of bromhexine coupled with antibiotics may help with sputum production and clearance.
Insights
Limited evidence supports mucolytics for bronchiectasis. High-dose bromhexine with antibiotics may improve sputum clearance in bronchiectasis patients. Further research is needed.
Area of Science:
- Pulmonary Medicine
- Pharmacology
Background:
- Bronchiectasis is an irreversible airway dilation often leading to difficulty clearing infected sputum.
- Mucolytic agents aim to improve sputum properties for easier expectoration.
- Recombinant human DNase targets DNA from neutrophils at infection sites.
Purpose of the Study:
- To review the efficacy of ingested or inhaled mucolytics for managing bronchiectasis.
Main Methods:
- Searched multiple databases and contacted experts for relevant randomized trials.
- Included trials on mucolytic treatment for bronchiectasis, excluding cystic fibrosis.
- Independent data extraction and author verification were performed.
Main Results:
- Three trials were identified; meta-analysis was not possible.
- High-dose bromhexine with antibiotics improved sputum expectoration and reduced production compared to placebo.
- Recombinant human DNase showed no benefit and potentially negative effects on lung function, with increased adverse events.
Conclusions:
- Insufficient evidence exists for routine mucolytic use in bronchiectasis.
- High-dose bromhexine combined with antibiotics may aid sputum clearance.
- More research is required to establish the role of mucolytics in bronchiectasis management.