Mucoactive agents in bronchiectasis: a systematic review and meta-analysis

Area of Science:

• Pulmonology
• Respiratory Medicine
• Clinical Pharmacology

Background:

• Mucoactive agents are used in bronchiectasis to improve mucociliary clearance, aiming to break the cycle of infection and inflammation.
• Prescribing of these agents varies due to limited robust evidence on their efficacy.
• This study updates the evidence on the effects of mucoactive agents in adult bronchiectasis patients.

Purpose of the Study:

• To systematically review and meta-analyze the evidence on the efficacy and safety of mucoactive agents in adults with bronchiectasis.
• To evaluate the impact of mucoactive agents on exacerbation frequency, lung function, quality of life, and adverse events.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials and observational studies.
• Searched major databases (Medline, Embase, CENTRAL) and trial registries up to October 2025.
• Included adult patients with bronchiectasis, excluding cystic fibrosis and pediatric populations. Primary outcome: exacerbation frequency.

Main Results:

• Analyzed 24 studies (7051 patients) evaluating eight mucoactive agents.
• Pooled analysis showed no statistically significant difference in annual exacerbation incidence (very low certainty evidence).
• A small, statistically significant increase in FEV1 % pred was observed (3.23%), but with very low certainty evidence. No significant differences in other outcomes.

Conclusions:

• Current pooled evidence does not demonstrate a reduction in exacerbations with mucoactive agents in bronchiectasis.
• Observed improvements in FEV1 % pred are small and of very low certainty, indicating uncertain clinical benefit.
• Highlights the need for targeted clinical trials to assess specific agents and patient subgroups.