Hypertonic Saline or Carbocisteine in Bronchiectasis.

Summary

In a 20-center, open-label, factorial RCT (n=288), neither hypertonic saline nor carbocisteine significantly reduced fully adjudicated pulmonary exacerbations over 52 weeks compared with standard care. Secondary outcomes and adverse events were similar across groups.

Key Findings

• Neither hypertonic saline nor carbocisteine reduced adjudicated exacerbations over 52 weeks versus no use.
• No significant differences in quality-of-life scores, time to next exacerbation, or safety outcomes.
• Open-label, two-by-two factorial design across 20 UK sites with 288 randomized participants.

Clinical Implications

Clinicians should avoid routine prescription of hypertonic saline or carbocisteine to prevent exacerbations in non-CF bronchiectasis and focus on proven strategies (airway clearance, macrolides for frequent exacerbators, inhaled antibiotics for chronic infection).

Limitations

• Open-label design may introduce performance bias
• Absolute exacerbation rates were relatively low, possibly limiting power for small effects

Future Directions

Evaluate patient subgroups (e.g., specific sputum rheology phenotypes) or combination strategies with airway clearance; prioritize trials of therapies targeting infection and inflammation.