Hypertonic saline, carbocisteine miss mark in bronchiectasis

Treatment with neither hypertonic saline nor carbocisteine helps prevent exacerbations in patients with bronchiectasis, as shown in an open-label study.

A total of 288 patients with noncystic fibrosis bronchiectasis who were experiencing frequent pulmonary exacerbations and daily sputum production participated in the study. None of the patients were actively smoking or had recently received mucoactive treatments.

All patients received standard care and were randomly allocated to groups that received standard care alone, hypertonic saline (hypertonic saline group), hypertonic saline and carbocisteine (combination group), and carbocisteine (carbocisteine group).

The number of pulmonary exacerbations over a 52-week period was the primary outcome. Key secondary outcomes included scores on disease-specific health-related quality-of-life assessments, time to next pulmonary exacerbation, and safety.

The trial had a two-by-two factorial design, with comparisons made between hypertonic saline (hypertonic saline and combination groups) and no hypertonic saline (carbocisteine and standard care alone groups) and between carbocisteine (carbocisteine and combination groups) and no carbocisteine (hypertonic saline and standard care alone groups), with each category consisting of two groups.

Over 52 weeks, the mean number of adjudicated fully qualifying pulmonary exacerbations was 0.76 (95 percent confidence interval [CI], 0.58–0.95) with hypertonic saline vs 0.98 (95 percent CI, 0.78–1.19) with no hypertonic saline (adjusted between-group difference in the means, −0.25, 95 percent CI, −0.57 to 0.07; p=0.12) and 0.86 (95 percent CI, 0.66–1.06) with carbocisteine vs 0.90 (95 percent CI, 0.70–1.09) with no carbocisteine (adjusted between-group difference in the means, −0.04, 95 percent CI, −0.36 to 0.28; p=0.81). There were no treatment interactions observed.

Secondary outcomes and the incidence of adverse events, including serious adverse events, did not significantly differ across the treatment groups.