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Lookup NU author(s): Ben McCullough, Professor Anthony De SoyzaORCiD
This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).
© The authors 2026. Background: Mucoactive agents aim to improve mucociliary clearance in bronchiectasis, disrupting the cycle of impaired clearance, infection and inflammation. Registry data show 28% of patients use these agents, but prescribing varies due to limited evidence. We aimed to update evidence on mucoactive agents’ effects in adults with bronchiectasis. Methods: We conducted a systematic review and meta-analysis, searching Medline, Embase, CENTRAL and trial registries to 1 October 2025. Eligible studies included adults with bronchiectasis, evaluating any mucoactive agent versus placebo or control. Cystic fibrosis and paediatric studies were excluded. The primary outcome was exacerbation frequency; secondary outcomes included lung function, quality of life and adverse events. Findings From 1512 records, 24 studies (20 randomised, four observational: n=7051) evaluated eight mucoactive agents (ambroxol, bromhexine, carbocisteine, erdosteine, hypertonic saline, mannitol, N-acetylcysteine, rhDNase). Most trials had high or some risk of bias. Seven randomised studies (n=1259) reported exacerbations; pooled analysis did not demonstrate a statistically significant difference in annualised exacerbation incidence (mean difference −0.40 per patient per year, 95% CI –1.04–0.24; p=0.22; I2=91%; very low certainty). Nine studies (n=767) reported percent predicted forced expiratory volume in 1 s (FEV1 % pred), showing a small mean increase of 3.23% (95% CI 0.31–6.15; p=0.03; I2 =69.9%; very low certainty). Pooled analyses did not demonstrate significant differences for other spirometry measures, quality of life or adverse events. Interpretation: Pooled evidence did not show a reduction in exacerbations and FEV1 % pred improvements were small. Evidence certainty was low/very low, meaning overall clinical benefit remains uncertain, highlighting the need for targeted trials of specific agents and subgroups.
Author(s): McCullough B, Busby J, O'neill B, Connolly B, McLeese RH, Linden D, McAuley DF, Elborn JS, De Soyza A, Chalmers JD, Clarke M, Bradley JM
Publication type: Review
Publication status: Published
Journal: European Respiratory Review
Year: 2026
Volume: 35
Issue: 180
Online publication date: 24/06/2026
Acceptance date: 06/04/2026
ISSN (print): 0905-9180
ISSN (electronic): 1600-0617
Publisher: European Respiratory Society
URL: https://doi.org/10.1183/16000617.0014-2026
DOI: 10.1183/16000617.0014-2026
PubMed id: 42342264
Data Access Statement: Supplementary material included with the article: https://publications.ersnet.org/content/errev/35/180/260014/DC1/embed/inline-supplementary-material-1.pdf
