Toggle Main Menu Toggle Search

Open Access padlockePrints

The Newcastle University research output collection, currently available on ePrints, will shortly be moving to a new open repository platform, Figshare. To prepare for the data migration we have paused adding new content to ePrints, and will resume once the new repository is launched. During this time you will continue to have access to ePrints (but no new content will appear). We will share updates here when available.

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

Lookup NU author(s): Ben McCullough, Professor Anthony De SoyzaORCiD

Downloads

Licence

This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).

Abstract

© 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.

Publication metadata

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

Share