Are mucoactive agents helpful in patients with bronchiectasis?

Mucoactive therapy with hypertonic saline or carbocisteine did not reduce 1-year pulmonary exacerbation rates in patients with bronchiectasis and sputum production.

CLEAR (NCT04140214) was a randomised, open-label trial in participants with CT scan-confirmed bronchiectasis who had frequent exacerbations and daily sputum production. Current smokers and patients on long-term mucoactive treatment were excluded. Participants were randomised to 1 of 4 groups: standard-of-care with hypertonic saline, standard-of-care with carbocisteine, hypertonic saline plus carbocisteine, or standard-of-care alone. The primary endpoint was the number of exacerbations over 52 weeks, and a total of 288 participants were included.

Prof. Judy Bradley (Queen's University Belfast, UK) presented the results. The mean difference in exacerbation over 52 weeks with hypertonic saline versus no hypertonic saline was -0.25 (95% CI -0.57 to 0.07), and -0.04 (95% CI -0.36 to 0.28) for participants with versus without carbocisteine, showing no significant difference between the groups. Furthermore, the time to the next exacerbation was similar across treatments. Finally, the incidence of adverse events and serious adverse events was comparable between groups [1].

“In conclusion, this large pragmatic trial showed no significant benefit of mucoactive therapy on the number of pulmonary exacerbations over 52 weeks, calling into question the value of their routine usage in patients with bronchiectasis,” said Prof. Bradley.

1. Bradley JM, et al. Effectiveness of hypertonic saline (HTS 6%) and carbocisteine in reducing bronchiectasis exacerbations (Results of the CLEAR randomised trial). ERS Congress, 27 September–1 October 2025, Amsterdam, the Netherlands.

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Posted on 30 October 202530 October 2025