PMID- 28397992
OWN - NLM
STAT- MEDLINE
DCOM- 20180307
LR  - 20220316
IS  - 1440-1843 (Electronic)
IS  - 1323-7799 (Linking)
VI  - 22
IP  - 6
DP  - 2017 Aug
TI  - Mucoactive agents for chronic, non-cystic fibrosis lung disease: A systematic 
      review and meta-analysis.
PG  - 1084-1092
LID - 10.1111/resp.13047 [doi]
AB  - Inhaled mucoactive agents are used in respiratory disease to improve mucus 
      properties and enhance secretion clearance. The effect of mannitol, recombinant 
      human deoxyribonuclease/dornase alfa (rhDNase) and hypertonic saline (HS) or 
      normal saline (NS) are not well described in chronic lung conditions other than 
      cystic fibrosis (CF). The aim of this review was to determine the benefit and 
      safety of inhaled mucoactive agents outside of CF. We searched Medline, Embase, 
      CINAHL and CENTRAL for randomized controlled trials investigating the effects of 
      mucoactive agents on lung function, adverse events (AEs), health-related quality 
      of life (HRQOL), hospitalization, length of stay, exacerbations, sputum clearance 
      and inflammation. There were detrimental effects of rhDNase in bronchiectasis, 
      with average declines of 1.9-4.3% in forced expiratory volume in 1 s (FEV(1) ) 
      and 3.7-5.4% in forced vital capacity (FVC) (n = 410, two studies), and increased 
      exacerbation risk (relative risk = 1.35, 95% CI = 1.01-1.79 n = 349, one study). 
      Some participants exhibited a reduction in FEV(1) (>/=10-15%) with mucoactive 
      agents on screening (mannitol = 158 of 1051 participants, rhDNase = 2 of 30, 
      HS = 3 of 80). Most AEs were mild and transient, including bronchospasm, cough 
      and breathlessness. NS eased symptomatic burden in COPD, while NS and HS improved 
      spirometry, HRQOL and sputum burden in non-CF bronchiectasis. Mannitol improved 
      mucociliary clearance in asthma and bronchiectasis, while the effects of 
      N-acetylcysteine were unclear. In chronic lung diseases outside CF, there are 
      small benefits of mannitol, NS and HS. Adverse effects of rhDNase suggest this 
      should not be administered in non-CF bronchiectasis.
CI  - (c) 2017 Asian Pacific Society of Respirology.
FAU - Tarrant, Benjamin J
AU  - Tarrant BJ
AUID- ORCID: 0000-0002-5572-1644
AD  - Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
AD  - Department of Rehabilitation, Nutrition and Sport, La Trobe University, 
      Melbourne, Victoria, Australia.
FAU - Le Maitre, Caitlin
AU  - Le Maitre C
AD  - Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
FAU - Romero, Lorena
AU  - Romero L
AUID- ORCID: 0000-0001-9884-5463
AD  - Ian Potter Library, Alfred Health, Melbourne, Victoria, Australia.
FAU - Steward, Ranjana
AU  - Steward R
AD  - Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
FAU - Button, Brenda M
AU  - Button BM
AD  - Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
AD  - Department of Allergy, Immunology and Respiratory Medicine (AIRmed), Monash 
      University, Melbourne, Victoria, Australia.
FAU - Thompson, Bruce R
AU  - Thompson BR
AUID- ORCID: 0000-0002-5885-0652
AD  - Department of Allergy, Immunology and Respiratory Medicine (AIRmed), Monash 
      University, Melbourne, Victoria, Australia.
AD  - Department of Allergy, Immunology and Respiratory Medicine, Alfred Health, 
      Melbourne, Victoria, Australia.
FAU - Holland, Anne E
AU  - Holland AE
AUID- ORCID: 0000-0003-2061-845X
AD  - Department of Physiotherapy, Alfred Health, Melbourne, Victoria, Australia.
AD  - Department of Rehabilitation, Nutrition and Sport, La Trobe University, 
      Melbourne, Victoria, Australia.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Review
PT  - Systematic Review
DEP - 20170411
PL  - Australia
TA  - Respirology
JT  - Respirology (Carlton, Vic.)
JID - 9616368
RN  - 0 (Expectorants)
RN  - 0 (Recombinant Proteins)
RN  - 0 (Saline Solution, Hypertonic)
RN  - 3OWL53L36A (Mannitol)
RN  - EC 3.1.21.1 (Deoxyribonuclease I)
RN  - EC 3.1.21.1 (dornase alfa)
RN  - NR7O1405Q9 (Mesna)
RN  - WYQ7N0BPYC (Acetylcysteine)
SB  - IM
MH  - Acetylcysteine/pharmacology/*therapeutic use
MH  - Administration, Inhalation
MH  - Bronchiectasis/*drug therapy/physiopathology
MH  - Chronic Disease
MH  - Deoxyribonuclease I/pharmacology/*therapeutic use
MH  - Expectorants/pharmacology/*therapeutic use
MH  - Forced Expiratory Volume
MH  - Humans
MH  - Lung Diseases/*drug therapy/physiopathology
MH  - Mannitol/pharmacology/*therapeutic use
MH  - Mesna/therapeutic use
MH  - Mucociliary Clearance/drug effects
MH  - Quality of Life
MH  - Recombinant Proteins/pharmacology/therapeutic use
MH  - Saline Solution, Hypertonic/pharmacology/*therapeutic use
MH  - Symptom Flare Up
MH  - Vital Capacity
OTO - NOTNLM
OT  - expectorants
OT  - humans
OT  - lung diseases
OT  - respiratory function tests
OT  - sputum
EDAT- 2017/04/12 06:00
MHDA- 2018/03/08 06:00
CRDT- 2017/04/12 06:00
PHST- 2016/09/06 00:00 [received]
PHST- 2017/02/06 00:00 [revised]
PHST- 2017/02/26 00:00 [accepted]
PHST- 2017/04/12 06:00 [pubmed]
PHST- 2018/03/08 06:00 [medline]
PHST- 2017/04/12 06:00 [entrez]
AID - 10.1111/resp.13047 [doi]
PST - ppublish
SO  - Respirology. 2017 Aug;22(6):1084-1092. doi: 10.1111/resp.13047. Epub 2017 Apr 11.