Non-antibiotic Inhaled Agents for Stable Non-CF Bronchiectasis in Adults - A Systematic Review

Aim: Update on efficacy and safety of non-antibiotic therapy for stable non-cystic fibrosis (CF) bronchiectasis.

Methods: Systematic review based on the PRISMA-guidelines.

Results: Fifteen studies (1278 patients) fulfilled the inclusion criteria. Studies (n = 3) suggest that inhaled hypertonic saline may be beneficial in patients with non-CF BE, although possibly not superior to isotonic saline. The effect of hypertonic saline on QoL, lung function, and exacerbation rate has, at best, been inconsistent. Inhaled mannitol (n = 6) affects sputum characteristics, but with no significant effect on exacerbation rate, lung function, or sputum, although it may have an effect on QoL and time to first exacerbation. High-dose inhaled corticosteroids (ICS) (n = 4) reduce sputum volume and eosinophils, possibly due to concomitant asthma, but with no effect on sputum purulence and bacteriology, lung function and exacerbation rate, although it seems to have positive impact on QoL and respiratory symptoms. One study investigating add-on long-acting beta2-agonist to ICS (n = 40) reported an effect on QoL, but no effect on lung function or exacerbation rate.

Conclusion: Airway clearing techniques, including hypertonic saline and mannitol, and asthma controller medication may have beneficial effects in patients with non-CF BE, but only limited evidence suggests an effect on lung function and exacerbation rate.