{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,27]],"date-time":"2026-09-27T09:35:44Z","timestamp":1790501744657,"version":"4.1.0"},"reference-count":42,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T00:00:00Z","timestamp":1491868800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Respirology"],"published-print":{"date-parts":[[2017,8]]},"abstract":"\nABSTRACT<\/jats:styled-content>\n<\/jats:title>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<\/jats:styled-content>) and hypertonic saline (HS<\/jats:styled-content>) or normal saline (NS<\/jats:styled-content>) are not well described in chronic lung conditions other than cystic fibrosis (CF<\/jats:styled-content>). The aim of this review was to determine the benefit and safety of inhaled mucoactive agents outside of CF<\/jats:styled-content>. We searched Medline, Embase, CINAHL<\/jats:styled-content> and CENTRAL<\/jats:styled-content> for randomized controlled trials investigating the effects of mucoactive agents on lung function, adverse events (AEs<\/jats:styled-content>), health\u2010related quality of life (HRQOL<\/jats:styled-content>), hospitalization, length of stay, exacerbations, sputum clearance and inflammation. There were detrimental effects of rhDNase<\/jats:styled-content> in bronchiectasis, with average declines of 1.9\u20134.3% in forced expiratory volume in 1\u2009s (FEV1<\/jats:sub>\n<\/jats:styled-content>) and 3.7\u20135.4% in forced vital capacity (FVC<\/jats:styled-content>) (n<\/jats:italic>\u2009=\u2009410, two studies), and increased exacerbation risk (relative risk\u2009=\u20091.35, 95% CI\u2009=\u20091.01\u20131.79 n<\/jats:italic>\u2009=\u2009349, one study). Some participants exhibited a reduction in FEV1<\/jats:sub>\n<\/jats:styled-content> (\u226510\u201315%) with mucoactive agents on screening (mannitol\u2009=\u2009158 of 1051 participants, rhDNase<\/jats:styled-content>\u2009=\u20092 of 30, HS<\/jats:styled-content>\u2009=\u20093 of 80). Most AEs<\/jats:styled-content> were mild and transient, including bronchospasm, cough and breathlessness. NS<\/jats:styled-content> eased symptomatic burden in COPD<\/jats:styled-content>, while NS<\/jats:styled-content> and HS<\/jats:styled-content> improved spirometry, HRQOL<\/jats:styled-content> and sputum burden in non\u2010CF<\/jats:styled-content> bronchiectasis. Mannitol improved mucociliary clearance in asthma and bronchiectasis, while the effects of N\u2010acetylcysteine were unclear. In chronic lung diseases outside CF<\/jats:styled-content>, there are small benefits of mannitol, NS<\/jats:styled-content> and HS<\/jats:styled-content>. Adverse effects of rhDNase<\/jats:styled-content> suggest this should not be administered in non\u2010CF<\/jats:styled-content> bronchiectasis.<\/jats:p>","DOI":"10.1111\/resp.13047","type":"journal-article","created":{"date-parts":[[2017,4,11]],"date-time":"2017-04-11T11:54:55Z","timestamp":1491911695000},"page":"1084-1092","source":"Crossref","is-referenced-by-count":85,"title":["Mucoactive agents for chronic, non\u2010cystic fibrosis lung disease: A<\/scp> systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5572-1644","authenticated-orcid":false,"given":"Benjamin J.","family":"Tarrant","sequence":"first","affiliation":[{"name":"Department of Physiotherapy Alfred Health Melbourne Victoria Australia"},{"name":"Department of Rehabilitation, Nutrition and Sport La Trobe University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitlin","family":"Le Maitre","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy Alfred Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9884-5463","authenticated-orcid":false,"given":"Lorena","family":"Romero","sequence":"additional","affiliation":[{"name":"Ian Potter Library Alfred Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ranjana","family":"Steward","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy Alfred Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda M.","family":"Button","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy Alfred Health Melbourne Victoria Australia"},{"name":"Department of Allergy, Immunology and Respiratory Medicine (AIRmed) Monash University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5885-0652","authenticated-orcid":false,"given":"Bruce R.","family":"Thompson","sequence":"additional","affiliation":[{"name":"Department of Allergy, Immunology and Respiratory Medicine (AIRmed) Monash University Melbourne Victoria Australia"},{"name":"Department of Allergy, Immunology and Respiratory Medicine Alfred Health Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2061-845X","authenticated-orcid":false,"given":"Anne E.","family":"Holland","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy Alfred Health Melbourne Victoria Australia"},{"name":"Department of Rehabilitation, Nutrition and Sport La Trobe University Melbourne Victoria Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,4,11]]},"reference":[{"key":"e_1_2_6_2_1","first-page":"859","article-title":"Mucolytics, expectorants, and mucokinetic medications","volume":"52","author":"Rubin BK","year":"2007","journal-title":"Respir. 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