{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T04:05:29Z","timestamp":1794542729226,"version":"4.9.1"},"reference-count":67,"publisher":"European Respiratory Society (ERS)","issue":"180","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["Eur Respir Rev"],"accepted":{"date-parts":[[2026,4,6]]},"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>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\u2019 effects in adults with bronchiectasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      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\n                      <jats:italic>versus<\/jats:italic>\n                      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.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      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 \u22120.40 per patient per year, 95% CI \u20131.04\u20130.24; p=0.22; I\n                      <jats:sup>2<\/jats:sup>\n                      =91%; very low certainty). Nine studies (n=767) reported percent predicted forced expiratory volume in 1 s (FEV\n                      <jats:sub>1<\/jats:sub>\n                      % pred), showing a small mean increase of 3.23% (95% CI 0.31\u20136.15; p=0.03; I\n                      <jats:sup>2<\/jats:sup>\n                      =69.9%; very low certainty). Pooled analyses did not demonstrate significant differences for other spirometry measures, quality of life or adverse events.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interpretation<\/jats:title>\n                    <jats:p>\n                      Pooled evidence did not show a reduction in exacerbations and FEV\n                      <jats:sub>1<\/jats:sub>\n                      % 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.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/16000617.0014-2026","type":"journal-article","created":{"date-parts":[[2026,6,24]],"date-time":"2026-06-24T08:30:14Z","timestamp":1782289814000},"page":"260014","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["Mucoactive agents in bronchiectasis: a systematic review and meta-analysis"],"prefix":"10.1183","volume":"35","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8871-4805","authenticated-orcid":false,"given":"Benjamin","family":"McCullough","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Busby","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brenda","family":"O'Neill","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bronwen","family":"Connolly","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0647-2503","authenticated-orcid":false,"given":"Rebecca H.","family":"McLeese","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dermot","family":"Linden","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3283-1947","authenticated-orcid":false,"given":"Daniel F.","family":"McAuley","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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