{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,13]],"date-time":"2026-11-13T04:17:32Z","timestamp":1794543452061,"version":"4.9.1"},"reference-count":16,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T00:00:00Z","timestamp":1770854400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,3,18]],"date-time":"2026-03-18T00:00:00Z","timestamp":1773792000000},"content-version":"vor","delay-in-days":34,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100009232","name":"University of Debrecen","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100009232","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Pulm Med"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Airway clearance is essential in managing bronchiectasis, yet the benefit of inhaled hypertonic saline (HS) in non\u2013cystic fibrosis (non-CF) disease remains unclear. While HS improves mucociliary clearance and clinical outcomes in cystic fibrosis, supporting evidence in non-CF bronchiectasis has been limited. With newly available trial data, this updated meta-analysis reassesses the efficacy of inhaled HS in adults with non-CF bronchiectasis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We systematically searched PubMed, Cochrane CENTRAL, and Embase for randomized controlled trials (RCTs) comparing inhaled HS with control group (Non-HS), either isotonic saline or standard of care, in adults with non-CF bronchiectasis. Outcomes included changes in forced expiratory volume in one second (FEV\u2081), forced vital capacity (FVC), and pulmonary exacerbation frequency within 52 weeks. The risk of bias was assessed with the Cochrane tool. A random-effects model was applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Four RCTs involving 386 adults were included. Compared with Non-HS, HS did not significantly improve FEV\u2081 (SMD 0.03; 95% CI\u2009\u2212\u20090.07 to 0.13; low certainty) or FVC (SMD 0.10; 95% CI\u2009\u2212\u20090.06 to 0.25; low certainty), and pulmonary exacerbation rates (SMD\u2009\u2212\u20090.02; 95% CI\u2009\u2212\u20090.48 to 0.45; very low certainty).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>In adults with non-CF bronchiectasis, inhaled HS offers no meaningful advantage over Non-HS for lung function or exacerbation reduction. Larger, high-quality RCTs are needed to identify potential benefits.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12890-026-04176-4","type":"journal-article","created":{"date-parts":[[2026,2,12]],"date-time":"2026-02-12T03:56:07Z","timestamp":1770868567000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Hypertonic saline in non\u2013cystic fibrosis bronchiectasis (Hyper-BRONCHI): an updated systematic review and meta-analysis"],"prefix":"10.1186","volume":"26","author":[{"ORCID":"https:\/\/orcid.org\/0009-0004-8995-240X","authenticated-orcid":false,"given":"Nhan","family":"Nguyen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yacin","family":"Zawam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nghi Bao","family":"Tran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathalia Alves","family":"de Barros e Lyra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vinh Quang Tri","family":"Ho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Downes","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vy Ngoc Dan","family":"Nguyen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ha Duc Thien","family":"Le","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jafar","family":"Aljazeeri","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,2,12]]},"reference":[{"issue":"1","key":"4176_CR1","doi-asserted-by":"publisher","first-page":"2202053","DOI":"10.1183\/13993003.02053-2022","volume":"62","author":"B Herrero-Cortina","year":"2023","unstructured":"Herrero-Cortina B, Lee AL, Oliveira A, et al. European respiratory society statement on airway clearance techniques in adults with bronchiectasis. Eur Respir J. 2023;62(1):2202053. https:\/\/doi.org\/10.1183\/13993003.02053-2022.","journal-title":"Eur Respir J"},{"issue":"1","key":"4176_CR2","doi-asserted-by":"publisher","first-page":"2300865","DOI":"10.1183\/13993003.00865-2023","volume":"62","author":"SH Donaldson","year":"2023","unstructured":"Donaldson SH. More is better? Hypertonic saline dose and response for cystic fibrosis: efficacy, tolerability and implications for clinical practice. Eur Respir J. 2023;62(1):2300865. https:\/\/doi.org\/10.1183\/13993003.00865-2023.","journal-title":"Eur Respir J"},{"issue":"5","key":"4176_CR3","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1089\/jamp.2017.1443","volume":"31","author":"B Herrero-Cortina","year":"2018","unstructured":"Herrero-Cortina B, Alcaraz V, Vilar\u00f3 J, et al. Impact of hypertonic saline solutions on sputum expectoration and their safety profile in patients with bronchiectasis: A randomized crossover trial. J Aerosol Med Pulm Drug Deliv. 2018;31(5):281\u20139. https:\/\/doi.org\/10.1089\/jamp.2017.1443.","journal-title":"J Aerosol Med Pulm Drug Deliv"},{"issue":"12","key":"4176_CR4","doi-asserted-by":"publisher","first-page":"1831","DOI":"10.1016\/j.rmed.2011.07.019","volume":"105","author":"F Kellett","year":"2011","unstructured":"Kellett F, Robert NM. Nebulised 7% hypertonic saline improves lung function and quality of life in bronchiectasis: A randomized controlled trial. Respir Med. 2011;105(12):1831\u20135. https:\/\/doi.org\/10.1016\/j.rmed.2011.07.019.","journal-title":"Respir Med"},{"issue":"5","key":"4176_CR5","doi-asserted-by":"publisher","first-page":"661","DOI":"10.1016\/j.rmed.2011.12.021","volume":"106","author":"CHH Nicolson","year":"2012","unstructured":"Nicolson CHH, Stirling RG, Borg BM, et al. The long term effect of inhaled hypertonic saline 6% in non-cystic fibrosis bronchiectasis: A randomized controlled trial. Respir Med. 2012;106(5):661\u20137. https:\/\/doi.org\/10.1016\/j.rmed.2011.12.021.","journal-title":"Respir Med"},{"issue":"6","key":"4176_CR6","doi-asserted-by":"publisher","first-page":"1084","DOI":"10.1111\/resp.13047","volume":"22","author":"BJ Tarrant","year":"2017","unstructured":"Tarrant BJ, Le Maitre C, Romero L, et al. Mucoactive agents for chronic, non-cystic fibrosis lung disease: A systematic review and meta-analysis. Respirology. 2017;22(6):1084\u201392. https:\/\/doi.org\/10.1111\/resp.13047.","journal-title":"Respirology"},{"issue":"12","key":"4176_CR7","doi-asserted-by":"publisher","first-page":"2713","DOI":"10.1016\/j.ajem.2020.08.042","volume":"38","author":"B Xie","year":"2020","unstructured":"Xie B, Liu P, Wu Q, Xiang W. The efficacy of inhaled hypertonic saline for bronchiectasis: a meta-analysis of randomized controlled studies. Am J Emerg Med. 2020;38(12):2713\u20137. https:\/\/doi.org\/10.1016\/j.ajem.2020.08.042.","journal-title":"Am J Emerg Med"},{"issue":"16","key":"4176_CR8","doi-asserted-by":"publisher","first-page":"1565","DOI":"10.1056\/NEJMoa2510095","volume":"393","author":"JM Bradley","year":"2025","unstructured":"Bradley JM, O\u2019Neill B, McAuley DF, Chalmers JD, De Soyza A, Hill AT, Carroll M, et al. Hypertonic saline or carbocisteine in bronchiectasis. N Engl J Med. 2025;393(16):1565\u201377. https:\/\/doi.org\/10.1056\/NEJMoa2510095.","journal-title":"N Engl J Med"},{"key":"4176_CR9","doi-asserted-by":"publisher","first-page":"n71","DOI":"10.1136\/bmj.n71","volume":"372","author":"MJ Page","year":"2021","unstructured":"Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https:\/\/doi.org\/10.1136\/bmj.n71.","journal-title":"BMJ"},{"key":"4176_CR10","unstructured":"Higgins JPT, Thomas J, Chandler J, et al. editors. Cochrane Handbook for Systematic Reviews of Interventions, version 6.5 (updated August 2024). Cochrane; 2024. https:\/\/www.cochrane.org\/authors\/handbooks-and-manuals\/handbook."},{"issue":"7650","key":"4176_CR11","doi-asserted-by":"publisher","first-page":"924","DOI":"10.1136\/bmj.39489.470347.AD","volume":"336","author":"GH Guyatt","year":"2008","unstructured":"Guyatt GH, Oxman AD, Vist GE, et al. GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008;336(7650):924\u20136. https:\/\/doi.org\/10.1136\/bmj.39489.470347.AD.","journal-title":"BMJ"},{"issue":"16","key":"4176_CR12","doi-asserted-by":"publisher","first-page":"1569","DOI":"10.1056\/NEJMoa2411664","volume":"392","author":"JD Chalmers","year":"2025","unstructured":"Chalmers JD, Burgel P-R, Daley CL, et al. Phase 3 trial of the DPP-1 inhibitor brensocatib in bronchiectasis. N Engl J Med. 2025;392(16):1569\u201381. https:\/\/doi.org\/10.1056\/NEJMoa2411664.","journal-title":"N Engl J Med"},{"issue":"4","key":"4176_CR13","doi-asserted-by":"publisher","first-page":"179","DOI":"10.1016\/j.paed.2014.12.002","volume":"25","author":"S Kansra","year":"2015","unstructured":"Kansra S, Bradbrook B. Non cystic fibrosis bronchiectasis. Paediatr Child Health. 2015;25(4):179\u201381. https:\/\/doi.org\/10.1016\/j.paed.2014.12.002.","journal-title":"Paediatr Child Health"},{"issue":"7","key":"4176_CR14","doi-asserted-by":"publisher","first-page":"907","DOI":"10.1164\/rccm.200909-1434OC","volume":"182","author":"T Bienvenu","year":"2010","unstructured":"Bienvenu T, Sermet-Gaudelus I, Burgel P-R, et al. Cystic fibrosis transmembrane conductance regulator channel dysfunction in non\u2013cystic fibrosis bronchiectasis. Am J Respir Crit Care Med. 2010;182(7):907\u201314. https:\/\/doi.org\/10.1164\/rccm.200909-1434OC.","journal-title":"Am J Respir Crit Care Med"},{"issue":"1","key":"4176_CR15","doi-asserted-by":"publisher","first-page":"12","DOI":"10.1016\/S2213-2600(19)30327-3","volume":"8","author":"JD Chalmers","year":"2020","unstructured":"Chalmers JD. Cystic fibrosis lung disease and bronchiectasis. Lancet Respir Med. 2020;8(1):12\u20134. https:\/\/doi.org\/10.1016\/S2213-2600(19)30327-3.","journal-title":"Lancet Respir Med"},{"key":"4176_CR16","doi-asserted-by":"publisher","first-page":"l4898","DOI":"10.1136\/bmj.l4898","volume":"366","author":"JAC Sterne","year":"2019","unstructured":"Sterne JAC, Savovi\u0107 J, Page MJ, et al. RoB 2: A revised tool for assessing risk of bias in randomised trials. BMJ. 2019;366:l4898. https:\/\/doi.org\/10.1136\/bmj.l4898.","journal-title":"BMJ"}],"container-title":["BMC Pulmonary Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12890-026-04176-4","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-026-04176-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12890-026-04176-4.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T18:07:50Z","timestamp":1781633270000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12890-026-04176-4"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,2,12]]},"references-count":16,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["4176"],"URL":"https:\/\/doi.org\/10.1186\/s12890-026-04176-4","relation":{},"ISSN":["1471-2466"],"issn-type":[{"value":"1471-2466","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,2,12]]},"assertion":[{"value":"14 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"10 February 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"12 February 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"122"}}