Inhaled hyperosmolar agents for bronchiectasis

Hart, Anna; Sugumar, Karnam; Milan, Stephen J; Fowler, Stephen J.; Crossingham, Iain

doi:10.1002/14651858.cd002996.pub3

Cited by 45 publications

(51 citation statements)

References 36 publications

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“…Extrapolating from studies in other groups of patients (non-cystic fibrosis bronchiectasis or airway malacia), it is likely but not certain that rhDNase is probably ineffective. Hypertonic saline or inhaled mannitol may offer some benefit in some patients [54] and this is supported by anecdotes of n=1 clinical trials for these medications in carefully selected patients and the experience of experts who look after children with A-T.…”

Section: Cough and Mucociliary Clearancementioning

confidence: 95%

ERS statement on the multidisciplinary respiratory management of ataxia telangiectasia

et al. 2015

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Ataxia telangiectasia (A-T) is a rare, progressive, multisystem disease that has a large number of complex and diverse manifestations which vary with age. Patients with A-T die prematurely with the leading causes of death being respiratory diseases and cancer. Respiratory manifestations include immune dysfunction leading to recurrent upper and lower respiratory infections; aspiration resulting from dysfunctional swallowing due to neurodegenerative deficits; inefficient cough; and interstitial lung disease/pulmonary fibrosis. Malnutrition is a significant comorbidity. The increased radiosensitivity and increased risk of cancer should be borne in mind when requesting radiological investigations. Aggressive proactive monitoring and treatment of these various aspects of lung disease under multidisciplinary expertise in the experience of national multidisciplinary clinics internationally forms the basis of this statement on the management of lung disease in A-T. Neurological management is outwith the scope of this document.

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Section: Cough and Mucociliary Clearancementioning

confidence: 95%

ERS statement on the multidisciplinary respiratory management of ataxia telangiectasia

et al. 2015

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“…13 Some mucoactive medications improve mucus clearance when used in patients with CF, but the evidence does not support the use of these medications for patients with non-CF pulmonary disease. [58][59][60][61] Novel therapies to improve mucus clearance in unique situations, such as burns and inhalation injuries, have shown promise, but the amount of evidence is small, and more investigation is necessary before making definitive recommendations. 7 The lack of high-level evidence has a significant impact on the respiratory therapist's ability to recommend for or against using inhaled medications to improve mucus clearance.…”

Section: Implications and Directions For Future Researchmentioning

confidence: 99%

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

et al. 2015

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Aerosolized medications are used as airway clearance therapy to treat a variety of airway diseases. These guidelines were developed from a systematic review with the purpose of determining whether the use of these medications to promote airway clearance improves oxygenation and respiratory mechanics, reduces ventilator time and ICU stay, and/or resolves atelectasis/consolidation compared with usual care. Recombinant human dornase alfa should not be used in hospitalized adult and pediatric patients without cystic fibrosis. The routine use of bronchodilators to aid in secretion clearance is not recommended. The routine use of aerosolized N-acetylcysteine to improve airway clearance is not recommended. Aerosolized agents to change mucus biophysical properties or promote airway clearance are not recommended for adult or pediatric patients with neuromuscular disease, respiratory muscle weakness, or impaired cough. Mucolytics are not recommended to treat atelectasis in postoperative adult or pediatric patients, and the routine administration of bronchodilators to postoperative patients is not recommended. There is no high-level evidence related to the use of bronchodilators, mucolytics, mucokinetics, and novel therapy to promote airway clearance in these populations.

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“…Small trials have shown equivocal benefit with hypertonic saline on clinical outcomes, such as exacerbation rate, quality of life, and lung function, and larger studies are required [64]. Inhaled mannitol at 400 mg twice daily given for one year in 461 patients did not reduce exacerbation rate, the primary outcome, compared with the control group.…”

Section: Treatments For Bronchiectasismentioning

confidence: 99%

Bronchiectasis in the Last Five Years: New Developments

Khoo

Venning

Wong

et al. 2016

JCM

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Bronchiectasis, a chronic lung disease characterised by cough and purulent sputum, recurrent infections, and airway damage, is associated with considerable morbidity and mortality. To date, treatment options have been limited to physiotherapy to clear sputum and antibiotics to treat acute infections. Over the last decade, there has been significant progress in understanding the epidemiology, pathophysiology, and microbiology of this disorder. Over the last five years, methods of assessing severity have been developed, the role of macrolide antibiotic therapy in reducing exacerbations cemented, and inhaled antibiotic therapies show promise in the treatment of chronic Pseudomonas aeruginosa infection. Novel therapies are currently undergoing Phase 1 and 2 trials. This review aims to address the major developments within the field of bronchiectasis over this time.

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Inhaled hyperosmolar agents for bronchiectasis

Cited by 45 publications

References 36 publications

ERS statement on the multidisciplinary respiratory management of ataxia telangiectasia

ERS statement on the multidisciplinary respiratory management of ataxia telangiectasia

AARC Clinical Practice Guideline: Effectiveness of Pharmacologic Airway Clearance Therapies in Hospitalized Patients

Bronchiectasis in the Last Five Years: New Developments

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