Nebulized Hypertonic Saline for Inpatient Use in COPD

Mucolytics for acute exacerbations of chronic obstructive pulmonary disease: a meta-analysis

“…One concluded that mucolytics delay the next exacerbation (hazard ratio 0.169, 95% CI 0.03–0.88, 40 participants, 2 months follow-up) [ 46 ], with the second showing a similar trend (MD 27.70 days, 95% CI −4.55–59.95, 38 participants, 6 months follow-up) [ 53 ]. The latter also suggested that mucolytics may delay the next hospitalisation (MD 21 days, 95% CI −14.5–56.5), but future hospitalisation rate was not affected (MD 0.30, 95% CI −0.34–0.94, 38 participants), as confirmed by a second study [ 38 ] (relative risk 1.03, 95% CI 0.23–4.71, 59 participants). Overall, mucolytics may delay future exacerbations and hospitalisation (very low certainty).…”

“…Acceptable concurrent treatments included bronchodilators, inhaled corticosteroids, systemic corticosteroids, antimicrobials and/or methylxanthines, with or without oxygen supplementation, whereas one study only included patients receiving noninvasive positive-pressure ventilation [ 36 ]. In two studies where administration of the mucolytic was via inhalation, the control group received normal saline as an inhaled placebo [ 38 , 39 ]. Concurrent chest physiotherapy to facilitate mucus expectoration was only reported in one trial [ 29 ].…”

“…The most commonly administered mucolytic was N-acetylcysteine (10 trials), followed by ambroxol (n=5), erdosteine (n=5) and bromhexine (n=2), whereas hypertonic saline and high molecular weight hyaluronan were assessed in one trial each. Mucolytics were usually administered orally, but inhaled [36,[37][38][39] and intravenous [40,41] routes were also used. The median treatment duration was 10 days, generally ranging between 7 and 30 days across the trials, but was limited to only 24 h in one [38].…”

“…Mucolytics were usually administered orally, but inhaled [36,[37][38][39] and intravenous [40,41] routes were also used. The median treatment duration was 10 days, generally ranging between 7 and 30 days across the trials, but was limited to only 24 h in one [38].…”