Effects of hypertonic saline and/or carbocisteine on sputum rheology in bronchiectasis: CLEAR-EME
Year: 2026
Type: article
Abstract: Background Mucoactives such as hypertonic saline (HTS) and carbocisteine are widely used in the treatment of bronchiectasis, though there is insufficient evidence to support their use. The aim of this mechanistic sub-study, embedded within the CLEAR trial, was to characterise the properties of sputum from patients with bronchiectasis and to assess whether treatment with HTS and/or carbocisteine altered these properties. Methods In CLEAR, patients were randomised to receive HTS, carbocisteine, HTS plus carbocisteine or standard care, and sputum samples were collected at randomisation (baseline) and at 2 and 8 weeks post-randomisation. Sputum viscoelasticity was determined by rotational plate rheometry. Biomarkers were quantified by ELISA and microbiome composition was assessed by next-generation sequencing. The primary outcome was differences in sputum viscoelasticity between groups at 2 weeks following the commencement of treatment. Results Sputum viscoelastic properties were not reduced by 2 or 8 weeks of treatment with HTS and/or carbocisteine (n=6–15 per group). Sputum biomarker levels and bacterial community composition were similar across groups at 2 or 8 weeks. At baseline, viscoelasticity (crossover point σ c ) was positively correlated with interleukin-8 (r=0.49, p=0.012) and greater relative bacterial dominance (r=0.35, p=0.041). Conclusions These data do not support the use of HTS or carbocisteine to alter sputum viscoelasticity, inflammatory marker levels or bacterial community composition in patients with bronchiectasis.
Source: ERJ Open Research
Authors: Michael C. McKelvey, Gisli G. Einarsson, Jack Carson, Aram Kadoom, Ryan R. Brown, Christina Campbell, Andrew Jackson, Cliona McDowell, Mike Clarke, Fiona Copeland, Kathryn Ferguson, Rebecca H. McLeese, Rory Convery, Adam T. Hill, Anthony De Soyza, Mitra Shahidi, Martin Kelly, Mary Carroll, Timothy Gatheral, Muhammed Anwar, Jamie Duckers, William Flight, John R. Hurst, A. Alina Ionescu, Michael R. Loebinger, Anita L. Sullivan, James D. Chalmers, Damian G. Downey, Michael M. Tunney, Brenda O'Neill, Daniel F. McAuley, J. Stuart Elborn, Judy M. Bradley, Clifford C. Taggart
Institutions: Queen's University Belfast, Belfast Health and Social Care Trust, Western Health and Social Care Trust, Wellcome Trust, Southern Health and Social Care Trust, Edinburgh Royal Infirmary, Centre for Inflammation Research, University of Edinburgh, Newcastle University, Buckinghamshire Healthcare NHS Trust, University Hospital Southampton NHS Foundation Trust, University Hospitals of Morecambe Bay NHS Foundation Trust, Princess Alexandra Hospital, Cardiff and Vale University Health Board, University Hospital Llandough, Oxford University Hospitals NHS Trust, University College London, Royal Gwent Hospital, Royal Brompton Hospital, Imperial College London, University of Dundee, Ninewells Hospital, University of Ulster
Language: English
Subfield: Pulmonary and Respiratory Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $808
Award: G7489737849
OpenAlex ID: W7154615136
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