| Design | Randomised factorial trial |
|---|---|
| Treatment | Nebulised hypertonic saline, oral carbocisteine, or both |
| Control | Neither treatment |
| Population | 288 participants with bronchiectasis |
| Follow-up | 52 weeks |
| Primary endpoint | Mean number of adjudicated pulmonary exacerbations over 52 weeks |
| Result | Exacerbations 0.76 (95% CI 0.58 to 0.95) with hypertonic saline versus 0.98 (0.78 to 1.19) without — adjusted difference -0.25 (-0.57 to 0.07, p=0.12). With carbocisteine 0.86 (0.66 to 1.06) versus 0.90 (0.70 to 1.09) without. No treatment interaction was found. |
| Secondary endpoints | Quality of life, lung function, adverse events |
In participants with bronchiectasis, neither hypertonic saline nor carbocisteine significantly reduced the mean incidence of pulmonary exacerbations over a period of 52 weeks.
The trial authors, in the published abstract
A properly conducted negative trial of two treatments in wide everyday use. It does not exclude symptomatic benefit for individual patients, which is the usual reason they are prescribed, but it removes exacerbation prevention as a justification.
Bradley JM, O'Neill B, McAuley DF, et al. Hypertonic Saline or Carbocisteine in Bronchiectasis. N Engl J Med 2025 Oct 23;393(16):1565-1577.