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Intervention Review

Inhaled hyperosmolar agents for bronchiectasis

  1. Peter J Wills1,*,
  2. Michael Greenstone2

Editorial Group: Cochrane Airways Group

Published Online: 19 APR 2006

Assessed as up-to-date: 3 OCT 2007

DOI: 10.1002/14651858.CD002996.pub2


How to Cite

Wills PJ, Greenstone M. Inhaled hyperosmolar agents for bronchiectasis. Cochrane Database of Systematic Reviews 2006, Issue 2. Art. No.: CD002996. DOI: 10.1002/14651858.CD002996.pub2.

Author Information

  1. 1

    Hillingdon Hospital, Dept of Respiratory Medicine, Uxbridge, Middlesex, UK

  2. 2

    Castle Hill Hospital, Cottingham, North Humberside, UK

*Peter J Wills, Dept of Respiratory Medicine, Hillingdon Hospital, Pield Heath Road, Uxbridge, Middlesex, UB8 3NN, UK. pjwills@doctors.org.uk.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 19 APR 2006

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This is not the most recent version of the article. View current version (12 MAY 2014)

 

Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Mucus retention in the lungs is a prominent feature of bronchiectasis. The stagnant mucus becomes chronically colonised with bacteria, which elicit a host neutrophilic response. This fails to eliminate the bacteria, and the large concentration of host-derived protease may contribute to the airway damage. The sensation of retained mucus is itself a cause of suffering, and the failure to maintain airway sterility probably contributes to the frequent respiratory infections experienced by many patients.

Hypertonic saline inhalation is known to accelerate tracheobronchial clearance in many conditions, probably by inducing a liquid flux into the airway surface, which alters mucus rheology in a way favourable to mucociliary clearance. Inhaled dry powder mannitol has a similar effect. Such agents are an attractive approach to the problem of mucostasis, and deserve further clinical evaluation.

Objectives

To determine whether inhaled hyperosmolar substances are efficacious in the treatment of bronchiectasis

Search methods

The Cochrane Airways Group Specialised Register was searched, and leaders in the field were contacted. Searches were current as of October 2007.

Selection criteria

Any trial using hyperosmolar inhalation in patients with bronchiectasis not caused by cystic fibrosis.

Data collection and analysis

Two reviewers assessed studies for suitability.

Main results

Two small studies met the inclusion criteria of the review (28 participants). One study reported tracheobronchial clearance of a particulate radio aerosol after inhalation of dry mannitol on a single occasion, with appropriate control. Airway clearance doubled in the central and intermediate regions of the lung, but not in the peripheral region, after mannitol administration. No side effects were observed, but two patients were premedicated with nedocromil to prevent bronchospasm. Findings from one further trial indicated that one domain of a sensitive health status instrument showed a favourable response to mannitol.

Authors' conclusions

Dry powder mannitol has been shown to improve tracheobronchial clearance in bronchiectasis, as well as cystic fibrosis, asthmatics, and normal subjects. Hypertonic saline has not been specifically tested in bronchiectasis, but improves clearance in these other conditions and in chronic bronchitis. The measurement of health status in one of the studies should be repeated in future longer term randomised controlled studies of mannitol and hypertonic saline. Consideration should also be given to exacerbations and symptom scores, as well as drug-related adverse events.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Inhaled hyperosmolar agents for bronchiectasis

Bronchiectasis is a lung condition that usually develops after a series of lung problems (such as childhood infections, problems in the lung structure, tuberculosis, and cystic fibrosis). A lot of mucus collects in the lungs, causing discomfort and the need to cough it up. The mucus also collects bacteria, and causes infections and other lung and breathing problems. Inhaling hypertonic saline liquids may help clear this mucus, as may the drug mannitol (inhaled in dry powder form). The review of trials found some evidence that mannitol may help. More research is needed.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

吸入型高滲壓劑(hyperosmolar agents)治療支氣管擴張症

肺臟黏液滯留是支氣管擴張症的一大特點。這些滯留的黏液長時間下來成為細菌的溫床,引起宿主嗜中性白血球反應。如果細菌無法因此被消除掉,來自宿主的大量蛋白? (protease)可能造成呼吸道損傷。黏液滯留本身就會造成患者痛苦,而且無法讓呼吸道維持無菌,這或許是許多患者呼吸道經常感染的原因。目前已知,在很多情況下,吸入高張食鹽水可以加速氣管支氣管的清除作用,或許是因為將液體引入呼吸道表層,在某方面改變黏液的流變學(rheology),有利於黏膜纖毛的清除作用。吸入型甘露醇(mannitol)乾粉末有類似的作用。此類藥物是處理黏液滯留問題的誘人方法,值得進一步臨床評估。

目標

判斷吸入型高滲壓物質治療支氣管擴張症是否有效。

搜尋策略

搜尋Cochrane Airways Group Specialised Register,並連絡該領域的領導者。目前搜尋到2007年10月。

選擇標準

針對非囊腫性纖維化(cystic fibrosis)所造成的支氣管擴張症患者,有關高滲透壓吸入的任何試驗。

資料收集與分析

兩位審查員評估適於納入的研究。

主要結論

兩個小型研究符合本回顧的納入標準(共28位參與者)。一項研究的報告指出:在適當控制下,單一次吸入乾式甘露醇後,氣管支氣管可以清除輻射懸浮微粒(particulate radioaerosol)。吸入甘露醇後,肺臟中央和中間區域的呼吸道清除加倍,但週邊區域則沒有類似反應。沒有觀察到副作用,但有兩位病患預先服用nedocromil預防支氣管攣縮。一個更進一步的研究發現指出:一個靈敏的健康狀態工具的其中一個面向顯示甘露醇的有利作用。

作者結論

甘露醇乾粉末已確定可以改善氣管支氣管的清除作用,無論對支氣管擴張症、囊腫性纖維化、氣喘患者和正常受試者。高張食鹽水還不曾特別針對支氣管擴張症患者做測試,但的確可以改善上述其他狀況和慢性支氣管炎的清除作用。其中一個研究的健康狀態測量,在將來進行甘露醇和高張食鹽水的長期隨機對照研究時,應該重複確認。同時也應考量發作頻率和症狀分數,以及藥物相關的不良事件。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

支氣管擴張症患者吸入甘露醇乾粉末和高張食鹽水,有助於清除肺臟分泌物;但還需要有更多評估長期使用效果的研究。支氣管擴張症是一種肺病,通常是在一連串的肺臟問題(如:兒童時期的感染、肺臟結構問題、結核病和囊腫性纖維化)後發生。大量的黏液堆積在肺部造成不適,需要被咳出來。黏液也會聚積細菌,造成感染和其他肺臟呼吸問題。吸入高張食鹽水有助於清除黏液,甘露醇(以乾粉末方式吸入)藥物也有此功效。本回顧發現一些甘露醇可能有所幫助的證據。但還需要有更多的研究。