Hypertonic saline in non–cystic fibrosis bronchiectasis (Hyper-BRONCHI): an updated systematic review and meta-analysis

Airway clearance is essential in managing bronchiectasis, yet the benefit of inhaled hypertonic saline (HS) in non–cystic fibrosis (non-CF) disease remains unclear. While HS improves mucociliary clearance and clinical outcomes in cystic fibrosis, supporting evidence in non-CF bronchiectasis has been limited. With newly available trial data, this updated meta-analysis reassesses the efficacy of inhaled HS in adults with non-CF bronchiectasis. We systematically searched PubMed, Cochrane CENTRAL, and Embase for randomized controlled trials (RCTs) comparing inhaled HS with control group (Non-HS), either isotonic saline or standard of care, in adults with non-CF bronchiectasis. Outcomes included changes in forced expiratory volume in one second (FEV₁), forced vital capacity (FVC), and pulmonary exacerbation frequency within 52 weeks. The risk of bias was assessed with the Cochrane tool. A random-effects model was applied. Four RCTs involving 386 adults were included. Compared with Non-HS, HS did not significantly improve FEV₁ (SMD 0.03; 95% CI − 0.07 to 0.13; low certainty) or FVC (SMD 0.10; 95% CI − 0.06 to 0.25; low certainty), and pulmonary exacerbation rates (SMD − 0.02; 95% CI − 0.48 to 0.45; very low certainty). In adults with non-CF bronchiectasis, inhaled HS offers no meaningful advantage over Non-HS for lung function or exacerbation reduction. Larger, high-quality RCTs are needed to identify potential benefits. Question: Does inhaled hypertonic saline (HS) provide better lung function outcomes for patients with non-cystic fibrosis bronchiectasis (non-CF bronchiectasis) ? Finding: Overall, hypertonic saline (HS) yielded outcomes comparable to those of the non-HS group (including isotonic saline or standard of care) with respect to FEV₁, FVC, and the annual number of pulmonary exacerbations. These findings were consistent during long-term follow-up of up to 52 weeks. Meaning: Up to date, the data on HS inhaled therapy for non-CF bronchiectasis is limited in high-quality studies, highlighting the need for further non-CF bronchiectasis-specific RCTs, focusing on HS of NaCl 6–7%.