PT  - JOURNAL ARTICLE
AU  - Diana Bilton
AU  - Gregory Tino
AU  - Alan F Barker
AU  - Daniel C Chambers
AU  - Anthony De Soyza
AU  - Lieven J A Dupont
AU  - Conor O'Dochartaigh
AU  - Eric H J van Haren
AU  - Luis Otero Vidal
AU  - Tobias Welte
AU  - Howard G Fox
AU  - Jian Wu
AU  - Brett Charlton
TI  - Inhaled mannitol for non-cystic fibrosis bronchiectasis: a randomised, controlled trial
AID  - 10.1136/thoraxjnl-2014-205587
DP  - 2014 Dec 01
TA  - Thorax
PG  - 1073--1079
VI  - 69
IP  - 12
4099  - http://thorax.bmj.com/content/69/12/1073.short
4100  - http://thorax.bmj.com/content/69/12/1073.full
SO  - Thorax2014 Dec 01; 69
AB  - Rationale Bronchiectasis is characterised by excessive production of mucus and pulmonary exacerbations. Inhaled osmotic agents may enhance mucociliary clearance, but few long-term clinical trials have been conducted.Objectives To determine the impact of inhaled mannitol on exacerbation rates in patients with non-cystic fibrosis (CF) bronchiectasis. Secondary endpoints included time to first exacerbation, duration of exacerbations, antibiotic use for exacerbations and quality of life (QOL) (St George's Respiratory Questionnaire, SGRQ).Methods Patients with non-CF bronchiectasis and a history of chronic excess production of sputum and ≥2 pulmonary exacerbations in the previous 12 months were randomised (1:1) to 52 weeks treatment with inhaled mannitol 400 mg or low-dose mannitol control twice a day. Patients were 18–85 years of age, baseline FEV1 ≥40% and ≤85% predicted and a baseline SGRQ score ≥30.Main results 461 patients (233 in the mannitol and 228 in the control arm) were treated. Baseline demographics were similar in the two arms. The exacerbation rate was not significantly reduced on mannitol (rate ratio 0.92, p=0.31). However, time to first exacerbation was increased on mannitol (HR 0.78, p=0.022). SGRQ score was improved on mannitol compared with low-dose mannitol control (−2.4 units, p=0.046). Adverse events were similar between groups.Conclusions Mannitol 400 mg inhaled twice daily for 12 months in patients with clinically significant bronchiectasis did not significantly reduce exacerbation rates. There were statistically significant improvements in time to first exacerbation and QOL. Mannitol therapy was safe and well tolerated.Trial registration number NCT00669331.