RT Journal Article
SR Electronic
T1 Inhaled mannitol for non-cystic fibrosis bronchiectasis: a randomised, controlled trial
JF Thorax
JO Thorax
FD BMJ Publishing Group Ltd and British Thoracic Society
SP 1073
OP 1079
DO 10.1136/thoraxjnl-2014-205587
VO 69
IS 12
A1 Diana Bilton
A1 Gregory Tino
A1 Alan F Barker
A1 Daniel C Chambers
A1 Anthony De Soyza
A1 Lieven J A Dupont
A1 Conor O'Dochartaigh
A1 Eric H J van Haren
A1 Luis Otero Vidal
A1 Tobias Welte
A1 Howard G Fox
A1 Jian Wu
A1 Brett Charlton
YR 2014
UL http://thorax.bmj.com/content/69/12/1073.abstract
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.