Mucoactive agents for adults with acute lung conditions: A systematic review

Benjamin J. Tarrant, Caitlin Le Maitre, Lorena Romero, Ranjana Steward, Brenda M. Button, Bruce R. Thompson, Anne E. Holland

Research output: Contribution to journalReview ArticleResearchpeer-review

12 Citations (Scopus)


Background and objectives: Inhaled mucoactive agents are used to enhance airway clearance, however efficacy and safety are unclear in adults with acute respiratory conditions. Methods: We systematically reviewed randomized controlled trials assessing respiratory function; safety; length of stay (LOS); mucus; radiology; and oxygenation. Results: No adverse events were reported for dornase alfa (n = 63), N-acetylcysteine (NAC, n = 50), ambroxol (n = 140), hypertonic saline (n = 33), heparin (n = 384), mannitol (n = 20) or isotonic saline. During invasive ventilation, NAC, dornase alfa and saline had no effect on mucus. Postoperatively, mucus characteristics improved with NAC (n = 10). Ambroxol lowered LOS (mean difference 4 days) and halved complications following lung carcinoma resection (n = 140). Heparin improved ventilator-free days (n = 130, mean difference 3.9–4.6) and intensive care LOS (n = 223, 3.2 days), but not ventilator-acquired pneumonia. Conclusion: Dornase alfa, hypertonic saline and NAC were ineffective for atelectasis/mucus plugging while intubated. More data are required to support using NAC, ambroxol and heparin during acute illness.

Original languageEnglish
Pages (from-to)141-147
Number of pages7
JournalHeart and Lung
Issue number2
Publication statusPublished - 1 Mar 2019


  • Expectorants
  • Humans
  • Lung diseases
  • Mucociliary clearance
  • Respiratory therapy
  • Sputum

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