B45-15 Reassessing Hypertonic Saline in Non-cystic Fibrosis Bronchiectasis: An Updated Meta-analysis of Randomized Controlled Trials

Background Airway clearance remains central to managing bronchiectasis, yet the benefit of hypertonic saline (HS) in non-cystic fibrosis (non-CF) disease is uncertain. While HS improves mucociliary clearance and outcomes in cystic fibrosis, evidence in non-CF bronchiectasis has been limited. Incorporating recent trial data, this updated meta-analysis reassesses the efficacy of HS in adults with non-CF bronchiectasis. Methods We systematically searched PubMed and the Cochrane Library for randomized controlled trials (RCTs) comparing HS with isotonic saline 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. Pooled mean differences (MDs) with 95% confidence intervals (CIs) were calculated using a random-effects model. Results Three RCTs involving 356 patients were included. Compared with isotonic saline, HS showed no significant improvement in FEV₁ (MD: 0.01; 95% CI: −0.06 to 0.08; p = 0.84) or FVC (MD: 0.05; 95% CI: −0.05 to 0.15; p = 0.36). The rate of pulmonary exacerbations was similar between groups (MD: 0.03; 95% CI: −1.08 to 1.14; p = 0.96). Heterogeneity across studies was minimal. Conclusion In adults with non-cystic fibrosis bronchiectasis, hypertonic saline offers no significant advantage over isotonic saline in improving lung function or reducing exacerbations. While safe and well tolerated, its routine use may have limited clinical value outside cystic fibrosis. Larger, high-quality RCTs are warranted to identify subgroups who may derive benefit.