Plain language summary
Role of inhaled corticosteroids (ICS) in the management of bronchiectasis
Bronchiectasis is a lung disease. People with bronchiectasis often experience long-term symptoms such as productive or wet cough, repeated flare-ups (exacerbations) and poor quality of life. People with bronchiectasis have airway inflammation and many have asthma-like symptoms (such as cough and wheeze). Because of this, inhaled corticosteroids (ICS), commonly used in asthma, might also improve symptoms, reduce flare-ups and/or reduce worsening of lung function for people with bronchiectasis. However, routine use of ICS may also cause unwanted side effects.
What are the benefits of using ICS regularly in the management of adults and children with bronchiectasis?
We included studies that compared ICS with no ICS, or with a placebo (i.e. a medication made to look the same as ICS but with no active ingredients). We only included studies where it was decided at random who would receive ICS and who would not. The participants included in the seven studies were 380 adults who had bronchiectasis diagnosed by symptoms or from a detailed lung scan (computed tomography (CT)). We did not include studies that involved participants with cystic fibrosis, which can also cause bronchiectasis. Although we planned to include studies involving children with bronchiectasis, we did not find such studies.
What evidence did we find?
From available evidence up to June 2017, we found seven eligible studies involving adult participants that examined the role of ICS in bronchiectasis. The adults had stable bronchiectasis - they were not having a flare-up at the start of the study.
We were able to include results from two studies that gave ICS for less than six months to adults with stable bronchiectasis. ICS did not make a difference to lung function, number of exacerbations during the study or quality of life. In a different study, which also gave ICS for less than six months, we found a small reduction in sputum (phlegm) and improvement in breathlessness. However, as these results were from a study which did not use a placebo we cannot be certain about them.
The single study on long-term use of ICS (i.e. for over 6 months) showed no meaningful benefit of ICS for any of the outcomes.
There were no studies conducted when the participants were having a flare-up of their bronchiectasis. There were also no studies that involved children with bronchiectasis. Importantly, we do not know if ICS are linked to more unwanted side effects, because the studies did not provide much information about this.
The review found that there is not enough evidence for the routine use of ICS in adults with stable bronchiectasis. We can make no conclusions about the use of ICS for flare-ups of bronchiectasis, or about their use in children, because we did not find any studies.
Quality of evidence
Overall, we judged the quality of evidence to be low. We were concerned because the largest study, which showed some benefits, did not use a placebo. This means that participants and staff in the study would have known who was getting ICS and who was not, which could affect the results. Also, our confidence was reduced because we only found a small number of studies to include in our review and some of the studies may have included people with other types of lung disease, in addition to bronchiectasis.