***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: BACKGROUND AND AIMS Inhalation of hypertonic saline ( HTS ) has short term positive effects on airways clearance in non-cystic fibrosis ( CF ) bronchiectasis , however its long term effects are unknown . The aim of this study was to determine the effect of HTS 6 % on exacerbations , quality of life ( QOL ) and respiratory function over 12 months in non-CF bronchiectasis . METHODS Forty patients were r and omised to inhale isotonic saline ( IS ) 0.9 % or HTS 6 % daily for 12 months . Participants recorded their symptoms in a daily diary . Quality of life and respiratory function were measured after three , six and 12 months . Number of exacerbations and changes in sputum colonisation were recorded at 12 months . Participants , assessors and clinicians were blinded to group allocation . RESULTS The exacerbation rate at 12 months was similar in the two groups and similar clinical ly significant improvements in QOL were seen in both groups . The FEV(1 ) increased in both groups after six months ( mean 90 ml , 95 % confidence interval 11 - 169 ml ) with no difference between groups ( p = 0.394 ) . The FEF(25 - 75 % ) significantly improved at all time points ( mean increase at 12 months 187 ml , 69 - 304 ml ) with no difference between groups ( p = 0.705 ) . There was a reduction in sputum colonisation in both groups ( p = 0.046 ) . CONCLUSIONS Inhalation of HTS or IS has similar effects on exacerbations , QOL , sputum colonisation and respiratory function over 12 months in non-CF bronchiectasis . The trial was registered with both Clinical Trials.gov - NCT00484263 and Australian New Zeal and Clinical Trials Registry - ACTRN12607000367448 BACKGROUND Inhaled dry powder mannitol enhanced mucus clearance and improved quality of life over 2 weeks in non-cystic fibrosis bronchiectasis . This study 's objective was to investigate the efficacy and safety of dry powder mannitol over 12 weeks . METHODS Patients with bronchiectasis confirmed by high-resolution CT ( H RCT ) scan , aged 15 to 80 years , with FEV1≥50 % predicted and ≥1 L participated in a r and omized , placebo-controlled , double-blind study . Patients with a negative mannitol provocation test were r and omized to inhale 320 mg mannitol ( n=231 ) or placebo ( n=112 ) bid for 12 weeks . To further assess safety , the same mannitol dose/frequency was administered to a patient subset in an open-label extension over 52 weeks . Primary end points were changes from baseline at 12 weeks in 24-h sputum weight and St. George 's Respiratory Question naire ( SGRQ ) score . RESULTS There was a significant difference of 4.3 g in terms of change in sputum weight over 12 weeks ( 95 % CI , 1.64 - 7.00 ; P=.002 ) between mannitol and placebo ; however , this was largely driven by a decrease in sputum weight in the placebo group . This was associated , in turn , with more antibiotic use in the placebo group ( 50 of 112 [ 45 % ] ) than in the inhaled mannitol group ( 85 of 231 [ 37 % ] ) . There was no statistical difference between the groups ( P=.304 ) in total SGRQ score  ( mannitol , -3.4 points [ 95 % CI , -4.81 to -1.94 ] vs placebo , -2.1 points [ 95 % CI , -4.12 to -0.09 ] ) . In a subgroup study ( n=82 ) , patients receiving mannitol  showed less small airway mucus plugging on H RCT scan at 12 weeks compared with patients receiving placebo ( P=.048 ) . Compliance rates were high , and mannitol was well tolerated with adverse events similar to those of placebo . CONCLUSION Because the difference in sputum weights appears to be associated with increased antibiotic use in the placebo group , a larger controlled study is now required to investigate the long-term mannitol effect on pulmonary exacerbations and antibiotic use . TRIAL REGISTRY Clinical Trials.gov ; No. : NCT0027753 ; URL : www . clinical trials.gov RATIONALE Bronchiectasis is a chronic debilitating disease with few evidence -based long-term treatments . OBJECTIVES A r and omized controlled trial assessing the efficacy of nebulized gentamicin therapy over 1 year in patients with non-cystic fibrosis bronchiectasis . METHODS Sixty-five patients were r and omized to either twice-daily nebulized gentamicin , 80 mg , or nebulized 0.9 % saline , for 12 months . All were review ed at three-monthly intervals during treatment and at 3 months ' follow-up . MEASUREMENTS AND MAIN RESULTS At each review the following were assessed : quantitative and qualitative sputum bacteriology ; sputum purulence and 24-hour volume ; FEV(1 ) , FVC , and forced expiratory flow , midexpiratory phase ; exercise capacity ; Leicester Cough Question naire and St. George 's Respiratory Question naire ; and exacerbation frequency .  Fifty-seven patients completed the study . At the end of 12 months ' treatment , compared with the saline group , in the gentamicin group there was reduced sputum bacterial density with 30.8 % eradication in those infected with Pseudomonas aeruginosa and 92.8 % eradication in those infected with other pathogens ; less sputum purulence ( 8.7 % vs. 38.5 % ; P < 0.0001 ) ; greater exercise capacity ( 510 [ 350 - 690 ] m vs. 415 [ 267.5 - 530 ] m ; P = 0.03 ) ; and fewer exacerbations ( 0 [ 0 - 1 ] vs. 1.5 [ 1 - 2 ] ; P < 0.0001 ) with increased time to first exacerbation ( 120 [ 87 - 161.5 ] d vs. 61.5 [ 20.7 - 122.7 ] d ; P = 0.02 ) . The gentamicin group had greater improvements in Leicester Cough Question naire ( 81.4 % vs. 20 % ; P < 0.01 ) and St. George 's Respiratory Question naire ( 87.5 % vs. 19.2 % ; P < 0.004 ) score . No differences were seen in 24-hour sputum volume , FEV(1 ) , FVC , or forced expiratory flow , midexpiratory phase . No P. aeruginosa isolates developed resistance to gentamicin . At follow-up , all outcome measures were similar to baseline . CONCLUSIONS Regular , long-term nebulized gentamicin is of significant benefit in non-cystic fibrosis bronchiectasis but treatment needs to be continuous for its ongoing efficacy . Clinical trial registered with www . clinical trials.gov ( NCT 00749866 ) BACKGROUND Inhaled hypertonic saline acutely increases mucociliary clearance and , in short-term trials , improves lung function in people with cystic fibrosis . We tested the safety and efficacy of inhaled hypertonic saline in a long-term trial . METHODS In this double-blind , parallel-group trial , 164 patients with stable cystic fibrosis who were at least six years old were r and omly assigned to inhale 4 ml of either 7 percent hypertonic saline or 0.9 percent ( control ) saline twice daily for 48 weeks , with quinine sulfate ( 0.25 mg per milliliter ) added to each solution to mask the taste . A bronchodilator was given before each dose , and other st and ard therapies were continued during the trial . RESULTS The primary outcome measure , the rate of change ( slope ) in lung function ( reflected by the forced vital capacity [ FVC ] , forced expiratory volume in one second [ FEV1 ] , and forced expiratory flow at 25 to 75 percent of FVC [ FEF25 - 75 ] ) during the 48 weeks of treatment , did not differ significantly between groups ( P=0.79 ) . However , the absolute difference in lung function between groups was significant ( P=0.03 ) when averaged across all post-r and omization visits in the 48-week treatment period . As compared with the control group , the hypertonic-saline group had significantly higher FVC ( by 82 ml ; 95 percent confidence interval , 12 to 153 ) and FEV1 ( by 68 ml ; 95 percent confidence interval , 3 to 132 ) values , but similar FEF25 - 75 values . The hypertonic-saline group also had significantly fewer pulmonary exacerbations ( relative reduction , 56 percent ; P=0.02 ) and a significantly higher percentage of patients without exacerbations ( 76 percent , as compared with 62 percent in the control group ; P=0.03 ) . Hypertonic saline was not associated with worsening bacterial infection or inflammation . CONCLUSIONS Hypertonic saline preceded by a bronchodilator is an inexpensive , safe , and effective additional therapy for patients with cystic fibrosis . ( Clinical Trials.gov number , NCT00271310 . RATIONALE The prevalence of bronchiectasis is high in patients with moderate-to-severe chronic obstructive pulmonary disease ( COPD ) and it has been associated with exacerbations and bacterial colonization . These have demonstrated some degree of prognostic value in patients with COPD but no information about the relationship between bronchiectasis and mortality in patients with COPD is currently available . OBJECTIVES To assess the prognostic value of bronchiectasis in patients with moderate-to-severe COPD . METHODS Multicenter prospect i ve observational study in consecutive patients with moderate-to-severe COPD . Bronchiectasis was diagnosed by high-resolution computed tomography scan . A complete st and ardized protocol was used in all patients covering general , anthrophometric , functional , clinical , and microbiologic data . After follow-up , the vital status was recorded in all patients . Multivariate Cox analysis was used to determine the independent adjusted prognostic value of bronchiectasis . MEASUREMENTS AND MAIN RESULTS Ninety-nine patients in Global Initiative for Chronic Obstructive Lung Disease ( GOLD ) II , 85 in GOLD III , and 17 in GOLD IV stages were included .  Bronchiectasis was present in 115 ( 57.2 % ) patients . During the follow-up ( median , 48 mo [ interquartile range , 35 - 53 ] ) there were 51 deaths ( 43 deaths in the bronchiectasic group ) . Bronchiectasis was associated with an increased risk of fully adjusted mortality ( hazard ratio , 2.54 ; 95 % confidence interval , 1.16 - 5.56 ; P = 0.02 ) . CONCLUSIONS Bronchiectasis was associated with an independent increased risk of all-cause mortality in patients with moderate-to-severe COPD Bronchiectasis is characterised by hypersecretion and impaired clearance of mucus . A 400-mg dose of inhaled mannitol improves mucus clearance however , the effect of other doses is unknown . A total of 14 patients , aged 63.3±5.7 yrs , were studied on five visits . Mucus clearance at baseline and with mannitol ( 160 , 320 and 480 mg ) was measured using technetium-99m-sulphur colloid and imaging with a gamma camera over 45 min , followed by a further 30 min involving 100 voluntary coughs . A control study assessed the effect of cough provoked by mannitol during the intervention . Whole right lung clearance over 45 min was 4.7±1.2 and 10.6±2.6 % on baseline and control days , respectively , and increased to 16.7±4.2 , 22.8±4.2 and 31±4.7 % with 160 , 320 and 480 mg mannitol , respectively . Clearance over 45 min with 480 mg mannitol was greater than clearance with 320 and 160 mg . Total clearance over 75 min , after mannitol administration and voluntary coughs , was 36.1±5.5 , 40.9±5.6 and 46.0±5.2 % with 160 , 320 and 480 mg mannitol , respectively , all significantly different from baseline ( 24.1±6.0 % ) and control ( 13.1±3.0 % ) . Total clearance over 75 min with 480 mg mannitol was greater compared with 160 mg . In conclusion , mucus clearance increases with increasing doses of mannitol and can be further increased by cough in patients with bronchiectasis The effects of broad-spectrum antibiotic and placebo therapy in patients with chronic obstructive 
    Output:
    
There is an indication from a single , large , unpublished study that inhaled mannitol increases time to first exacerbation in patients with bronchiectasis .
In patients with near normal lung function , spirometry does not change dramatically with mannitol and adverse events are not more frequent than placebo .