***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: It has previously been shown that unproductive coughing in both healthy subjects and patients with airways obstruction is not effective in clearing lung secretions . This study investigates the regional mucus transport in a group of subjects with airways obstruction who failed to expectorate following instructed  cough and forced expiration technique . Fourteen patients ( mean + /- SEM age : 68 + /- 2 years ) with airways obstruction ( mean + /- SEM percent predicted . FEV1 : 54 + /- 5 ; daily wet weight sputum : 9.1 + /- 2.0 g ) took part in the study which was a r and omized , three-way crossover within-patient design . Each patient underwent three treatment maneuvers : control , cough ( 30 coughs over a 10-min period ) , and forced expiration ( 30 forced expirations over a 10-min period ) . An objective radioaerosol technique was used to monitor regional mucus movement within the lungs of the patients . The lungs were divided arbitrarily into four regions of interest : tracheal , inner , intermediate , and outer . Peak expiratory flow rate during cough and forced expiration was measured at the mouth . There was no correlation between the radioaerosol clearance from all regions and ( 1 ) mean peak flow during cough and forced expiration , and ( 2 ) mean 24-h sputum production prior to the study day . There were no differences in regional radioaerosol clearance between cough and forced expiration . However , both cough and forced expiration result ed in significant clearance compared with control for all regions with the exception of the forced expiration in the outer region . To our knowledge , this study is the first to demonstrate that unproductive cough and forced expiration result in movement of secretions proximally from all regions of the lung in patients with airways obstruction Eight patients with Young 's syndrome were treated with four " mucoregulatory " agents for eight weeks in a r and omised , open crossover study . There was no improvement in tracheobronchial clearance , pulmonary function , or sperm count The effectiveness of bromhexine in the treatment of patients with bronchiectasis , in a stage of clinical exacerbation , was assessed in a double-blind , placebo-controlled trial involving 88 in- patients . Bronchiectasis was diagnosed by bronchography and /or CT scan .  Bromhexine or matched placebo was administered as 30-mg capsules three times daily per os . Ceftazidine , 1 g i.m . , was given to all patients once a day for the first week only . Bromhexine seemed to improve the clinical picture , with significantly positive trends for expectoration , quantity of sputum and auscultatory findings . It also increased the FEV1 and was well-tolerated . Both patients and investigators judged it efficacious BACKGROUND --In vitro studies have suggested that both the viscoelastic properties of lung secretions and the peak flow attained during simulated cough influence clearance . This study examines the possible association of the viscoelastic properties of sputum and maximum expiratory flow with measured effectiveness of mucus clearance induced by instructed cough and by forced expiration technique ( FET ) in patients with airways obstruction . METHODS --Nineteen patients ( 11 men and eight women ) of mean ( SE ) age , % predicted FEV1 , and daily sputum wet weight of 64 ( 2 ) years , 52 (6)% , and 37.5 ( 7.9 ) g respectively participated in the study . Mucus movement from proximal and peripheral lung regions was measured by an objective non-invasive radioaerosol technique . Each patient underwent three assessment s : control , cough , and FET . During cough and FET , maximum expiratory flow was measured at the mouth level . Apparent viscosity and elasticity of the expectorated sputum sample s were measured with a viscometer . RESULTS --Compared with the control run ( mean ( SE ) clearance : 16 (3)% ) there was an increase in clearance from the whole lung during cough ( 44 (5)% ) and FET ( 42 (5)% ) , and also an enhanced clearance of inhaled , deposited radioaerosol from the trachea , inner and intermediate regions of the lungs , but not from the outer region . There were , however , no differences in regional clearance between cough and FET . Neither regional nor total clearance correlated with maximum expiratory flow , apparent viscosity , elasticity , or daily sputum wet weight . CONCLUSIONS --These results confirm that cough and FET both promote effective clearance but suggest that , unlike in vitro studies , sputum production and viscoelasticity , as well as maximum expiratory flow , provide no guide to clearance efficacy in humans The authors report the results of a study design ed to evaluate the possible increase of penetration into bronchial secretions of  antibiotics  when combined with a fluidifying agent : bromhexine . The study was carried out in a double-blind experiment :  erythromycin in 22 patients ( group I ) or amoxycillin in 26 patients ( group II ) were administered orally ; in both groups several patients were given a placebo , instead of bromhexine . Antibiotics were administered at the usual dosage : 0.5 g X 2 for erythromycin ( 3 days ) ; 1 g X 2 for amoxycillin ( 7 days ) ; with the latter , two different doses of bromhexine were administered simultaneously : 48 mg/day and 96 mg/day in ten and eight patients respectively . Sample s of bronchial secretions were collected by means of fibreoptic bronchoscopy at the second hour for erythromycin and for amoxycillin ; simultaneous serum sample s were also collected . The results of the study showed in both groups a significant increase of the ratios between bronchial levels and simultaneous serum concentrations when combined with bromhexine ; in patients receiving amoxycillin  with 96 mg of bromhexine the percentage penetration was noticeably higher ( 7.5 % ) than in those treated with 48 mg bromhexine ( 4.3 % ) . These results confirm the efficacy of bromhexine as a drug able to disrupt mucopolysaccharides of bronchial secretions and , as a result , to increase the bronchial penetration of antimicrobial drugs as evaluated on the basis of percentage penetration ratio The effect of peroral N-acetylcysteine ( NAC ) in patients with cystic fibrosis ( CF ) and primary ciliary dyskinesia ( PCD ) was investigated . 41 CF patients and 13 PCD patients completed the study which was a double-blind , placebo-controlled , cross-over trial . The patients received either NAC or placebo for two periods of three months followed by a three month follow-up period . Active treatment consisted of NAC , either 200 mg x 3 daily ( patients weighing less than 30 kg ) or 400 mg x 2 daily ( greater than 30 kg ) . The effect was evaluated in terms of a subjective clinical score , weight , sputum bacteriology , blood leucocyte count , sedimentation rate , titres of specific antimicrobial antibodies , lung function parameters and measurement of the ciliary function . No effect was seen in PCD patients , but in CF patients an improved lung function was seen in the period when the patients suffer most from lower airway infections We report a double blind placebo-controlled phase II study of the efficacy and safety of nebulized recombinant human DNase ( rhDNase ) administered for 14 d to adults with bronchiectasis not caused by cystic fibrosis . All were in a stable clinical state at the commencement of the study , and they received ( 1 ) rhDNase 2.5 mg twice daily , ( 2 ) rhDNase once daily , or ( 3 ) placebo ( excipient only ) inhalation . The outcome measures were spirometry , subjective quality of life/dyspnea , and safety . We also measured the ciliary transportability of the sputum expectorated before and after the treatment period , using the mucus-depleted bovine trachea . The drug was well tolerated , but it produced no significant change in any of the outcome variables or in sputum transportability . When the drug was incubated with bronchiectatic sputum in vitro , a fall in transportability was observed . We discuss possible explanations for the lack of a measurable benefit from rhDNase in this study population , which appears to contrast with the improvements shown in cystic fibrosis using studies of similar design Bromhexeine has been widely used as an adjunct in the management of lower respiratory infections and is useful in altering the physical characteristics of sputum . Its effect on the sputum penetration of an antibiotic has been sparsely studied . The present study highlights the improvement in sputum amoxycillin ( amoxy ) levels when a combination tablet , amoxy 500 mg plus bromhexeine 8 mg , is administered as compared to plain amoxy 500 mg .  Sputum amoxy levels were significantly higher in the combination group ( 0.674 + /- 0.588 micrograms ml-1 ) as compared to 0.272 + /- 0.19 micrograms ml-1 in the amoxy group ( P = 0.028 ) . The clinical responses assessed by the physician as well as the patient were significantly better in the amoxy plus bromhexeine group as compared to the amoxy group . The radiological and bacteriological responses were similar in both groups . There was no increase in the side-effects due to bromhexeine and , overall , its use can be recommended in the treatment of acute lower respiratory infections STUDY OBJECTIVE To study the safety and efficacy of aerosolized recombinant human DNase I in the treatment of idiopathic bronchiectasis . DESIGN Double-blind , r and omized , placebo-controlled , multicenter study . POPULATION S Three hundred forty-nine adult out patients in stable condition with idiopathic bronchiectasis from 23 centers in North America , Great Britain , and Irel and . INTERVENTIONS AND MEASUREMENTS Study patients received aerosolized rhDNase or placebo twice daily for 24 weeks . Primary end points were incidence of pulmonary exacerbations and mean percent change in FEV1 from baseline over the treatment period . RESULTS Pulmonary exacerbations were more frequent and FEV1 decline was greater in patients who received rhDNase compared with placebo during this 24-week trial . CONCLUSIONS rhDNase was ineffective and potentially harmful in this group of adult out patients in stable condition with idiopathic bronchiectasis . This contrasts with previously published results that demonstrated efficacy of rhDNase in patients with cystic fibrosis bronchiectasis Summary : A double-blind crossover clinical trial design ed to evaluate the mucolytic activity of bromhexine hydrochloride on sputum was completed by 15 patients with chronic lung disease . All the subjects chosen were troubled by production of tenacious mucoid or mucopurulent sputum at the beginning of the trial . Each subject received 16 mg of bromhexine by mouth , three times daily and identical appearance placebo tablets , for an equal number of weeks , in r and om sequence . Twenty-four-hour sputum production was collected for each subject throughout the trial . Viscosity of sputum was evaluated with a Wells-Brookfield Micro-Viscometer Model RVT , study ing the highest viscosity sample produced per 24-hour period . In eight patients some significant decrease in sputum viscosity was observed during bromhexine therapy . In one patient a significant decrease in sputum viscosity was observed while he was receiving the placebo . The mean sputum viscosity for all 15 patients considered as a group was significantly lower during bromhexine therapy than during the placebo therapy . It is concluded from the results obtained that bromhexine has a demonstrable mucolytic effect on tenacious sputum and consequently may play a useful role in the management of patients with chronic lung disease involving the production of high viscosity bronchial secretions BACKGROUND The synthetic mucolytic neltene-xine is an amide derivative of ambroxol and thiophencarboxylic acid . The aim of this open , r and omised , controlled study versus sobrerol was to evaluate the efficacy and tolerability of neltenexine ( oral granules in sachets ) as compared with sobrerol ( oral granules in sachets ) , administered to patients with obstructive airways disease . METHODS Thirty male and female patients were recruited . The exclusion criteria were allergy to neltenexine or sobrerol , an assessed diagnosis of severe bronchospasm requiring beta2-agonists , corticosteroids or aminophylline , pregnant or nursing women , cystic fibrosis , active tuberculosis or an assessed diagnosis of bronchiectasis . No infections of other organs ( such as urinary tract infections ) were present at baseline . Concomitant treatment with antitussives or other mucolytic agents was not allowed during the course of the study . Fifteen patients were r and omised to treatment with neltenexine , 1 sachet thrice daily for 20 days orally ( neltenexine group ) and 15 patients to treatment with sobrerol , 1 sachet thrice daily for 20 days orally ( sobrerol group ) . The efficacy parameters were : sputum characteristics and volume , difficulty in expectorating , cough , dyspnoea , pulmonary auscultation . Tolerability was monitored and adverse events were reported . RESULTS The study highlighted that neltenexine has a good efficacy in the treatment of patients with obstructive airways disease entailing significant impairment of clinical parameters . CONCLUSIONS Neltenexine can be an effective therapeutic alternative to sobrerol Bronchiectasis is a disease characterized by hypersecretion and retention of mucus requiring physical and ph 
    Output:
    
There was no difference in forced expiratory volume .
In a second study , compared to placebo , recombinant human DNase showed no difference in forced expiratory volume or forced vital capacity .
Adverse effects , including influenza-like symptoms , were more common in the group receiving recombinant human DNase .
REVIEW ER 'S CONCLUSIONS There is not enough evidence to evaluate the routine use of mucolytics for bronchiectasis .
High doses of bromhexine coupled with antibiotics may help with sputum production and clearance