Ambroxol for women at risk of preterm birth for preventing neonatal respiratory distress syndrome

Garay, Alejandro G Gonzalez; Revéiz, Ludovic; Hidalgo, Liliana Velasco; Galicia, Cecilia Solis

doi:10.1002/14651858.cd009708.pub2

Cited by 12 publications

(7 citation statements)

References 25 publications

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“…General and respiratory health and the frequency of respiratory symptoms were worse among adults who had BPD in the neonatal period . In one study, the prevalence of childhood asthma was inversely related to gestational age at birth .…”

Section: System/organ‐specific Outcomesmentioning

confidence: 98%

Adults born preterm: a review of general health and system-specific outcomes

et al. 2017

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In this review of 126 publications, we report that an overwhelming majority of adults born at preterm gestations remain healthy and well. However, a small, but a significant fraction of them remain at higher risk for neurological, personality and behavioural abnormalities, cardio-pulmonary functional limitations, systemic hypertension and metabolic syndrome compared to their term-born counterparts. The magnitude of increased risk differed across organ systems and varied across reports. The risks were proportional to the degree of prematurity at birth and seemed to occur more frequently among preterm infants born in the final two decades of the 20th century and later. These findings have considerable public health and clinical practice relevance.

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Section: System/organ‐specific Outcomesmentioning

confidence: 98%

Adults born preterm: a review of general health and system-specific outcomes

et al. 2017

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“…Ambroxol also maintains the airway surface environment by modulating surfactant protein levels in the airways and increased mucociliary clearance ( 17 18 ). Based on these results, clinical trials with ambroxol to prevent or treat infant respiratory distress syndrome have been carried out ( 19 20 ). In a mouse model of lipopolysaccharide-induced acute lung injury, ambroxol treatment reduced lung inflammation and damage as well as cytokine levels in bronchoalveolar lavage (BAL) fluid, including IL-6, TNF-α, and TGF-β ( 21 ).…”

Section: Introductionmentioning

confidence: 99%

Immunomodulatory Effects of Ambroxol on Airway Hyperresponsiveness and Inflammation

et al. 2016

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Ambroxol is used in COPD and asthma to increase mucociliary clearance and regulate surfactant levels, perhaps through anti-oxidant and anti-inflammatory activities. To determine the role and effect of ambroxol in an experimental model of asthma, BALB/c mice were sensitized to ovalbumin (OVA) followed by 3 days of challenge. Airway hyperresponsiveness (AHR), lung cell composition and histology, and cytokine and protein carbonyl levels in bronchoalveolar lavage (BAL) fluid were determined. Ambroxol was administered either before the first OVA challenge or was begun after the last allergen challenge. Cytokine production levels from lung mononuclear cells (Lung MNCs) or alveolar macrophages (AM) were also determined. Administration of ambroxol prior to challenge suppressed AHR, airway eosinophilia, goblet cell metaplasia, and reduced inflammation in subepithelial regions. When given after challenge, AHR was suppressed but without effects on eosinophil numbers. Levels of IL-5 and IL-13 in BAL fluid were decreased when the drug was given prior to challenge; when given after challenge, increased levels of IL-10 and IL-12 were detected. Decreased levels of protein carbonyls were detected in BAL fluid following ambroxol treatment after challenge. In vitro, ambroxol increased levels of IL-10, IFN-γ, and IL-12 from Lung MNCs and AM, whereas IL-4, IL-5, and IL-13 production was not altered. Taken together, ambroxol was effective in preventing AHR and airway inflammation through upregulation of Th1 cytokines and protection from oxidative stress in the airways.

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“…This conclusion was not consistent with a Cochrane systematic review showing insufficient evidence to support or refute the practice of giving ambroxol to women at risk of preterm birth. 95 Additionally, ambroxol is not even mentioned in relevant guidelines for the management of preterm birth. 7,89 Unlike this study and the previous systematic review, the authors included studies with repeated exposure to antenatal corticosteroids and due to the search date, relevant recent trials could not be included.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%