Mucoactive drugs

Abstract

Mucus hypersecretion is a clinical feature of severe respiratory diseases such as asthma, cystic fibrosis and chronic obstructive pulmonary disease. Airway mucosal infection and/ or inflammation associated with these diseases often gives rise to inflammatory products, including neutrophil-derived DNA and filamentous actin, in addition to bacteria, apoptotic cells and cellular debris, that may collectively increase mucus production and viscosity. Mucoactive agents have been the medication of choice for the treatment of respiratory diseases in which mucus hypersecretion is a clinical complication. The main purpose of mucoactive drugs is to increase the ability to expectorate sputum and/or decrease mucus hypersecretion. Many mucoactive drugs are currently available and can be classified according to their putative mechanism of action. Mucoactive medications include expectorants, mucoregulators, mucolytics and mucokinetics. By developing our understanding of the specific effects of mucoactive agents, we may result in improved therapeutic use of these drugs. The present review provides a summary of the most clinically relevant mucoactive drugs in addition to their potential mechanism of action.

Vinpocetine Inhibits Streptococcus pneumoniae–Induced Upregulation of Mucin MUC5AC Expression via Induction of MKP-1 Phosphatase in the Pathogenesis of Otitis Media

“…Mucoactive agents can be classified as expectorants (guaifenesin), mucolytics (N-acetylcysteine and peptide enzymes), mucokinetics (b 2 -adrenoceptor agonist and surfactant), and mucoregulators (corticosteroids and macrolide antibiotics) according to their potential mechanism of action: reducing mucus viscosity, increasing mucociliary clearance, or suppressing mucus hypersecretion (35,36). Although these medications are useful at certain stages of the disease, treatment with mucoactive agents has not proved to be effective and has shown side effects including vomiting, diarrhea, stomach upset, headache, skin rash, and even bleeding from the gastrointestinal tract (35,36). In addition, the mechanism of action for most of these drugs remains unclear.…”

Pharmacologic Agents That Promote Airway Clearance in Hospitalized Subjects: A Systematic Review

“…Mucokinetic agents such as bronchodilators promote clearance by increasing action of the cilia and may facilitate mucus transportability. 1,2,7 Surfactants may also reduce mucus adhesiveness and increase transportability. 6 The goal of this project was to systematically review comparative studies of pharmacologic agents that respiratory therapists and other health professionals can employ to achieve mucus clearance in hospitalized or postoperative patients over the age of 12 months.…”

“…Although airway cilia clear mucus continually in healthy individuals, in the presence of inflammation or infection, mucus production increases, ciliary function may become impaired, and the biophysical properties of sputum may change. 1,2 Mucus hypersecretion is associated with declines in pulmonary function and quality of life, excess cough, discomfort, and exacerbation of conditions such as COPD. 3,4 Mucoactive agents may increase sputum expectoration or decrease hypersecretion of mucus.…”

Normal Saline and Mucous Plugging

“…10 Inhaled hypertonic (3%-14%) saline solution improves mucociliary clearance in patients with cystic fibrosis. 7,11 Additionally, inhaled dry powder mannitol has been used in patients with bronchiectasis and cystic fibrosis. 12 The synthetic proteolytic enzyme rhDNase reduces viscosity and has also been used in patients other than those with cystic fibrosis.…”

“…12 The synthetic proteolytic enzyme rhDNase reduces viscosity and has also been used in patients other than those with cystic fibrosis. 7 Mucolytic agents may be used in some patients to assist in secretion removal.…”