Mucoactive therapy in COPD

Abstract

It has been shown that mucus hypersecretion is associated with greater susceptibility for chronic obstructive pulmonary disease (COPD), excess forced expiratory volume in 1 s decline, hospitalisations and excess mortality. The effects of mucoactive drugs on outcomes have been reviewed in several meta-analyses, the largest one including 26 studies. 21 studies were performed in patients with chronic bronchitis and five in patients with COPD. The majority of these trials were performed with N-acetylcysteine (n513) and carbocysteine (n53).Overall, there was a significant reduction in exacerbations (0.05 per patient per month) and the number of days with disability (0.56 days per patient per month). Mucolytics were well tolerated and the number of adverse events was lower than with placebo (odds ratio 0.78). In the largest and best designed study with N-acetylcysteine in 523 patients with COPD, the reduction in exacerbations was only observed in patients not taking inhaled corticosteroids. In addition, a 374 mL reduction in functional residual capacity was found. A recent large study (n5709) with high-dose carbocysteine (1,500 mg?day -1 ) demonstrated a significant effect on exacerbations (25% reduction) and also reported an improvement in health-related quality of life (-4.06 units in St George's Respiratory Questionnaire).It is unclear what the mechanisms underlying these effects may be and which phenotypes benefit from this treatment. On the basis of this evidence mucoactive drugs may deserve consideration in the long-term treatment of COPD.

Impact of exacerbations on COPD

“…These findings could be explained by severity of patients enrolled in these studies and the use of concomitant medications. More detailed discussion is presented elsewhere in the present issue of the European Respiratory Review [75,76].…”

Chronic Obstructive Pulmonary Disease: Official diagnosis and treatment guidelines of the Czech Pneumological and Phthisiological Society; a novel phenotypic approach to COPD with patient-oriented care

“…Some positive effects were observed, particularly with macrolides, most prominently azithromycin, but also with the respiratory fluoroquinolone moxifloxacin 3,[95][96][97][98][99][100][101][102][103] . Long-term application of muco-active agents (erdosteine, carbocysteine, N-acetylcysteine) may be considered for symptomatic persons with the bronchitic phenotype and COPD patients with bronchiectasis 3,104,105 . A complete recommendation regarding the phenotype-specific treatment is given in Table 2 and Fig.…”

Novel Concept in Pulmonary Delivery

“…Mucus hypersecretion is not an innocent disorder. However, despite these observations, until now few studies have focused on the effects of mucolytic drugs in patients with COPD, even though some of these mucolytic drugs also appear to have antioxidant properties (Dekhuijzen, 2004;Rahman et al, 1997;Rahman & Kilty 2006;Decramer & Janssens, 2010).…”

“…Accordingly, IL-6 levels are increased in COPD patients (Bucchioni et al, 2003), and during experimental respiratory viral infections in humans and mice (Decramer & Janssens, 2010).…”