title: Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease.
abstract: BACKGROUND
  Individuals with chronic bronchitis or chronic obstructive pulmonary disease (COPD) may suffer recurrent exacerbations with an increase in volume and/or purulence of sputum and any therapy that reduced the number of exacerbations would be useful. There is a marked difference between countries in terms of the prescribing of mucolytics depending on whether or not they are perceived to be effective.
  
  
  OBJECTIVE
  To assess the effects of oral mucolytics in adults with stable chronic bronchitis or COPD.
  
  
  METHODS
  We searched the Cochrane Airways Group trials register and reference lists of articles.
  
  
  METHODS
  Randomised trials that compared oral mucolytic therapy with placebo for at least two months in adults with chronic bronchitis or COPD. Studies of people with asthma and cystic fibrosis were excluded.
  
  
  METHODS
  One reviewer extracted data. Study authors and drug companies were contacted for missing information.
  
  
  RESULTS
  Twenty two trials were included. Compared with placebo, there was a significant reduction in the number of exacerbations per patient with oral mucolytics (weighted mean difference (WMD) -0.067 per month, 95% confidence interval -0.079, -0.055, p<0.001) which is a 29% reduction. The annualised rate of exacerbations in the control patients was 2.7 per year. The number of days of disability also fell on mucolytic therapy (WMD -0.56, 95% confidence interval -0.77, -0.35, p<0.001). The number of patients who remained exacerbation-free was greater in the mucolytic group thanin the placebo group (OR 2.22, 95% confidence interval 1.93, 2.54, p<0.001). There was no difference in lung function or in adverse effects reported between treatments.
  
  
  CONCLUSIONS
  In subjects with chronic bronchitis or COPD, treatment with mucolytics was associated with a small reduction in acute exacerbations and a somewhat greater reduction in total number of days of disability.
authors.affiliation: Medicine, University of Auckland, Private Bag 92019, Auckland, New Zealand. p.poole@auckland.ac.nz
authors.forename: P J
authors.initials: PJ
authors.lastname: Poole
authors.forename: P N
authors.initials: PN
authors.lastname: Black
mesh_terms: D000328:Adult; D001991:Bronchitis / Q000188:drug therapy*; D002908:Chronic Disease; D005100:Expectorants / Q000627:therapeutic use*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000188:drug therapy*
chemical_list: D005100:Expectorants