Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease.
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. Because of the personal and healthcare costs associated with exacerbations, any therapy that reduces the number of exacerbations is useful. There is a marked difference between countries in terms of 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 have searched the Cochrane Airways Group Specialised Register and reference lists of articles on four separate occasions, the most recent being in June 2005. This is the third major update.


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 six trials were included (7335 participants). Compared with placebo, there was a significant reduction in the number of exacerbations per patient with oral mucolytics (weighted mean difference (WMD) -0.05 per month, 95% confidence interval -0.05, -0.04). Using the annualised rate of exacerbations in the control patients of 2.6 per year, this is a 20% reduction. The number of days of disability also fell (WMD -0.56, 95% confidence interval -0.77, -0.35). A recent study has shown that the benefit may apply only to those patients not already receiving inhaled corticosteroids. The number of patients who remained exacerbation-free was greater in the mucolytic group (OR 2.13 (95% CI 1.86 to 2.42)). There was no difference in lung function or in adverse effects reported between the treatments.


CONCLUSIONS
In subjects with chronic bronchitis or COPD, treatment with mucolytics was associated with a small reduction in acute exacerbations and a reduction in total number of days of disability. Benefit may be greater in individuals who have frequent or prolonged exacerbations, or those who are repeatedly admitted to hospital with exacerbations with COPD. They should be considered for use, through the winter months at least, in patients with moderate or severe COPD in whom inhaled corticosteroids (ICS) are not prescribed.
Poole
P J
PJ
University of Auckland, Private Bag 92019, Auckland, New Zealand. p.poole@auckland.ac.nz
Black
P N
PN
D000328:Adult; D001991:Bronchitis / Q000188:drug therapy*; D002908:Chronic Disease; D005100:Expectorants / Q000627:therapeutic use*; D006801:Humans; D008173:Lung Diseases, Obstructive / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic
D005100:Expectorants