Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease

  • Review
  • Intervention

Authors


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. 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.

Objectives

To assess the effects of oral mucolytics in adults with stable chronic bronchitis or COPD.

Search methods

We searched the Cochrane Airways Group Specialised Register and reference lists of articles on eight separate occasions, the most recent being in September 2008.

Selection criteria

Randomised trials that compared oral mucolytic therapy with placebo for at least two months in adults with chronic bronchitis or COPD. We excluded studies of people with asthma and cystic fibrosis.

Data collection and analysis

One review author extracted data. We contacted study authors and drug companies for missing information.

Main results

Twenty-eight trials involving 7042 participants were included. Compared with placebo, there was a significant reduction in the number of exacerbations per patient with oral mucolytics (weighted mean difference (WMD) -0.04 per month, 95% confidence interval -0.05 to -0.03). Using a weighted annualised rate of exacerbations in the control patients of 2.4 per year, this is a 21% reduction. The number of days of disability also fell (WMD -0.56, 95% confidence interval (CI) -0.77 to -0.35). One recent study has shown that the benefit may apply only to patients not already receiving inhaled corticosteroids. The number of patients who remained exacerbation-free was greater in the mucolytic group (odds ratio (OR) 1.93 (95% CI 1.71 to 2.17)). There is no strong evidence of improvement in lung function and treatment is not associated with any increase in adverse effects. Patients on mucolytics may be less likely to be hospitalised during the study period.

Authors' conclusions

In participants 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. Mucolytics 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.

摘要

背景

化痰劑治療慢性支氣管炎或慢性阻塞性肺病

慢性支氣管炎或慢性阻塞性肺疾病(COPD)的病患可能遭受與增加痰的量和/或化膿的痰相關的反覆性的惡化狀況。取決與病情惡化相關的個人和醫療費用的[因素,任何治療用以減少了病情惡化的次數被視為是有益的。對不同的國家而言,處方化痰劑的狀況有很大的差異,取決於此處方是否被認為是有效的。

目標

為了評估口服化痰劑對穩定慢性支氣管炎或COPD成人病患的影響。

搜尋策略

我們檢索了the Cochrane Airways Group Specialised Register 和八次不同檢索中參考文獻目錄的文章。其最近的一次檢索是於2008年9月進行。

選擇標準

隨機性的試驗用以比較服用口服化痰劑與服b用安慰劑治療至少2個月的慢性支氣管炎或COPD成人病患。我們排除了對氣喘和囊腫性纖維化病患的研究。

資料收集與分析

一位審查作者分析數據。我們聯繫了研究的作者及製藥公司以獲得缺失的資訊。

主要結論

總共涵括了28個試驗,包含了7042名受試者。與安慰劑相比,使用口服化痰劑有顯著減少每名患者病情惡化的次數(加權均差(WMD)−0.04每月95%信賴區間 −0.05至−0.03)。以對照組病情惡化的加權年率為2.4年為基礎,使用口服化痰劑減少了21%。行動不便的天數也減少了(WMD0.56,95%信賴區間(CI)−0.77到0.35)。最近的一項研究顯示,可能只對尚未使用過吸入式皮質類固醇的病人有益。無病情惡化的病人數目於使用化痰劑的組別仍然也是增加(odds ratio(OR)1.93(95%CI為 1.71至2.17))。沒有強有力的證據顯示肺功能有改善和治療不與任何副作用的增加相關。使用化痰劑的患者於研究期間顯示可能較不需要住院。

作者結論

在慢性支氣管炎或COPD受試者中,使用化痰劑治療與急性病情惡化次數的些微減少和減少行動不便的總天數有關。對於頻繁性或長期病情惡化的個體或是一再因為COPD病情惡化住院的病患,效益可能會更大些。最少在冬天,應該要考慮對尚未使用過吸入式皮質類固醇(ICS)的中度或重度COPD患者病人使用化痰劑。

翻譯人

本摘要由臺北醫學大學萬芳醫院劉怡敏翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

化痰劑治療慢性支氣管炎或慢性阻塞性肺病此次審查總共涵括了28個試驗,包含了7042名受試者。有證據顯示,如果患者於冬季規律性的服用藥物,可能導減少21%的病情惡化次數(大約每年減少0.5次),尤其是在人們尚未使用吸入式皮質類固醇前。在這次審查中,不同的研究結果之間有相當大的差異並且沒有完全被解釋。這些藥物均無法改變COPD病患肺功能的喪失,但這些藥物非常安全而且耐受性良好。。

Plain language summary

Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease

Twenty-eight trials with 7042 participants were included in this review of trials. The evidence suggests that if patients take the medicines regularly through the winter months this could result in a 21% reduction in the number of exacerbations (approximately 0.5 fewer per year), especially in people not already taking inhaled corticosteroids. There is considerable variation between the results of different studies in this review that is not fully explained. These medicines do not alter the loss of lung function in COPD, but they are very safe and well tolerated.

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