Mucolytics for acute exacerbations of chronic obstructive pulmonary disease: a meta-analysis

Abstract

This meta-analysis explored the safety and effectiveness of mucolytics as an add-on treatment for chronic obstructive pulmonary disease (COPD) exacerbations. Based on a pre-registered protocol and following Cochrane methods, we systematically searched for relevant randomised or quasi-randomised controlled trials (RCTs). We used the Risk of Bias v2 tool for appraising the studies and performed random-effect meta-analyses when appropriate. We assessed certainty of evidence using GRADE. This meta-analysis included 24 RCTs involving 2192 patients with COPD exacerbations, entailing at least some concerns of methodological bias. We demonstrated with moderate certainty that mucolytics increase the rate of treatment success (relative risk 1.37, 95% CI 1.08–1.73, n=383), while they also exert benefits on overall symptom scores (standardised mean difference 0.86, 95% CI 0.63–1.09, n=316), presence of cough at follow-up (relative risk 1.93, 95% CI 1.15–3.23) and ease of expectoration (relative risk 2.94, 95% CI 1.68–5.12). Furthermore, low or very low certainty evidence suggests mucolytics may also reduce future risk of exacerbations and improve health-related quality of life, but do not impact on breathlessness, length of hospital stay, indication for higher level of care or serious adverse events. Overall, mucolytics could be considered for COPD exacerbation management. These findings should be validated in further, rigorous RCTs.

Inhaledversussystemic corticosteroids for acute exacerbations of COPD: a systematic review and meta-analysis

“…However, we did not note any difference when excluding these RCTs in a sensitivity analysis. Additionally, concomitant treatments, such as antibiotics, bronchodilators and mucolytics may have impacted the outcomes, and potential imbalances between treatment groups were not reported in all RCTs [ 73 , 74 ].…”

Lung function and exacerbations in patients with COPD escalated to triple therapy: The RETRIEVE real‐world study

“…Clinical trial registration: NCT03858348 at ClinicalTrials.gov Stavros Tryfon 1 Efthymia Papadopoulou 1 Maria Bertoli 2 Konstantinos Exarchos 3 Alexandros Ginis 2 Konstantinos Kostikas 3 1 Pulmonology Department, General Hospital of Thessaloniki "G. Papanikolaou", Thessaloniki, Greece…”

“…1 Exacerbations of the disease, that call for additional therapeutic measures, are classified as mild if treated with short-acting bronchodilators only, moderate if requiring antibiotics and/or oral corticosteroids or severe if leading to hospitalization. 2,3 Inhaled maintenance treatments that improve symptoms and reduce exacerbations are long-acting bronchodilators (β2 agonists [long-acting beta-2 agonist, LABA], muscarinic antagonists [long-acting muscarinic antagonist, LAMA]), inhaled corticosteroids (ICS) and their combinations. Although the GOLD 2023 document discourages the use of LABA/ICS, 4 there is long-standing evidence that a LABA/ICS is more effective than the individual components alone, leading to lung function improvement and exacerbation reduction.…”

Rational mucolytic therapy with ambroxol: controversial and indisputable. A review

“…1) респираторные симптомы, сообщаемые пациентом, преимущественно оцениваемые с помощью валидизированных опросников; 2) успех терапии, определяемый как комплексный показатель общего исхода обострения, оцененный врачом и/или шкалой симптомов, признаков и/или результатов лабораторных исследований [33].…”

“…Вязкость мокроты оценивалась невалидизированными шкалами только в 4 исследованиях, 3 из которых показали значительное улучшение в группе муколитиков. Другими словами, муколитическая терапия с хорошей достоверностью и значительно (≈2 раза) устраняла кашель, повышала (≈3 раза) легкость отхождения секрета и восстанавливала вязкость мокроты у пациентов с обострением ХОБЛ [33].…”