Efficacy and safety of mucolytics in patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis

IF 2.4 Q2 RESPIRATORY SYSTEM Respiratory investigation Pub Date : 2024-10-15 DOI:10.1016/j.resinv.2024.10.004

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Abstract

Background

The efficacy and safety of mucolytics in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis or exacerbations of COPD have been reported. We conducted a systematic review and meta-analysis of mucolytics in patients with stable COPD.

Methods

Reports from randomized controlled trials to evaluate the efficacy and safety of mucolytics, including ambroxol, bromhexine, carbocisteine, erdosteine, fudosteine, l-methylcysteine, and N-acetylcysteine used in patients with stable COPD were searched for in PubMed, Scopus, Embase, Web of Science, the Cochrane Library, and the Igaku Cyuo Zasshi database.

Results

Twenty-three reports with ambroxol, carbocisteine, erdosteine, l-methylcysteine, or N-acetylcysteine were included in the review. Mucolytics significantly reduced the rates of exacerbation and hospitalization, shortened the duration of antibiotic use and exacerbations, prolonged the time to first exacerbation, and had a tendency to reduce the occurrence of two or more exacerbations in patients with stable COPD compared to placebo. Mucolytics did not improve mortality, number of lost workdays, scores on St. George's respiratory questionnaire, forced expiratory volume in 1 s, or forced vital capacity. The safety profile of mucolytics was comparable to that of placebo.

Conclusions

Mucolytics reduce exacerbations and hospitalizations in patients with stable COPD and have a safety profile comparable to that of placebo.

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粘液溶解剂对稳定期慢性阻塞性肺病患者的疗效和安全性：系统回顾与荟萃分析

背景据报道，粘液溶解剂对慢性阻塞性肺疾病（COPD）、慢性支气管炎或慢性阻塞性肺疾病加重患者具有疗效和安全性。我们对慢性阻塞性肺疾病稳定期患者使用粘液溶解剂的情况进行了系统回顾和荟萃分析。方法在 PubMed、Scopus、Embase、Web of Science、Cochrane Library 和 Igaku Cyuo Zasshi 数据库中检索了用于评估慢性阻塞性肺病稳定期患者使用的粘液溶解剂（包括氨溴索、溴己新、卡波司坦、厄多司坦、夫多司坦、l-甲基半胱氨酸和 N-乙酰半胱氨酸）的疗效和安全性的随机对照试验报告。结果23篇关于氨溴索、卡波司汀、厄多司汀、l-甲基半胱氨酸或N-乙酰半胱氨酸的报告被纳入综述。与安慰剂相比，氨甲环酸能明显降低慢性阻塞性肺病患者的病情加重率和住院率，缩短抗生素使用时间和病情加重时间，延长首次病情加重时间，并有减少两次或两次以上病情加重的趋势。粘多糖并未改善死亡率、损失工作日数、圣乔治呼吸问卷评分、1 秒内用力呼气量或用力肺活量。结论粘液溶解剂可减少慢性阻塞性肺疾病稳定期患者的病情加重和住院次数，其安全性与安慰剂相当。

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