Poole P J, Black P N
University of Auckland, Private Bag 92019, Auckland, New Zealand.
Cochrane Database Syst Rev. 2003(2):CD001287. doi: 10.1002/14651858.CD001287.
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 prescribing of mucolytics depending on whether or not they are perceived to be effective.
To assess the effects of oral mucolytics in adults with stable chronic bronchitis or COPD.
We have searched the Cochrane Airways Group trials register and reference lists of articles, on three separate occasions.
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.
One reviewer extracted data. Study authors and drug companies were contacted for missing information.
Twenty three 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) -0.066 per month, 95% confidence interval -0.077, -0.054, p<0.001). Using the annualised rate of exacerbations in the control patients of 2.7 per year, this is a 29% reduction. The number of days of disability also fell (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 (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.
REVIEWER'S 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.
患有慢性支气管炎或慢性阻塞性肺疾病（COPD）的个体可能会反复出现病情加重，痰液量和/或脓性增加，任何能减少病情加重次数的治疗方法都将是有益的。在不同国家，黏液溶解剂的处方存在显著差异，这取决于它们是否被认为有效。
评估口服黏液溶解剂对患有稳定期慢性支气管炎或COPD的成年人的疗效。
我们分别在三个不同时间检索了Cochrane气道组试验注册库和文章的参考文献列表。
在患有慢性支气管炎或COPD的成年人中，比较口服黏液溶解剂治疗与安慰剂治疗至少两个月的随机试验。哮喘和囊性纤维化患者的研究被排除。
一名综述作者提取数据。就缺失信息联系了研究作者和制药公司。
纳入了23项试验。与安慰剂相比，口服黏液溶解剂使每位患者的病情加重次数显著减少（加权平均差（WMD）为每月-0.066，95%置信区间为-0.077，-0.054，p<0.001）。以对照组患者每年2.7次的病情加重年化率计算，这是29%的降幅。残疾天数也有所下降（WMD为-0.56，95%置信区间为-0.77，-0.35，p<0.001）。黏液溶解剂组中无病情加重的患者数量更多（比值比为2.22，95%置信区间为1.93，2.54，p<0.001）。治疗之间在肺功能或不良反应报告方面没有差异。
在患有慢性支气管炎或COPD的受试者中，黏液溶解剂治疗与急性加重次数略有减少以及残疾总天数略有更多减少相关。
