Poole Phillippa J, Black Peter N
University of Auckland, Auckland, New Zealand.
Am J Respir Med. 2003;2(5):367-70. doi: 10.1007/BF03256664.
It is important to find interventions that will reduce the frequency and severity of exacerbations of COPD, because of their effect on morbidity and healthcare expenditure. A Cochrane systematic review included 23 studies that had evaluated the effects of treatment with mucolytic agents in patients with chronic bronchitis or COPD. Mucolytic treatment was associated with a significant reduction of 0.79 exacerbations per patient per year compared with placebo, a 29% decrease. Patients who received treatment with mucolytic agents were twice as likely to remain exacerbation-free in the study period than if they had received placebo, with six patients needing regular treatment with mucolytic agents for 3-6 months to achieve one less exacerbation over that time. Treatment with mucolytic agents resulted in nearly 7 days less illness per patient per year. How mucolytic agents work is unknown, although they may reduce exacerbations by altering mucus production, antioxidation, or antibacterial or immunostimulatory effects. They do not appear to affect the decline in lung function that occurs in COPD. The treatment appears to be without any adverse effects, apart from the need to take oral medication daily. Cost-effectiveness analysis suggests that the point at which the costs of treatment and non-treatment were equal was 1.2 less exacerbations per year. This is higher than the effect observed in the Cochrane review, suggesting that treating everyone with COPD with mucolytic agents would not be cost effective. Those with more frequent and severe exacerbations appear to have the most to gain.
找到能够降低慢性阻塞性肺疾病（COPD）急性加重频率和严重程度的干预措施很重要，因为这会影响发病率和医疗保健支出。一项Cochrane系统评价纳入了23项评估黏液溶解剂治疗慢性支气管炎或COPD患者效果的研究。与安慰剂相比，黏液溶解剂治疗使每位患者每年的急性加重次数显著减少0.79次，降幅为29%。在研究期间，接受黏液溶解剂治疗的患者无急性加重的可能性是接受安慰剂治疗患者的两倍，即每6名接受黏液溶解剂常规治疗3至6个月的患者在此期间可少发生1次急性加重。黏液溶解剂治疗使每位患者每年的患病天数减少近7天。尽管黏液溶解剂可能通过改变黏液分泌、抗氧化、抗菌或免疫刺激作用来减少急性加重，但它们的作用机制尚不清楚。它们似乎不影响COPD患者肺功能的下降。除了需要每日口服药物外，该治疗似乎没有任何不良反应。成本效益分析表明，治疗与不治疗成本相等时的急性加重减少次数为每年1.2次。这高于Cochrane评价中观察到的效果，这表明对所有COPD患者使用黏液溶解剂治疗不具有成本效益。急性加重更频繁、更严重的患者似乎获益最大。
