Poole Phillippa J
University of Auckland, Auckland, New Zealand.
Int J Chron Obstruct Pulmon Dis. 2006;1(2):123-8. doi: 10.2147/copd.2006.1.2.123.
There is, to date, no medical therapy that modifies the decline in lung function that occurs in COPD. As the disease becomes more severe, exacerbations of COPD become increasingly common, affecting patient quality of life and increasing health care costs. Mucolytic agents, through their actions on inflammatory and oxidative pathways, have potential benefits in COPD. This paper reviews the randomized controlled trial (RCT) evidence for the effectiveness of at least 2 months of daily therapy with oral mucolytics in COPD. Based on evidence from 26 RCTs, mucolytics reduce exacerbations by up to 0.8 exacerbations per year, with a greater effect in patients with more severe COPD. This effect appears to be of a similar magnitude to the reduction in exacerbations seen with tiotropium and inhaled corticosteroids (ICS), but RCTs that compared the agents would be required to confirm this. Mucolytics do not affect the rate of lung function decline, but they do not have any significant adverse effects. Mucolytic treatment should be considered in: patients with more severe COPD who have frequent or prolonged exacerbations; those who are repeatedly admitted to hospital; or in those patients with frequent exacerbations who are unable to take tiotropium or ICS.
迄今为止，尚无能够改变慢性阻塞性肺疾病（COPD）患者肺功能下降的药物治疗方法。随着疾病的加重，COPD急性加重变得越来越常见，这影响了患者的生活质量，并增加了医疗成本。黏液溶解剂通过作用于炎症和氧化途径，对COPD可能具有潜在益处。本文综述了关于口服黏液溶解剂每日治疗至少2个月对COPD有效性的随机对照试验（RCT）证据。基于26项RCT的证据，黏液溶解剂可使每年急性加重次数减少多达0.8次，对病情更严重的COPD患者效果更显著。这种效果似乎与噻托溴铵和吸入性糖皮质激素（ICS）所观察到的急性加重次数减少幅度相似，但需要通过比较这些药物的RCT来证实这一点。黏液溶解剂不会影响肺功能下降的速率，但也没有任何显著的不良反应。对于以下患者应考虑使用黏液溶解剂治疗：病情较严重、急性加重频繁或持续时间较长的患者；反复住院的患者；或频繁急性加重且无法使用噻托溴铵或ICS的患者。
