a Department of Systems Medicine , University of Rome Tor Vergata , Rome , Italy.
b Section of Pulmonary, Critical Care and Sleep Medicine , Baylor College of Medicine , Houston , Texas , USA.
COPD. 2017 Oct;14(5):552-563. doi: 10.1080/15412555.2017.1347918. Epub 2017 Jul 28.
Mucolytics are potentially useful for the management of chronic obstructive pulmonary disease (COPD), although there is conflicting advice on their use in different guideline documents. Furthermore, there is paucity of data comparing the efficacy of the different mucolytic agents in reducing the odds of COPD exacerbations. We performed pair-wise and network meta-analyses to evaluate the impact of mucoly-tics in COPD. Randomized clinical trials lasting at least 3 months and investigating the effects of mucolytics on COPD exacerbations were identified from published studies and repository databases. Mucolytics significantly reduced the odds of exacerbation vs. placebo (11 studies analyzed: odds ratio (OR) 0.51, 95% confidence interval (CI) 0.39-0.67; p < 0.001). The most effective drugs were carbocysteine, erdosteine, and N-acetylcysteine 1,200 mg/day (SUCRA 68.0-79.0%), whereas the OR was similar to placebo for ambroxol and N-acetylcysteine 600 mg/day. Only N-acetylcysteine 1,200 mg/day significantly protected against exacerbations vs. placebo (2 studies analyzed: OR 0.56, 95% CI 0.35-0.92; p < 0.05; high quality of evidence). A signal of effectiveness was detected for carbocysteine (2 studies analyzed: OR 0.45, 95% CI 0.20-1.01; p ≥ 0.05; moderate quality of evidence). Specific differences in study designs and patient-related characteristics, such as history of exacerbations and ethnicity, were potential effect modifiers for our statistical models, whereas neither respiratory function nor the use of corticosteroids influenced the analysis. This meta-analysis demonstrates that mucolytics are useful in preventing COPD exacerbations as maintenance add-on therapy to patients with frequent exacerbations. The effectiveness of mucolytics is independent of the severity of airway obstruction and the use of inhaled corticosteroids.
黏液溶解剂对于慢性阻塞性肺疾病（COPD）的治疗可能具有一定作用，但不同指南对其使用的建议存在冲突。此外，比较不同黏液溶解剂降低 COPD 加重风险的疗效的数据也很少。我们进行了两两比较和网络荟萃分析，以评估黏液溶解剂在 COPD 中的作用。从已发表的研究和数据库中确定了持续至少 3 个月并调查黏液溶解剂对 COPD 加重影响的随机临床试验。与安慰剂相比，黏液溶解剂显著降低了加重的几率（11 项研究分析：比值比（OR）0.51，95%置信区间（CI）0.39-0.67；p<0.001）。最有效的药物是羧甲司坦、厄多司坦和 N-乙酰半胱氨酸 1200mg/天（SUCRA 68.0-79.0%），而氨溴索和 N-乙酰半胱氨酸 600mg/天的 OR 与安慰剂相似。只有 N-乙酰半胱氨酸 1200mg/天与安慰剂相比能显著降低加重的风险（2 项研究分析：OR 0.56，95%CI 0.35-0.92；p<0.05；高质量证据）。检测到 N-乙酰半胱氨酸 1200mg/天有治疗效果的信号（2 项研究分析：OR 0.45，95%CI 0.20-1.01；p≥0.05；中等质量证据）。研究设计和患者相关特征（如加重史和种族）的差异可能是我们统计模型的潜在效应修饰因子，而呼吸功能或吸入皮质类固醇的使用均未影响分析结果。这项荟萃分析表明，黏液溶解剂作为经常加重的 COPD 患者的维持治疗附加疗法，有助于预防 COPD 加重。黏液溶解剂的有效性与气道阻塞的严重程度和吸入皮质类固醇的使用无关。
