Respiratory Medicine, University of Ferrara, Ferrara, Italy.
Sechenov First Moscow State Medical University, Moscow, Russia.
Respir Med. 2020 Dec;175:106190. doi: 10.1016/j.rmed.2020.106190. Epub 2020 Nov 13.
International guidelines recommend mucolytic agents as add-on therapy in selected patients with COPD because they may reduce exacerbations and improve health status. As the evidence varies among mucolytic agents, we used the Delphi method to assess consensus amongst an international panel of COPD experts on mucolytics use in COPD.
53 COPD experts from 12 countries were asked to complete an online questionnaire and rate their agreement with 15 statements using a 5-point scale. The mucolytic agents evaluated were carbocysteine, erdosteine and N-acetylcysteine (NAC). Data were collected anonymously and consensus presented using descriptive statistics.
The 47 respondents reached consensus on the statements. They agreed that regular treatment with mucolytic agents effectively reduces the frequency of exacerbations, reduces the duration of mild-to-moderate exacerbations, and can increase the time to first exacerbation and symptom-free time in COPD patients. Consensus was consistently highest for erdosteine. The experts agreed that all three mucolytics display antioxidant and anti-inflammatory activity. Erdosteine and NAC were thought to improve the efficacy of some classes of antibacterial drugs. All three mucolytics were considered effective for the short-term treatment of symptoms of acute exacerbations when added to other drugs. The panel agreed that approved doses of mucolytic agents have favorable side-effect profiles and can be recommended for regular use in patients with a bronchitic phenotype.
Consensus findings support the wider use of mucolytic agents as add-on therapy for COPD. However, the differences in pharmacological actions and clinical effectiveness must be considered when deciding which mucolytic to use.
国际指南建议在选定的 COPD 患者中使用黏液溶解剂作为附加治疗，因为它们可能减少加重并改善健康状况。由于黏液溶解剂的证据存在差异，我们使用 Delphi 方法来评估 COPD 专家国际小组对黏液溶解剂在 COPD 中的使用的共识。
来自 12 个国家的 53 名 COPD 专家被要求完成在线问卷，并使用 5 分制对 15 个陈述的同意程度进行评分。评估的黏液溶解剂为卡巴司坦、厄多司坦和 N-乙酰半胱氨酸（NAC）。数据匿名收集，共识以描述性统计呈现。
47 名应答者就陈述达成共识。他们一致认为，常规使用黏液溶解剂可有效降低加重的频率，减少轻度至中度加重的持续时间，并可延长 COPD 患者的首次加重时间和无症状时间。厄多司坦的共识度始终最高。专家们一致认为，三种黏液溶解剂均具有抗氧化和抗炎活性。厄多司坦和 NAC 被认为可提高某些类抗菌药物的疗效。当添加到其他药物中时，三种黏液溶解剂都被认为可有效短期治疗急性加重症状。专家组一致认为，批准剂量的黏液溶解剂具有良好的副作用特征，可推荐用于具有支气管表型的患者常规使用。
共识性发现支持更广泛地将黏液溶解剂作为 COPD 的附加治疗。然而，在决定使用哪种黏液溶解剂时，必须考虑到药理学作用和临床疗效的差异。
