Polu J M, Puchelle E, Sadoul P
Sem Hop. 1984 Feb 23;60(9):643-58.
Prescription of bronchial mucus modifiers has benefited from recent advances in the knowledge of biochemical constituents of bronchial fluids, their regulation and disturbances on the one hand, and the consequences of biochemical changes in these fluids on rheological characteristics of bronchial secretions on the other. In addition, the significance of these characteristics has been evidenced by the study of mucociliary transportation. Drugs which modify bronchial fluids are studied according to their mode of action upon the organized gel phase, mobilized by ciliary activity, and the aqueous sol phase, which enables this ciliary activity. Drugs which modify the gel phase are either true mucolytic agents or muco-regulators. True mucolytic drugs include reducing agents with a free thiol group, chiefly N-acetyl-cysteine which breaks disulfide bonds linking different protein chains, and proteolytic enzymes which break protein chains. The latter also have an appreciable anti-inflammatory effect but are rarely used at present owing to allergic reactions. Mucoregulating drugs are cysteine derivatives whose thiol group is not free. They are headed by carbocysteine which activates the synthesis of sialidized acid mucins. They enable reorganization of bronchial mucus, reversing former drops in viscosity and elasticity, thereby improving mucociliary transportation. They have a complementary anti-inflammatory action.
支气管黏液调节剂的处方受益于近年来在支气管液生化成分、其调节与紊乱方面的知识进展，以及这些液体中生化变化对支气管分泌物流变学特性的影响。此外，通过对黏液纤毛运输的研究，这些特性的重要性也得到了证实。根据药物对由纤毛活动驱动的有组织凝胶相以及使这种纤毛活动得以实现的水溶胶相的作用方式，对改变支气管液的药物进行研究。改变凝胶相的药物要么是真正的黏液溶解剂，要么是黏液调节剂。真正的黏液溶解药物包括具有游离巯基的还原剂，主要是能打破连接不同蛋白质链的二硫键的N - 乙酰半胱氨酸，以及能打断蛋白质链的蛋白水解酶。后者也有明显的抗炎作用，但由于过敏反应目前很少使用。黏液调节药物是巯基不游离的半胱氨酸衍生物。它们以羧甲司坦为首，羧甲司坦能激活唾液酸化黏蛋白的合成。它们能使支气管黏液重新组织，逆转先前的黏度和弹性下降，从而改善黏液纤毛运输。它们具有互补的抗炎作用。
