Efficacy and safety of mucolytics in patients with stable chronic obstructive pulmonary disease: A systematic review and meta-analysis.

2024-11
Respiratory investigation 62(6)
- Hiroshi Ohnishi
- Takuya Tanimoto
- Ryunosuke Inaba
- Masamitsu Eitoku

PubMed: 39413571
DOI: 10.1016/j.resinv.2024.10.004

Study Design

Type: Meta-Analysis
Population: patients with stable COPD
Methods: systematic review and meta-analysis of randomized controlled trials; mucolytics including ambroxol, bromhexine, carbocisteine, erdosteine, fudosteine, l-methylcysteine, and N-acetylcysteine

Background

The efficacy and safety of mucolytics in patients with chronic obstructive pulmonary disease (COPD) and chronic bronchitis or exacerbations of COPD have been reported. We conducted a systematic review and meta-analysis of mucolytics in patients with stable COPD.

Methods

Reports from randomized controlled trials to evaluate the efficacy and safety of mucolytics, including ambroxol, bromhexine, carbocisteine, erdosteine, fudosteine, l-methylcysteine, and N-acetylcysteine used in patients with stable COPD were searched for in PubMed, Scopus, Embase, Web of Science, the Cochrane Library, and the Igaku Cyuo Zasshi database.

Results

Twenty-three reports with ambroxol, carbocisteine, erdosteine, l-methylcysteine, or N-acetylcysteine were included in the review. Mucolytics significantly reduced the rates of exacerbation and hospitalization, shortened the duration of antibiotic use and exacerbations, prolonged the time to first exacerbation, and had a tendency to reduce the occurrence of two or more exacerbations in patients with stable COPD compared to placebo. Mucolytics did not improve mortality, number of lost workdays, scores on St. George's respiratory questionnaire, forced expiratory volume in 1 s, or forced vital capacity. The safety profile of mucolytics was comparable to that of placebo.

Conclusions

Mucolytics reduce exacerbations and hospitalizations in patients with stable COPD and have a safety profile comparable to that of placebo.

Research Insights

N-Acetyl Cysteine→Improved Forced Expiratory Volume in One Second
Mucolytics did not improve ... forced expiratory volume in 1 s
Effect
Neutral
Effect size
Small
N-Acetyl Cysteine→Improved Forced Vital Capacity
Mucolytics did not improve ... forced vital capacity
Effect
Neutral
Effect size
Small
N-Acetyl Cysteine→Improved St. George's Respiratory Questionnaire Score
Mucolytics did not improve ... scores on St. George's respiratory questionnaire
Effect
Neutral
Effect size
Small
N-Acetyl Cysteine→Prolonged Time to First Exacerbation
prolonged the time to first exacerbation
Effect
Beneficial
Effect size
Moderate
N-Acetyl Cysteine→Reduced Duration of Antibiotic Use
shortened the duration of antibiotic use and exacerbations
Effect
Beneficial
Effect size
Small
N-Acetyl Cysteine→Reduced Exacerbation Duration
shortened the duration of antibiotic use and exacerbations
Effect
Beneficial
Effect size
Small
N-Acetyl Cysteine→Reduced Exacerbation Occurrence
had a tendency to reduce the occurrence of two or more exacerbations
Effect
Neutral
Effect size
Small
N-Acetyl Cysteine→Reduced Exacerbation Rate
Mucolytics significantly reduced the rates of exacerbation and hospitalization
Effect
Beneficial
Effect size
Moderate
N-Acetyl Cysteine→Reduced Hospitalization Rate
Mucolytics significantly reduced the rates of exacerbation and hospitalization
Effect
Beneficial
Effect size
Moderate
N-Acetyl Cysteine→Reduced Mortality Risk
Mucolytics did not improve mortality
Effect
Neutral
Effect size
Small
N-Acetyl Cysteine→Reduced Sick Leave Days
Mucolytics did not improve ... number of lost workdays
Effect
Neutral
Effect size
Small