Background

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.

Methods

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.

Results

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.

Conclusions

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.

中文翻译：

---

在 COPD 中使用粘液溶解剂：Delphi 共识研究

背景

国际指南推荐粘液溶解剂作为特定 COPD 患者的附加治疗，因为它们可以减少病情加重并改善健康状况。由于粘液溶解剂的证据各不相同，我们使用 Delphi 方法来评估国际 COPD 专家小组对 COPD 中粘液溶解剂使用的共识。

方法

来自 12 个国家的 53 名 COPD 专家被要求完成一份在线问卷，并使用 5 分制对他们对 15 项陈述的同意程度进行评分。评估的粘液溶解剂是羧甲司坦、厄多司坦和 N-乙酰半胱氨酸 (NAC)。数据是匿名收集的，并使用描述性统计提出共识。

结果

47 名受访者就这些声明达成了共识。他们一致认为，常规使用粘液溶解剂治疗可有效降低急性加重的频率，缩短轻中度急性加重的持续时间，并可以增加 COPD 患者的首次急性加重时间和无症状时间。对于厄多司坦的共识一直是最高的。专家们一致认为，所有三种粘液溶解剂都显示出抗氧化和抗炎活性。厄多司坦和 NAC 被认为可以提高某些类别的抗菌药物的疗效。当加入其他药物时，所有三种粘液溶解剂都被认为对急性加重症状的短期治疗有效。

结论

共识结果支持更广泛地使用粘液溶解剂作为 COPD 的附加疗法。然而，在决定使用哪种粘液溶解剂时，必须考虑药理作用和临床有效性的差异。