Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease (Cochrane Review)

A substantive amendment to this systematic review was last made on 09 September 2002. Cochrane reviews are regularly checked and updated if necessary.

Background: Individuals with chronic bronchitis or chronic obstructive pulmonary disease (COPD) may suffer recurrent exacerbations with an increase in volume and/or purulence of sputum and any therapy that reduced the number of exacerbations would be useful. There is a marked difference between countries in terms of prescribing of mucolytics depending on whether or not they are perceived to be effective.

Objectives: To assess the effects of oral mucolytics in adults with stable chronic bronchitis or COPD.

Search strategy: We have searched the Cochrane Airways Group trials register and reference lists of articles, on three separate occasions.

Selection criteria: Randomised trials that compared oral mucolytic therapy with placebo for at least two months in adults with chronic bronchitis or COPD. Studies of people with asthma and cystic fibrosis were excluded.

Data collection and analysis: One reviewer extracted data. Study authors and drug companies were contacted for missing information.

Main results: Twenty three trials were included. Compared with placebo, there was a significant reduction in the number of exacerbations per patient with oral mucolytics (weighted mean difference (WMD) -0.066 per month, 95% confidence interval -0.077, -0.054, p<0.001). Using the annualised rate of exacerbations in the control patients of 2.7 per year, this is a 29% reduction. The number of days of disability also fell (WMD -0.56, 95% confidence interval -0.77, -0.35, p<0.001). The number of patients who remained exacerbation-free was greater in the mucolytic group (OR 2.22, 95% confidence interval 1.93, 2.54, p<0.001). There was no difference in lung function or in adverse effects reported between treatments.

Reviewers' conclusions: In subjects with chronic bronchitis or COPD, treatment with mucolytics was associated with a small reduction in acute exacerbations and a somewhat greater reduction in total number of days of disability.

Citation: Poole PJ, Black PN. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease (Cochrane Review). In: The Cochrane Library, Issue 3, 2003. Oxford: Update Software.

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This is an abstract of a regularly updated, systematic review prepared and maintained by the Cochrane Collaboration. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).

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