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Mucolytics for bronchiectasisCrockett A, Cranston JM, Alpers JH, Latiner KM
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SummaryMucolytic drugs (to help make phlegm easier to cough up) for people with bronchiectasisBronchiectasis is a lung condition that usually develops after a series of lung problems (such as childhood infections, problems in the lung structure, tuberculosis, and cystic fibrosis). A lot of mucus (phlegm) collects in the lungs, causing discomfort and the need to cough it up. The phlegm also collects bacteria, which can add to breathing difficulties. Mucolytic drugs break down phlegm, which can make it easier to cough up. However, the review of trials found there is not enough evidence about the effects of mucolytics for people with bronchiectasis.
This is a Cochrane review abstract and plain language summary, prepared and maintained by The Cochrane Collaboration, currently published in The Cochrane Database of Systematic Reviews 2009 Issue 2, Copyright © 2009 The Cochrane Collaboration. Published by John Wiley and Sons, Ltd.. The full text of the review is available in The Cochrane Library (ISSN 1464-780X).
This version first published online:
October 26. 1998 AbstractBackgroundBronchiectasis is predominantly an acquired disease process representing the end stage of a variety of unrelated pulmonary insults. It is defined as a persistent irreversible dilatation and distortion of medium-sized bronchi. Patients diagnosed with bronchiectasis frequently have difficulty expectorating the infected sputum. Mucolytic agents target hyper-secretion or changed physiochemical properties of sputum to make it easier to clear. One drug, recombinant human DNase, breaks down the DNA that is released at the site of infection by neutrophils. ObjectivesThe objective of this review was to assess the effects of ingested or inhaled mucolytics in people with bronchiectasis. Search strategyWe searched the Cochrane Airways Group Specialised Register and reference lists of relevant articles. We also contacted experts in the field and drug companies. Searches were current as of January 2008. Selection criteriaRandomised trials of mucolytic treatment in people with bronchiectasis but not cystic fibrosis. Data collection and analysisData extraction was performed independently by two reviewers. Study authors were contacted for confirmation. Main resultsThree trials were included, but none of their data could be aggregated in a meta analysis. Compared to placebo, high doses of bromhexine with antibiotics eased difficulty in expectoration (weighted mean difference -0.53, 95% confidence interval -0.81 to -0.25 at 16 days). There was also a reduction in sputum production with bromhexine (weighted mean difference -21.5%, 95% confidence interval -38.9 to -4.1 % at day 16). Compared to placebo, recombinant human DNase showed no difference in forced expiratory volume or forced vital capacity in one study and was reported to have a significant negative effect on forced expiratory volume in another study. Adverse effects, including influenza-like symptoms, were more common in the group receiving recombinant human DNase. An update search conducted in January 2008 did not yield any further studies for inclusion in the review. Authors' conclusionsThere is not enough evidence to evaluate the routine use of mucolytics for bronchiectasis. High doses of bromhexine coupled with antibiotics may help with sputum production and clearance. |