The mucolytic* drug carbocisteine can help slow the worsening of symptoms in patients with chronic obstructive pulmonary disease (COPD), and should be recognised as a treatment for the condition. These are the conclusions of authors of an Article in this week's edition of The Lancet .
COPD is characterised by airflow limitation, and has many components including over-secretion of mucus, oxidative stress, and airway inflammation. Dr Nan-Shang Zhong, Gangzhou Institute of Respiratory Disease, China, and colleagues did a randomised controlled trial to assess whether carbocisteine could reduce the yearly exacerbation rate in patients with COPD.
The study looked at 709 patients from 22 centres in China with COPD aged between 40 and 80 years, with a history of at least two COPD exacerbations** in the previous two years and who had remained clinically stable in the four weeks before the study. Patients were randomised to receive either 1500mg carbocisteine (354) or placebo (355) per day for a year. Numbers of exacerbations declined significantly in the carbocisteine group compared with the placebo group (1.01 vs 1.35) – a 25% risk reduction for carbocisteine group.
The authors conclude: "Mucolytics, such as carbocisteine should be recognised as a worthwhile treatment for prevention of exacerbations in Chinese patients with COPD." They add that this much cheaper treatment could be vital for treating COPD in developing countries.
In an accompanying Comment, Dr Paul Albert and Professor Peter Calverley, University of Liverpool, UK ask whether the findings can be applied to patients who are not of Chinese origin. They say: "What is clear from PEACE is the rigorous clinical trials of existing drugs can offer new insights into COPD care."
Notes to editors: *mucolytic: a drug that breaks down mucus so that it can be cleared from the body
**An exacerbation is a sustained worsening of symptoms that lasts at least 2 days
Dr Nan-Shang Zhong, Gangzhou Institute of Respiratory Disease, China T) +86-13609003622 E) nanshan@vip.163.com
Professor Peter Calverley, University of Liverpool, UK T) +44 (0) 7792 055390 E) pmacal@liverpool.ac.uk
http://www.eurekalert.org/jrnls/lance/PEACE%20study%20p2013-2018%20+%20Com%201975-76%20June%2014.pdf
The Lancet