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.

Faculty of Medicine Pulmonology Dept Uludağ University Bursa Turkey

Faculty of Medicine University Medical School Cairo Egypt

Faculty of Medicine University of Coimbra Coimbra Portugal

Institute of Ageing and Chronic Disease University of Liverpool Liverpool UK

Institute of Pneumology Marius Nasta Bucharest Romania

Jessenius Faculty of Medicine in Martin Comenius University in Bratislava University Hospital Martin Martin Slovakia

Medical University Varna Bulgaria; University Hospital St Marina Varna Bulgaria

Pneumology Dept University Hospital Hradec Králové Faculty of Medicine Charles University Hradec Králové Czech Republic

Pulmonary Division Lady Davis Carmel Medical Center Haifa Israel

Pulmonology Dept University Hospital of Crete Crete Greece

Respiratory Medicine Unit Department of Experimental Medicine University of Rome Tor Vergata Rome Italy

Respiratory Medicine University of Ferrara Ferrara Italy

Sechenov 1st Moscow State Medical University Moscow Russia

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