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.
- MeSH
- Acetylcysteine administration & dosage adverse effects therapeutic use MeSH
- Pulmonary Disease, Chronic Obstructive drug therapy MeSH
- Expectorants administration & dosage adverse effects therapeutic use MeSH
- Internationality MeSH
- Carbocysteine administration & dosage adverse effects therapeutic use MeSH
- Drug Therapy, Combination MeSH
- Consensus * MeSH
- Humans MeSH
- Surveys and Questionnaires MeSH
- Practice Guidelines as Topic * MeSH
- Symptom Flare Up * MeSH
- Thiophenes administration & dosage adverse effects therapeutic use MeSH
- Thioglycolates administration & dosage adverse effects therapeutic use MeSH
- Treatment Outcome MeSH
- Health Status MeSH
- Check Tag
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- MeSH
- Ambroxol administration & dosage therapeutic use MeSH
- Antitussive Agents administration & dosage therapeutic use MeSH
- Bromhexine administration & dosage therapeutic use MeSH
- Bronchodilator Agents administration & dosage classification therapeutic use MeSH
- Cysteine analogs & derivatives administration & dosage therapeutic use MeSH
- Expectorants administration & dosage therapeutic use MeSH
- Phytotherapy utilization MeSH
- Guaifenesin administration & dosage therapeutic use MeSH
- Carbocysteine administration & dosage therapeutic use MeSH
- Cough * etiology drug therapy classification physiopathology MeSH
- Humans MeSH
- Sputum secretion drug effects MeSH
- Check Tag
- Humans MeSH
