INTRODUCTION: Studies indicate that chronic treatment with mucoactive drugs may reduce COPD exacerbation rates. This real-world, multicenter, prospective, observational study aimed to determine the effect of long-term mucoactive treatment on exacerbations in patients with COPD in the Czech Republic. METHODS: 452 adult patients on the Czech Multicenter Research Database of COPD with post-bronchodilator FEV1 ≤ 60% of predicted value received standard of care and were followed up for 5 years. For the first 24 months, 81 patients received regular thiol-based mucoactive drugs (77 erdosteine, 4 N-acetylcysteine) at the discretion of the treating physician and 371 patients had no mucoactive treatment (control group). Erdosteine was fully reimbursed, and NAC was partially reimbursed for COPD patients. The annual number/rate of COPD exacerbations over 5 years was monitored. RESULTS: Patients receiving mucoactive treatment for 24 months had a significantly larger reduction from baseline in all exacerbations compared to the control group (- 0.61 vs - 0.18, p = 0.026; - 0.54 vs - 0.09, p = 0.007; - 0.55 vs 0.04, p = 0.005; - 0.67 vs 0.13, p = 0.002; - 0.53 vs 0.10, p = 0.019 in the first to fifth year, respectively). The reduction in moderate exacerbations was also significantly larger in those receiving mucoactive treatment versus no mucoactive treatment. The exacerbation rate was reduced to a greater extent in the subgroups with cough or with stage 3‒4 COPD who received mucoactive treatment but was independent of the use of inhaled corticosteroids (ICS). CONCLUSION: Mucoactive treatment for two years reduced the number of COPD exacerbations (all, moderate) over five years of follow-up. The reduction in exacerbations was more pronounced in patients with cough or with stage 3‒4 COPD but was independent of the use of ICS.
- MeSH
- Acetylcysteine * therapeutic use MeSH
- Time Factors MeSH
- Pulmonary Disease, Chronic Obstructive * drug therapy physiopathology diagnosis MeSH
- Expectorants * therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Follow-Up Studies MeSH
- Disease Progression MeSH
- Prospective Studies MeSH
- Aged MeSH
- Forced Expiratory Volume MeSH
- Treatment Outcome MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Observational Study MeSH
- Geographicals
- Czech Republic MeSH
- Keywords
- erdostein,
- MeSH
- Adrenergic beta-2 Receptor Agonists administration & dosage pharmacology therapeutic use MeSH
- Muscarinic Antagonists administration & dosage pharmacology therapeutic use MeSH
- Administration, Inhalation MeSH
- Pulmonary Disease, Chronic Obstructive * etiology therapy MeSH
- Expectorants pharmacology therapeutic use MeSH
- Humans MeSH
- Check Tag
- Humans MeSH
Plicní rehabilitace představuje komplexní mezioborovou individualizovanou nefarmakologickou péči o pacienty s respiračním onemocněním. Součástí plicní rehabilitace je edukace, fyzioterapie, ergoterapie, nutriční a psychosociální poradenství. Fyzioterapeutická péče obvykle zahrnuje pohybový trénink (vytrvalostní a silový), respirační fyzioterapii a měkké a mobilizační techniky. Cílem pohybového tréninku je zlepšit toleranci fyzické zátěže a cílem respirační fyzioterapie je optimalizovat dechový vzor, usnadnit expektoraci a udržet čistotu dýchacích cest, zvýšit sílu dýchacích svalů a podpořit dechovou a posturální funkci dýchacích svalů. Jednotlivé fyzioterapeutické postupy jsou individuálně zvoleny na podkladě výsledků kineziologického vyšetření pacienta.
Pulmonary rehabilitation represents comprehensive interdisciplinary individualized non-pharmacoiogicai treatment in patients with respiratory diseases. Pulmonary rehabilitation includes education, physiotherapy, occupational therapy, and nutritional and psychosocial counselling. Physiotherapy treatment usually includes exercise training (endurance and strength training), respiratory physiotherapy, and soft tissue and mobilization techniques. Exercise training aims to improve exercise tolerance. Respiratory physiotherapy seeks to optimize the breathing pattern, facilitate expectoration and maintain airway clearance, increase respiratory muscle strength, and support the respiratory and postural function of the respiratory muscles. Physiotherapy techniques are individually selected based on the results of kinesiological assessment.
- Keywords
- plicní rehabilitace,
- MeSH
- Humans MeSH
- Lung Diseases * rehabilitation MeSH
- Rehabilitation methods MeSH
- Physical Therapy Modalities MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
- MeSH
- Adrenergic beta-2 Receptor Agonists pharmacology therapeutic use MeSH
- Muscarinic Antagonists pharmacology therapeutic use MeSH
- Pulmonary Disease, Chronic Obstructive * epidemiology drug therapy complications MeSH
- Diagnostic Imaging methods MeSH
- Expectorants pharmacology therapeutic use MeSH
- Cardiovascular Diseases etiology MeSH
- Clinical Studies as Topic methods MeSH
- Congresses as Topic MeSH
- Cigarette Smoking adverse effects MeSH
- Humans MeSH
- Tomography, X-Ray Computed methods MeSH
- Disease Progression MeSH
- Risk Factors MeSH
- Spirometry methods MeSH
- Check Tag
- Humans MeSH
Erdostein byl objeven v roce 1996 a na počátku byla studována jeho mukolytická aktivita v léčbě chronického kašle, v léčbě bronchitid a následně i chronické obstrukční plicní nemoci. Poté se pozornost zaměřila na antioxidační a protizánětlivé vlastnosti této molekuly, které souvisejí se snížením zánětlivé odpovědi v průběhu infekce dýchacích cest. V roce 2013-2015 jsme prováděli studii ERICA u dětí. Předpokládali jsme, že při podávání erdosteinu v prvních dnech rozbíhajícího se infektu horních dýchacích cest se sníží míra zánětlivé odpovědi a tím tíže klinických příznaků a nutnost antibiotické léčby. V dalším desetiletí byly publikovány nové účinky erdosteinu, které naši hypotézu podpořily.
Erdosteine was discovered in 1996 and initially its mucolytic activity was studied in the treatment of chronic cough, in the treatment of bronchitis and subsequently chronic obstructive pulmonary disease. Attention then focused on the antioxidant and anti-inflammatory properties of this molecule, which lead to a reduction in the inflammatory response during respiratory tract infection. In 2013-2015, we conducted the ERICA study in children. We hypothesized that the use of erdosteine in the first days of an emerging upper respiratory tract infection will reduce the strength of the inflammatory response and thus the severity of clinical symptoms and the need for antibiotic treatment. In the next decade, new activities of erdosteine were published, which supported our hypothesis.
- Keywords
- erdostein, studie ERICA,
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Early Diagnosis MeSH
- Bronchitis, Chronic diagnosis drug therapy MeSH
- Pulmonary Disease, Chronic Obstructive * etiology drug therapy prevention & control MeSH
- Child MeSH
- Expectorants * pharmacology classification therapeutic use MeSH
- Clinical Trials as Topic MeSH
- Humans MeSH
- Oxidative Stress drug effects MeSH
- Check Tag
- Child MeSH
- Humans MeSH
V roce 2013-2015 probíhala ve spolupráci s praktickými lékaři pro děti a dorost studie ERICA u dětí s recidivujícími infekty dýchacích cest. Předpokládali jsme, že při podávání erdosteinu v prvních dnech rozbíhajícího se infektu se sníží míra zánětlivé odpovědi v dýchacích cestách, a tím i tíže klinických příznaků a nutnost antibiotické léčby. Během deseti let byly potvrzené nové vlastnosti erdosteinu u pacientů s chronickou obstruktivní plicní nemocí a během epidemie SARS-CoV-2. Erdostein tak není jen mukolytická látka, ale má významné antioxidační a protizánětlivé vlastnosti. S odstupem let tyto nové poznatky naši hypotézu podpořily.
In 2013-2015, in cooperation with general practitioners for children and adolescents, the ERICA study was conducted in children with recurrent respiratory tract infections. We hypothesized that when erdosteine is administered in the first days of an incipient infection, the rate of inflammatory response in the respiratory tract will decrease and thus the severity of clinical symptoms and the need for antibiotic treatment. Within ten years, the new properties of erdostein were confirmed in patients with chronic obstructive pulmonary disease and during the SARS-Covid-2 epidemic. Thus, erdostein is not only a mucolytic substance, but has significant antioxidant and anti-inflammatory properties. Over the years, these new findings have supported our hypothesis.
- Keywords
- erdostein,
- MeSH
- Anti-Bacterial Agents therapeutic use MeSH
- Child MeSH
- Expectorants * pharmacology therapeutic use MeSH
- Respiratory Tract Infections * epidemiology drug therapy MeSH
- Clinical Studies as Topic MeSH
- Humans MeSH
- Adolescent MeSH
- Lung Diseases drug therapy MeSH
- Child, Preschool MeSH
- Check Tag
- Child MeSH
- Humans MeSH
- Adolescent MeSH
- Male MeSH
- Child, Preschool MeSH
- Female MeSH
- Publication type
- Review MeSH
Erdostein patří ke známým thiolovým mukoaktivním léčivům, jehož efektu se využívá u respiračních infekcí. V poslední době z odborných zjištění vyplývá, že efekt erdosteinu je komplexnější a může významným způsobem přispět ke zvládnutí respiračního infektu. Do popředí vystupují jeho antioxidační a protizánětlivé vlastnosti, resp. s nimi související antivirové vlastnosti, a také schopnost snižovat bakteriální přilnavost a zvyšovat účinky některých antibiotik. Erdostein představuje komplexní terapeutickou možnost jak na poli samoléčení respiračních infekcí, tak i u dalších respiračních onemocnění.
Erdostein belongs to the well-known thiol mucoactive drugs, whose effect is used in respiratory infections. Recently, expert findings show that the effect of erdosteine is more complex and can significantly contribute to the management of respiratory infections. Its antioxidant and anti-inflammatory properties come to the fore, or antiviral properties associated with them, as well as the ability to reduce bacterial adhesion and increase the effects of some antibiotics. Erdostein represents a comprehensive therapeutic option both in the field of self-treatment of respiratory infections and in other respiratory diseases.
- Keywords
- Erdostein,
- MeSH
- Pulmonary Disease, Chronic Obstructive * drug therapy MeSH
- Expectorants * pharmacology therapeutic use MeSH
- Drug Evaluation MeSH
- Humans MeSH
- Lung Diseases * drug therapy MeSH
- Thiophenes pharmacology therapeutic use MeSH
- Thioglycolates pharmacology therapeutic use MeSH
- Check Tag
- Humans MeSH
- Keywords
- Erdostein,
- MeSH
- Pulmonary Disease, Chronic Obstructive * drug therapy MeSH
- Expectorants * pharmacology therapeutic use MeSH
- Drug Evaluation MeSH
- Lung Diseases * drug therapy MeSH
- Thiophenes pharmacology therapeutic use MeSH
- Thioglycolates pharmacology therapeutic use MeSH
- Publication type
- Interview MeSH
