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.

• Klíčová slova
• COPD, Consensus, Delphi study, Erdosteine, Exacerbation, Mucolytic,
• MeSH
• acetylcystein aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• chronická obstrukční plicní nemoc farmakoterapie   MeSH
• expektorancia aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• internacionalita MeSH
• karbocystein aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• kombinovaná farmakoterapie MeSH
• konsensus * MeSH
• lidé MeSH
• průzkumy a dotazníky MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• syndrom vzplanutí nemoci * MeSH
• thiofeny aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• thioglykoláty aplikace a dávkování   škodlivé účinky   terapeutické užití   MeSH
• výsledek terapie MeSH
• zdravotní stav MeSH
• Check Tag
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• práce podpořená grantem MeSH
• Názvy látek
• acetylcystein MeSH
• erdosteine MeSH Prohlížeč
• expektorancia MeSH
• karbocystein MeSH
• thiofeny MeSH
• thioglykoláty MeSH

BACKGROUND: Patients with chronic obstructive pulmonary disease (COPD) can be classified into groups A/C or B/D based on symptom intensity. Different threshold values for symptom questionnaires can result in misclassification and, in turn, different treatment recommendations. The primary aim was to find the best fitting cut-points for Global initiative for chronic Obstructive Lung Disease (GOLD) symptom measures, with an modified Medical Research Council dyspnea grade of 2 or higher as point of reference. METHODS: After a computerized search, data from 41 cohorts and whose authors agreed to provide data were pooled. COPD studies were eligible for analyses if they included, at least age, sex, postbronchodilator spirometry, modified Medical Research Council, and COPD Assessment Test (CAT) total scores. MAIN OUTCOMES: Receiver operating characteristic curves and the Youden index were used to determine the best calibration threshold for CAT, COPD Clinical Questionnaire, and St. Georges Respiratory Questionnaire total scores. Following, GOLD A/B/C/D frequencies were calculated based on current cut-points and the newly derived cut-points. FINDINGS: A total of 18,577 patients with COPD [72.0% male; mean age: 66.3 years (standard deviation 9.6)] were analyzed. Most patients had a moderate or severe degree of airflow limitation (GOLD spirometric grade 1, 10.9%; grade 2, 46.6%; grade 3, 32.4%; and grade 4, 10.3%). The best calibration threshold for CAT total score was 18 points, for COPD Clinical Questionnaire total score 1.9 points, and for St. Georges Respiratory Questionnaire total score 46.0 points. CONCLUSIONS: The application of these new cut-points would reclassify about one-third of the patients with COPD and, thus, would impact on individual disease management. Further validation in prospective studies of these new values are needed.

• Klíčová slova
• COPD, GOLD, clinical significance, health status,
• MeSH
• celosvětové zdraví MeSH
• chronická obstrukční plicní nemoc klasifikace   diagnóza   terapie   MeSH
• hodnocení rizik MeSH
• lidé středního věku MeSH
• lidé MeSH
• medicína založená na důkazech MeSH
• progrese nemoci * MeSH
• senioři MeSH
• sexuální faktory MeSH
• směrnice pro lékařskou praxi jako téma * MeSH
• stupeň závažnosti nemoci MeSH
• stupnice dopadu nemoci na kvalitu života MeSH
• určení symptomu metody   MeSH
• věkové faktory MeSH
• Check Tag
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH