Role of ambroxol in therapeutic interaction of mucociliary clearance in the “bronchitic phenotype” of COPD
Authors:
V. Koblížek; T. Dobešová; P. Papoušek; Š. Prachařová
Authors‘ workplace:
Přednosta: doc. MUDr. František Salajka, CSc.
; Plicní klinika FN Hradec Králové
Published in:
Prakt. Lék. 2009; 89(10): 570-574
Category:
Of different specialties
Overview
Chronic obstructive pulmonary disease (COPD) is one of the leading causes of morbidity and mortality in the world. In addition, the prevalence of this syndrome is continually growing. The majority of COPD subjects suffer from the expectoration phenotype of this condition. The cornerstone of the expectoration phenotype is chronic mucus hypersecretion, which is a physiologically protective process that occurs in connection with non-infectious chronic inflammation of the airways and lung parenchyma. This prolonged and excess mucus secretion can usually lead to mucus retention inside the airways. This retention can often contribute to chronic expiratory airflow limitation. Therefore any pharmacotherapy that is able to reduce mucus secretion may play a considerable role in the management of the expectoration (bronchitic) phenotype of COPD.
Mucus over-secretion could be normalized with multiple mucoactive drugs that decrease inflammation, produce antioxidant activity, block secretion, break down the molecular structure of mucus and generally reduce the amount or viscosity of mucus. There are many mucoactive medications on the market and more are being clinically evaluated in the field of COPD. Presently we have several safe and effective drugs, which we can recommend for day-to-day clinical practice (ambroxol, erdosteine, N-acetylcysteine and bromhexine).
This article describes the realistic role of ambroxol in mucoactive therapy of COPD. Overall beneficial effects of mucoactive pharmaceutics appear to be in the treatment of acute exacerbations and presumably during chronic therapy of long-term mucus expectoration (bronchitic phenotype of COPD).
Key words:
mucociliary clearance, mucociliary pathology, COPD, mucoactive substances, ambroxol, treatment.
Sources
1. Houtmeyers, E. Gosselink, R., Gayan-Ramirez, G. et al. Regulation of mucociliary clearance in health and disease. ERJ 1999, 13, p. 1177-1188.
2. Rogers, D.F. The role of airway secretions in COPD: pathophysiology, epidemiology and pharmacotherapeutic options. COPD 2005,; 2, p. 341-353.
3. Rogers, D.F. Airway Mucus Secretion. In: Barnes PJ. Chronic Obstructive Pulmonary Disease (Cellular and Molecular Machanisms). Boca Raton: Taylor & Francis 2005, p. 83-111.
4. Agnew, J.E., Little, F., Pavia, D., Clarke, S.W. Mucus clearance from the airways in chronic bronchitis – smokers and ex-smokers. Bull. Eur. Phsiopathol. Respir. 1982, 18, p. 473-484.
5. Prescott, E., Lange, P., Vestbo, J. Chronic mucus hypersecretion in COPD and death from pulmonary infection. ERJ 1995, 8, p. 1333-1338.
6. Wanner, A., Salathe, M., O´Riordan, T.G. Mucociliary clearance in the airways. AJRCCM 1996,; 154, p. 1868-1902.
7. Giembytcz, M.A. Mucolytics pharmacotherapy for COPD. In: Rennard SI et al. Clinical management of chronic obstructive pulmonary disease. 2nd ed. New York: Informa Healthcare 2007, p. 339-341.
8. Davies, J.R., Hermann, A., Russell, W. et al. Respiratory tract mucins: structure and expression patterns. In: Mucus hypersecretion in respiratory disease, No. 248. Chichester: John Wiley & Sons 2002, p. 76-88.
9. Kirkham, S., Sheehan, J.K., Knight, D. et al. Heterogenity of airways mucus: variations in the amounts and glycoforms of the major oligomeric mucins MUC5AC ad MUC5B. Biochem. J. 2002, 361, p. 542-553.
10. Hogg, J.C. Pathophysilogy of airflow limitation in COPD. Lancet 2004, 364, p. 709-721.
11. Caramori, G., Di, G.C., Carlstedt, I. et al. Mucin expression in peripheral airways of patiens with chronic obstructive ulmonary disease. Histopathology 2004, 45, p. 477-484.
12. Rogers, D.F., Barnes, P.J. Treatment of airway mucus hyper-sectretion. Ann. Med. 2006, 38, p. 116-125.
13. Henke, M.O., Shah, S.A., Rubin, B.K. The role of airway secretion in COPD – clinical applications. COPD 2005, 2, p. 377-390.
14. Rubin, B.K. Mucolytics, expectorants and mucokinetics medications. Respir. Care 2007, 52, p. 859-865.
15. Koblížek, V., Tomšová, M. a kol. Mukoaktivní léky. Stud. Pneumol. Phthiseol. 2007, 67, s. 18-23.
16. Beeh, K.M., Beier, J., Esperester, A., Paul, L.D. Antiinflammatory properties of ambroxol. Eur. J. Med. Res. 2008, 13, p. 557-562.
17. Janssens, W., Decramer, M. Use of bronchodilators and mucolytics at COPD exacerbations. In: Wedzicha JA, Martinez FJ. Chronic obstructive pulmonary disease exacerbations. New York: Informa Healthcare 2009, p. 203-238.
18. Halbert, R.J., Natoli, J.L., Gano, A. et al. Global burden of COPD: systematic review and meta-analysis. ERJ 2006, 28, 523-532.
19. World Health Organization. Chronic respiratory disease: Burden (2007) [on line]. Dostupné na http://who.int/respiratory/copd/burden/en/index.html.
20. The Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for diagnosis, management, and prevention of COPD [on line]. Dostupné na http://www.goldcopd.com/ Guidelineitem.asp?l1=2&l2=1&intId=2003.
21. Vestbo, J. Epidemiological studies in mucus hypersecretion. Novartis Found Symp. 2002, 248, p. 3-12.
22. Koblížek, V., Salajka, F., Čermáková, E. a kol. Vztah mezi kvalitou života a BODE indexem u bývalých kuřáků ve stabilní fázi chronické obstrukční plicní nemoci (Ciliární studie). Vnitřní lékařství 2009, 10 (v tisku).
23. Rogers, D.F. Mucus pathophysiology in COPD: differences to astma, and pharmacotherapy. Monaldi Arch. Chest. Dis. 2000, 55, p. 324-332.
24. Anthonisen, N.R. Bacteria and exacerbation of COPD. NEJM 2002, 347, p. 526-527.
25. Rogers, D.F. Mucoactive drugs for astma and COPD: any place in therapy? Expert Opin. Investig. Drugs 2002, 11, p. 15-35.
26. Rabe, K.F., Hurd, S., Anzueto, A. et al. Global strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease: GOLD executive summary. AJRCCM 2007, 176, p. 532-555.
27. National Institute for Clinical Excellence (NICE). Chronic obstructive pulmonary disease. National clinical guideline on management of chronic obstructive pulmonary disease in adults in primary and secondary care – Managing stable COPD. Thorax 2004, 59,, p. 139-130.
28. Poole, P.J. Black, P.N. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst, Rev. 2003, CD001287.
29. Poole, P.J., Black, P.N. Mucolytic agents for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2006, CD001287.
30. Gerrits, C.M., Herings, R.M., Leufkens, H.G. et al. N-acetylcysteine reduces the risk of re- hospitalisation among patients with chronic obstructive pulmonary disease. ERJ 2003, 21, p. 795-798.
Labels
General practitioner for children and adolescents General practitioner for adultsArticle was published in
General Practitioner
2009 Issue 10
Most read in this issue
- Recombinant human erythropoietin treatment
- A new clinical unit DSD – disorders of sexual development and their consequences
- Accreditation of general practitioners‘ surgeries in the Czech Republic
- Micrometastases in the sentinel lymph node – necessity of axillar lymph node dissection?