Claudia Stey, MD
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Stey C.; Acute Exacerbations of Chronic Obstructive Pulmonary Disease. Ann Intern Med. 2002;136:556-557. doi: 10.7326/0003-4819-136-7-200204020-00020
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Published: Ann Intern Med. 2002;136(7):556-557.
TO THE EDITOR:
I read the position paper on acute exacerbations of chronic obstructive pulmonary disease (COPD) with great interest (1, 2). The statement that mucolytic medications are not beneficial needs further comment. The authors failed to mention a Cochrane review that primarily discussed the preventive effect of mucolytic agents on exacerbations but also showed that mucolytic therapy was associated with a significant reduction in days of disability (0.65 day per patient per month) and days of treatment with antibiotics (0.68 day per patient per month) (3). Furthermore, the authors did not consider N-acetylcysteine, which is a thiol-containing substance that may act as an anti-inflammatory drug. In our systematic review of randomized, controlled trials of N-acetylcysteine (4), my colleagues and I used a validated score to evaluate the quality of each study before including it in our analysis (5). Eleven of 39 retrieved trials were included, 9 of which addressed prevention of exacerbation and 5 of which addressed improvement of symptoms. With N-acetylcysteine, 61.4% of patients reported improved symptoms compared with 34.6% of patients receiving placebo (relative benefit, 1.78 [95% CI, 1.54 to 2.05]) (4). On the basis of the published data, the position paper's recommendations regarding mucolytics do not reflect the best available evidence.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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