Mucus and mucoactive therapy in chronic bronchitis

Bruce K. Rubin, Cees P. Van Der Schans, Chikako Kishioka, Anthony R. Dowell, Stanley Fiel

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

Mucus retention is usually due to both hypersecretion and impaired clearance. Infected secretions induce inflammation, and this cart further damage the airway. To break this cycle, efforts are made to reduce the secretion burden. To choose appropriate therapy, it is important to understand the secretion properties and the mechanism of action of mucoactive medications. Expectorants are postulated to increase the volume or hydration of airway secretions. Systemic hydration and classic expectorants have not been shown to be clinically effective. Modifiers of airway water transport including tricyclic nucleotides are now being investigated as expectorants. Mucolytics degrade polymers in secretions. Classic mucolytics have free thiol groups to degrade mucin and peptide mucolytics break pathologic filaments of neutrophil-derived DNA and actin in sputum. These appear to be effective in chronic inflammatory airway diseases. Mucokinetics are agents that increase mucociliary or cough efficiency. Cough flow can be increased by bronchodilators in patients with airway hyperreactivity. Abhesives such as surfactants decrease epithelial-mucus attachment, augmenting both cough and mucociliary clearance. Mucoregulatory agents reduce the volume of mucus secretion and seem to be especially effective in hypersecretory states such as bronchorrhea and panbronchiolitis. These medications include antiinflammatory agents, anticholinergic agents, and some macrolide antibiotics. Patients most likely to benefit from mucoactive therapy usually have a history of increased sputum expectoration and preserved airflow. With the possible exception of external chest wall oscillation, most clearance assistive devices and mucoactive medications seem to be less beneficial in patients with severe lung disease. However, therapeutic efficacy can be difficult to assess in an individual patient. When the patient feels better and there is an improved airflow, benefit is clear. The expectorated sputum volume relates poorly, at best, to improvement in pulmonary function or the clinical status of the patient. There is significant controversy regarding clinically relevant outcome measurement for clinical trials of mucoactive agents.

Original languageEnglish (US)
Pages (from-to)1-14
Number of pages14
JournalClinical Pulmonary Medicine
Volume5
Issue number1
DOIs
StatePublished - Jan 1 1998

Fingerprint

Expectorants
Chronic Bronchitis
Mucus
Sputum
Cough
Chest Wall Oscillation
Therapeutics
Epithelial Attachment
Mucociliary Clearance
Self-Help Devices
Bronchodilator Agents
Macrolides
Cholinergic Antagonists
Mucins
Sulfhydryl Compounds
Surface-Active Agents
Lung Diseases
Actins
Polymers
Neutrophils

All Science Journal Classification (ASJC) codes

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

Cite this

Rubin, Bruce K. ; Van Der Schans, Cees P. ; Kishioka, Chikako ; Dowell, Anthony R. ; Fiel, Stanley. / Mucus and mucoactive therapy in chronic bronchitis. In: Clinical Pulmonary Medicine. 1998 ; Vol. 5, No. 1. pp. 1-14.
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Rubin, BK, Van Der Schans, CP, Kishioka, C, Dowell, AR & Fiel, S 1998, 'Mucus and mucoactive therapy in chronic bronchitis', Clinical Pulmonary Medicine, vol. 5, no. 1, pp. 1-14. https://doi.org/10.1097/00045413-199801000-00001

Mucus and mucoactive therapy in chronic bronchitis. / Rubin, Bruce K.; Van Der Schans, Cees P.; Kishioka, Chikako; Dowell, Anthony R.; Fiel, Stanley.

In: Clinical Pulmonary Medicine, Vol. 5, No. 1, 01.01.1998, p. 1-14.

Research output: Contribution to journalReview article

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