Poole PJ, Black PN
Department of Medicine, University of Auckland, Private Bag 92019,
Auckland, New Zealand.
BMJ 2001 May 26;322(7297):1271-4
Link zum Volltextartikel
Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary
disease: systematic review.
OBJECTIVE: To assess the effects of oral mucolytics in adults with
stable chronic bronchitis and chronic obstructive pulmonary disease.
DESIGN: Systematic review of randomised controlled trials that
compared at least two months of regular oral mucolytic drugs with
STUDIES: Twenty three randomised controlled trials in outpatients
in Europe and United States. MAIN OUTCOME MEASURES: Exacerbations,
days of illness, lung function, adverse events.
RESULTS: Compared with placebo, the number of exacerbations was
significantly reduced in subjects taking oral mucolytics (weighted
mean difference -0.07 per month, 95% confidence interval -0.08 to
-0.05, P<0.0001). Based on the annualised rate of exacerbations
in the control subjects of 2.7 a year, this is a 29% reduction.
The number needed to treat for one subject to have no exacerbation
in the study period would be 6. Days of illness also fell (weighted
mean difference -0.56, -0.77 to -0.35, P<0.0001). The number
of subjects who had no exacerbations in the study period was greater
in the mucolytic group (odds ratio 2.22, 95% confidence interval
1.93 to 2.54, P<0.0001). There was no difference in lung function
or in adverse events reported between treatments.
CONCLUSIONS: In chronic bronchitis and chronic obstructive pulmonary
disease, treatment with mucolytics is associated with a reduction
in acute exacerbations and days of illness. As these drugs have
to be taken long term, they could be most useful in patients who
have repeated, prolonged, or severe exacerbations of chronic obstructive
· Review, academic
PMID: 11375228, UI: 21268913
Tashkin D, Kanner R, Bailey W, Buist S, Anderson P, Nides M, Gonzales
D, Dozier G, Patel MK, Jamerson B
Division of Pulmonary and Critical Care Medicine, Department of
Medicine, UCLA School of Medicine, 90095, Los Angeles CA, USA. email@example.com
Lancet 2001 May 19;357(9268):1571-5
Smoking cessation in patients with chronic obstructive pulmonary
disease: a double-blind, placebo-controlled, randomised trial.
BACKGROUND: Tobacco smoking is associated with chronic obstructive
pulmonary disease (COPD) in more than 80% of cases. Our aim was
to investigate the effect of sustained-release bupropion (amfebutamone)
(SR) in promoting abstinence from smoking in patients with COPD.
METHODS: In a double-blind, randomised, placebo-controlled trial
404 individuals with mild or moderate COPD who smoked 15 or more
cigarettes per day, were assigned bupropion SR (150 mg twice daily)
or placebo for 12 weeks. All patients received smoking cessation
counselling. Study medication was taken for 1 week before patients
attempted to stop smoking. The primary efficacy endpoint was the
complete and continuous abstinence from smoking from the beginning
of week 4 to the end of week 7. Participants were followed up at
month 6. Analysis was by intention to treat.
FINDINGS: All patients were chronic smokers with a smoking history
of about 51 pack-years. Continuous smoking abstinence rates from
week 4 to 7 were significantly higher in participants receiving
bupropion SR than in those receiving placebo (28% [57/204] vs 16%
[32/200], p=0.003). Continuous abstinence rates from weeks 4 to
12 (18% [36/204] vs 10% [20/200]) and weeks 4 to 26 (16% [32/204]
vs 9% [18/200]) were also higher in participants receiving bupropion
SR than in those taking placebo (p<0.05). Furthermore, symptoms
of tobacco craving and withdrawal were attenuated in those receiving
bupropion SR. Seven individuals discontinued study medication because
of adverse events.
INTERPRETATION: Bupropion SRis a well-tolerated and effective aid
to smoking cessation in people with mild to moderate COPD.
· Clinical trial
· Multicenter study
· Randomized controlled trial
PMID: 11377644, UI: 21272983