Subject: An observational, cross-sectional survey to assess role of mucolytics in routine clinical practice
Asthma and Chronic Obstructive Pulmonary Disease (COPD) are major health problems globally. These are indicated as different diseases with similar epidemiological features as well as pathophysiological mechanisms.
Asthma is a very common disease in worldwide population, in which almost 1 in 10 children and 1 in 12 adults are affected. According to Global Asthma Report 2018, 339 million people are affected worldwide. Asthma is a chronic inflammatory disease characterized by bronchial hyper-reactivity (BHR) which leads to overproduction of mucus, airway narrowing and airway wall remodelling by reacting to non-specific stimuli (such as exercise and cold air) on smooth muscle cells in people with asthma. COPD is a chronic respiratory disease characterized by progressive and irreversible airway obstruction and is one of the major cause of morbidity and mortality worldwide. The most commonly encountered risk factor for COPD, which is the fourth leading cause of death, is cigarette smoking, although in most countries, air pollution resulting from the burning of wood and other biomasses fuels has also been considered as a COPD risk factor.
According to GINA (Global Initiative for Asthma), the goal of treatment in ASTHMA is to: achieve total control and to reduce inflammation. The goal of treatment in COPD is to: prevent exacerbations, reduce symptoms and decrease mortality. Methylxanthines are included in the category of controller drugs in the GINA guidelines. Clinicians commonly use various pharmacological treatments in the management of COPD and asthma to relieve symptoms, improve quality of life, enhance exercise tolerance, prevent and treat exacerbations. The main strategy to be considered in the pharmacological treatment of COPD and asthma are bronchodilators; short-acting bronchodilators (β -agonist and anti- cholinergics) are given as first-line treatment and long-acting bronchodilators can be given in more symptomatic patients with greater functional impact. Acebrophylline has been widely used as an inexpensive oral treatment of asthma and COPD. Previously, this drug was known to have long clinical effectiveness to bronchodilation, however it also showed to have anti-inflammatory actions.8 Acebrophylline have been developed with the expectation that such drugs would have greater potency than theophylline, but with an improved side effect profile.
Airway mucus hypersecretion is one of the prominent features of severe respiratory diseases including asthma and COPD. Pharmacological approach for relieving mucus accumulation in airways currently involves several classes of agents, including mucolytics. Mucolytics have gained importance as the drugs that can degrade the mucin polymers of mucus gel, and by reducing the viscosity and elasticity of mucus are thought to increase the mucus expulsion, either by ciliary movement or cough reflex. Best known of these agents is N-acetylcysteine (NAC).
Thus the combination of acebrophylline and NAC may prove beneficial in respiratory conditions including asthma and COPD but there is scarce evidence to support this. Hence our study aims to analyse the role of Acebrophylline plus N Acetylcysteine in respiratory conditions.
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