Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject: An observational cross-sectional survey study to understand the treatment pattern of Chronic Mucus Hypersecretion (CMH) and the potential role of Acebrophylline + N-Acetylcysteine in the management of mucus hypersecretion.

Chronic obstructive pulmonary disease (COPD) is a major health problem globally. These are indicated as different diseases with similar epidemiological features as well as pathophysiological mechanisms.¹

COPD is a chronic respiratory disease characterized by progressive and irreversible airway obstruction and is one of the major causes of morbidity and mortality worldwide.¹ 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.²

The goal of treatment in COPD is to: prevent exacerbations, reduce symptoms and decrease mortality. Clinicians commonly use various pharmacological treatments in the management of COPD 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 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.^3,4 Acebrophylline has been widely used as an inexpensive oral treatment of asthma, and COPD.^3,5 Previously, this drug known to have long clinical effectiveness to bronchodilation, however it also showed to have anti-inflammatory actions.^3,6 Acebrophylline have been developed with the expectation that such drugs would have greater potency than theophylline, but with an improved side effect profile.³

Airway mucus hypersecretion is one of the prominent features of severe respiratory diseases including asthma and COPD.⁷ Pharmacological approach for relieving mucus accumulation in airways currently involves several classes of agents, including mucolytics.

Tracheobronchial mucus contributes significantly to the symptoms of chronic obstructive pulmonary disease (COPD) and is a defining feature of the condition, Chronic mucus hypersecretion(CMH) is a major cause of airflow obstruction in COPD. Is associated with increased mortality, an accelerated decline of forced expiratory volume in one second (FEV1), reduced quality of life, and increased risk of exacerbations and hospitalizations.⁸

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).⁹

Thus the combination of acebrophylline and NAC may prove beneficial in respiratory conditions including COPD but there is scarce evidence to support this. Hence our study to understand the treatment pattern of Chronic Mucus Hypersecretion (CMH) and the potential role of Acebrophylline + N-Acetylcysteine in the management of mucus hypersecretion.

We trust you and we are partners in providing safe and effective drug therapy. In that spirit, we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for the accuracy of records.