Erdosteine Erdosteine

Drugs 1996 Dec; 52 (6): 882 GUEST COMMENTARY 0012-6667/96/0012-0882/$01.00/0

Erdosteine particularly during acute infective exacerbation A Viewpoint by Margaret Wilsher of disease. These benefits need to be measured Respiratory Services, Green Lane Hospital, against the cost of these drugs and their tolerability Auckland, New Zealand profile. ... Cough and the production of mucoid, often vis cous, sputum are among the more distressing Erdosteine symptoms experienced by patients with chronic A Viewpoint by Carlo Felice Marchioni obstructive pulmonary disease (COPD). Although and Maurizio Moretti early studies failed to demonstrate a clear role for Institute of Lung Diseases, University School mucolytics in the management of COPD, larger of Medicine, Modena, Italy multi centre trials have shown clinical efficacy for Mucus hypersecretion due to bronchial gland some of these agents in reducing cough, improving enlargement and hyperplasia of mucosal cells is expectoration of sputum and reducing the inci one of the major mechanisms of airway obstruction dence of disease exacerbation. Improvement in in patients with chronic obstructive pulmonary dis physiological parameters of airflow limitation has ease (COPD), both in the stable phase of the dis been less convincingly demonstrated. Even newer ease and during an infective exacerbation. The pro agents with clear benefits in cystic fibrosis, such as duction of large amounts of mucus with increased dornase alfa, have yet to be shown to improve lung viscoelastic properties impairs airway clearance by function in COPD. the mucociliary system and the cough mechanism. Erdosteine is a thiol derivative ofthe same class Treatment with mucokinetic agents is indicated to as acetylcysteine, a mucolytic widely used in both enhance airway secretion clearance. its oral and nebulised form. It is of interest that both The new mucolytic agent erdosteine is a pro erdosteine and acetylcysteine have antioxidant drug which generates metabolites with free sulfhy properties which theoretically protect the lung dryl radicals; these are responsible for its pharma from oxidant damage, especially in those patients codynamic properties. Clinical studies have shown who continue to smoke. that erdosteine decreases sputum viscoelastic prop Erdosteine, like many mucolytics, appears to erties in both stable and acute COPD and that it improve sputum viscosity and sputum clearance. It increases mucociliary clearance in comparison has been shown, in a placebo-controlled trial, to with placebo. Erdosteine also promotes the pene increase the concentration of amoxicillin in the tration of amoxicillin into bronchial secretions, sputum of patients with an acute infective exacer favouring faster regression of symptoms of infec bation of COPD. Despite improving global clinical tion. These data support the use of erdosteine in the assessment indices, including sputum viscosity, treatment of acute infective exacerbation of COPD. cough and dyspnoea, no improvement in lung func Moreover, erdosteine metabolites are able to tion could be demonstrated with erdosteine in these scavenge oxygen-free radicals and thereby protect patients. Nevertheless, symptoms resolved more the efficacy of (Xl-antitrypsin. The metabolites also quickly in the active treatment group and the drug exert an anti-inflammatory effect by reducing mu was well tolerated. cus markers of bronchial inflammation in stable There are now a number of mucolytic agents chronic bronchitis. These pharmacodynamic prop available for physicians to consider for use in the erties highlight the importance of long term treat management of COPD. Whilst clear evidence of ment with erdosteine in patients with COPD and, their relative efficacy in improving lung function indeed, erdosteine has been shown to decrease the remains lacking, symptoms such as cough and spu number of acute exacerbations after 6 months' ther tum production may be improved in some patients, apy....