- Prescribing Advice for GPs - https://www.prescriber.org.uk -

Carbocisteine may prevent COPD exacerbations

The Lancet has published the results of a study that aimed to assess the efficacy of carbocisteine in reducing the yearly exacerbation rate in patients with chronic obstructive pulmonary disease (COPD).

The study was conducted in 709 Chinese patients aged 40 to 80 years with a diagnosis of COPD. Participants were randomly assigned to treatment with 1500 mg carbocisteine or placebo per day for a year. The primary endpoint was COPD exacerbation.

The annual per-patient rate of exacerbation was 1.01 in the treated group compared to 1.35 in the placebo group. There was a statistically significant difference in the risk ratio (RR=0·75; 95% CI 0·62–0·92, p=0·004).

The authors conclude that, "mucolytics, such as carbocisteine, should be recognised as a worthwhile treatment for prevention of exacerbations" although this statement is qualified to Chinese patients. Further research is necessary to confirm whether this finding applies to other ethnic groups.

Action: Clinicians may wish to consider using mucolytics to reduce exacerbation rates in patients who are poorly controlled despite optimal therapy with other treatments.