Comparison of Clinical Outcomes between Acetylcysteine and Ambroxol in Post Acute Exacerbation of COPD Patients
Main Article Content
Abstract
Literature studies show that the use of acetylcysteine or ambroxol can accelerate improvement of clinical outcomes of post acute exacerbation chronic obstructive pulmonary disease (AECOPD) patients. This study aims to compare the clinical outcomes of acetylcysteine and ambroxol administration in post AECOPD patients. The study was cohort design, prospective, to comparison of clinical outcomes of acetylcysteine and ambroxol with post AECOPD outpatients coming for clinical chekups in August 2023 at Respira Lung Hospital Yogyakarta. Clinical outcomes parameters were observed on day zero and thirty for CAT score and day zero and four for cough score. The patients were categorized into two groups: acetylcysteine group (n=30) and ambroxol group (n=30). There was no significant difference between two groups to change of CAT score and cough score (p>0.05) post AECOPD. The acetylcysteine group compared to ambroxol, there was a mean decrease in morning cough score -1.10±1.11 vs -0.87±1.12 (p=0.228), night cough score -1.53±1.43 vs -1.13±1.31 (p=0.438), and CAT score -2.43±5.45 vs -2.90±3.41 (p=0.391). Providing additional therapy of acetylcysteine or ambroxol in this study did not significantly reduce cough scores and CAT scores in post AECOPD patients.
Article Details
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
The authors retain the copyright and grant the journal the right of first publication simultaneously under the Creative Commons Attribution License. This license allows others to share the work with proper acknowledgment of authorship and initial publication in this journal. Authors are permitted and encouraged to deposit their articles in institutional repositories, on their personal websites, or in other online repositories after the article has been published in JSFK.
References
Kosasih A, Sutanto YS, Susanto AD, editors. Panduan Umum Praktek Klinis Penyakit Paru dan Pernapasan. Jakarta: Perhimpunan Dokter Paru Indonesia; 2021.
Kepmenkes RI. Tata Laksana Penyakit Paru Obstruktif Kronik. Jakarta: Menteri Kesehatan Republik Indonesia; 2019.
Kemenkes RI. Riset Kesehatan Dasar. Jakarta: Badan Penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia; 2013.
DiPiro JT, Yee GC, Posey LM, Haines ST, Nolin TD, Ellingrod V, editors. Pharmacotherapy: a Pathophysiologic Approach. 11th ed. New York: McGraw Hill Medical; 2020.
Rogliani P, Matera MG, Page C, Puxeddu E, Cazzola M, Calzetta L. Efficacy and Safety Profile of Mucolytic/Antioxidant Agents in Chronic Obstructive Pulmonary Disease: a Comparative Analysis Across Erdosteine, Carbocysteine, and N-acetylcysteine. Respir Res 2019;20:104. https://doi.org/10.1186/s12931-019-1078-y.
GOLD. Pocket Guide to COPD Diagnosis, Management, and Prevention a Guide for Health Care Professionals. United State: Global Initiative for Chronic Obstructive Lung Disease Inc; 2022.
Kolarov V, Stevuljevi JK, Ili M, Bogdan M, Tušek B, Agic A, et al. Factorial Analysis of N-acetylcysteine and Propolis Treatment Effects on Symptoms, Life Quality and Exacerbations in Patients with Chronic Obstructive Pulmonary Disease (COPD): a Randomized, Double-blind, Placebo-controlled Trial. European Review for Medical and Pharmacological Sciences 2022. https://doi.org/10.26355/eurrev_202205_28737.
Cazzola M, Rogliani P, Calzetta L, Hanania NA, Matera MG. Impact of Mucolytic Agents on COPD Exacerbations: A Pair-wise and Network Meta-analysis. COPD: Journal of Chronic Obstructive Pulmonary Disease 2017;14:552–63. https://doi.org/10.1080/15412555.2017.1347918.
Ansari SF, Memon M, Brohi N, Tahir A. N-acetylcysteine in the Management of Acute Exacerbation of Chronic Obstructive Pulmonary Disease. Cureus 2019;11:2–7. https://doi.org/10.7759/cureus.6073.
Malerba M, Ponticiello A, Radaeli A, Bensi G, Grassi V. Effect of Twelve-months Therapy with Oral Ambroxol in Preventing Exacerbations in Patients with COPD. Double-blind, Randomized, Multicenter, Placebo-Controlled Study. Pulmonary Pharmacology & Therapeutics 2004;17:27–34. https://doi.org/10.1016/j.pupt.2003.08.004.
Cazan D, Klimek L, Sperl A, Plomer M, Kölsch S. Safety of Ambroxol in the Treatment of Airway Diseases in Adult Patients. Expert Opinion on Drug Safety 2018;17:1211–24. https://doi.org/10.1080/14740338.2018.1533954.
Polkey M, Vogelmeier C, Dransfield M. COPD Assessment Test. COPD Assessment Test 2022. www.CATestonline.org (accessed March 28, 2023).
Decalmer SC, Webster D, Kelsall AA, McGuinness K, Woodcock AA, Smith JA. Chronic cough: how do cough reflex sensitivity and subjective assessments correlate with objective cough counts during ambulatory monitoring? Thorax Journal 2007;62:329–34. https://doi.org/10.1136/thx.2006.067413.
Sari CP, Hanifah S, Rosdiana R, Anisa Y. Efektivitas Pengobatan pada Pasien Penyakit Paru Obstruksi Kronis (PPOK) di Rumah Sakit Wilayah Yogyakarta. J Manaj dan Pelayanan Farm 2021;11:215. https://doi.org/10.22146/jmpf.56418.
Kwon J-W, Moon J-Y, Kim S-H, Song W-J, Kim M-H, Kang M-G, et al. Korean version of the Cough Symptom Score: clinical utility and validity for chronic cough. Korean J Intern Med 2017;32:910–5. https://doi.org/10.3904/kjim.2016.132.
Wang Z, Wang M, Wen S, Yu L, Xu X. Types and applications of cough-related questionnaires. J Thorac Dis 2019;11:4379–88. https://doi.org/10.21037/jtd.2019.09.62.
Han MK, Martinez FJ. Host, Gender, and Early-Life Factors as Risks for Chronic Obstructive Pulmonary Disease. Clinics in Chest Medicine 2020;41:329–37. https://doi.org/10.1016/j.ccm.2020.06.009.
Zhang Y, Wang L, Mutlu GM, Cai H. More to Explore: Further Definition of Risk Factors for COPD – Differential Gender Difference, Modest Elevation in PM2.5, and e-Cigarette Use. Front Physiol 2021;12:669152. https://doi.org/10.3389/fphys.2021.669152.
Walia GK, Vellakkal R, Gupta V. Chronic Obstructive Pulmonary Disease and its Non-Smoking Risk Factors in India. COPD: Journal of Chronic Obstructive Pulmonary Disease 2016;13:251–61. https://doi.org/10.3109/15412555.2015.1057807.
Kemenkes RI. Riset Kesehatan Dasar. Jakarta: Badan Penelitian dan Pengembangan Kementerian Kesehatan Republik Indonesia; 2018.
Bhatt SP, Kim Y, Harrington KF, Hokanson JE, Lutz SM, Cho MH, et al. Smoking duration alone provides stronger risk estimates of chronic obstructive pulmonary disease than pack-years. Thorax 2018;73:414–21. https://doi.org/10.1136/thoraxjnl-2017-210722.
Chang JT, Meza R, Levy DT, Arenberg D, Jeon J. Prediction of COPD risk accounting for time-varying smoking exposures. PLoS ONE 2021;16:e0248535. https://doi.org/10.1371/journal.pone.0248535.
Rey-Brandariz J, Pérez-Ríos M, Ahluwalia JS, Beheshtian K, Fernández-Villar A, Represas-Represas C, et al. Tobacco Patterns and Risk of Chronic Obstructive Pulmonary Disease: Results From a Cross-Sectional Study. Archivos de Bronconeumología 2023;59:717–24. https://doi.org/10.1016/j.arbres.2023.07.009.
Kim S-H, Park J-H, Lee J-K, Heo EY, Kim DK, Chung HS. Chronic obstructive pulmonary disease is independently associated with hypertension in men: A survey design analysis using nationwide survey data. Medicine 2017;96:e6826. https://doi.org/10.1097/MD.0000000000006826.
Chen H, Luo X, Du Y, He C, Lu Y, Shi Z, et al. Association between chronic obstructive pulmonary disease and cardiovascular disease in adults aged 40 years and above: data from NHANES 2013–2018. BMC Pulm Med 2023;23:318. https://doi.org/10.1186/s12890-023-02606-1.
Ko FW, Chan KP, Hui DS, Goddard JR, Shaw JG, Reid DW, et al. Acute exacerbation of COPD. Respirology 2016;21:1152–65. https://doi.org/10.1111/resp.12780.
Han MK. Patient Education: Chronic Obstructive Pulmonary Disease (COPD) treatments (Betond Basics). UpToDate 2023.
Poole P, Sathananthan K, Fortescue R. Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews 2019;2020. https://doi.org/10.1002/14651858.CD001287.pub6.
Cho PSP, Fletcher HV, Turner RD, Patel IS, Jolley CJ, Birring SS. The Relationship Between Cough Reflex Sensitivity and Exacerbation Frequency in Chronic Obstructive Pulmonary Disease. Lung 2020;198:617–28. https://doi.org/10.1007/s00408-020-00366-x.
Crooks MG, Den Brinker AC, Thackray-Nocera S, Van Dinther R, Wright CE, Morice AH. Domiciliary Cough Monitoring for the Prediction of COPD Exacerbations. Lung 2021;199:131–7. https://doi.org/10.1007/s00408-021-00435-9.
Papi A, Avdeev S, Calverley PMA, Cordeiro CR, Jesenak M, Koblížek V, et al. Use of mucolytics in COPD: A Delphi consensus study. Respiratory Medicine 2020;175:106190. https://doi.org/10.1016/j.rmed.2020.106190.
Papadopoulou E, Hansel J, Lazar Z, Kostikas K, Tryfon S, Vestbo J, et al. Mucolytics for Acute Exacerbations of Chronic Obstructive Pulmonary Disease: a Meta-analysis. Eur Respir Rev 2023;32:220141. https://doi.org/10.1183/16000617.0141-2022.
Zheng L. The Effect of Adjuvant Therapy with Ambroxol Hydrochloride in Elderly Chronic Obstructive Pulmonary Disease Patients. Am J Transl Res 2021. https://doi.org/PMID: 34540045; PMCID: PMC8430100.
Chen H, Zhou H, Luo C, Zong K, Fu Y, Li W, et al. Efficacy of treatment with N‐acetylcysteine inhalation for AECOPD: A propensity‐score‐matched cohort study. Clinical Respiratory J 2023;17:1038–47. https://doi.org/10.1111/crj.13690.
Dahlan MS. Statistik Untuk Kedokteran dan Kesehatan. 6th ed. Epidemologi Indonesia; 2020.
Cook N, Gey J, Oezel B, Mackay AJ, Kumari C, Kaur VP, et al. Impact of cough and mucus on COPD patients: primary insights from an exploratory study with an Online Patient Community. COPD 2019;Volume 14:1365–76. https://doi.org/10.2147/COPD.S202580.
Janjua S, Pike KC, Carr R, Coles A, Fortescue R. Interventions to improve adherence to pharmacological therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database of Systematic Reviews 2019. https://doi.org/10.1002/14651858.CD013381.