Erdosteine is effective as a treatment for acute exacerbation of COPD: a systematic review of clinical trials
Introduction: Acute exacerbations of COPD (AECOPD) are characterised by a burst of airway and systemic inflammation with increased oxidative stress. Thiol donors evidenced beneficial effect on the systemic oxidative stress associated with AECOPD. Erdosteine is an original pro thiol agent, which works both as a mucolytic antioxidant with anti inflammatory activity in stable and AECOPD. Objective: To investigate the effect of Erdosteine in improving signs and symptoms in AECOPD compared to placebo. Methods: We specifically selected double blind, randomised, placebo controlled clinical trials primarily investigating the effect of Erdosteine in AECOPD with a treatment duration up to 10 days in association with standard therapy. Databases utilised Medline, Embase and Pubmed. Results: Five trials including 186 patients were obtained. Compared to baseline, Erdosteine induced a significant reduction of individual symptoms: it positively impacted on cough frequency 64+ 12% cough severity 60+ 9% sputum viscosity 37+ 9% sputum volume 24+ 3% and sputum purulence 51+ 5% All the reported differences were all significant versus control group. The effects on spirometry were significant vs placebo. The treatment with Erdosteine was overall well tolerated and no serious adverse events were reported. Conclusions: Treatment with Erdosteine plus standard therapy in AECOPD is effective by improving both clinical symptoms, and large airway impairment with a more rapid and complete recovery of exacerbation compared with placebo. Mucoactive agents with relevant antioxidant activity may allow a more rapid and complete recovery of exacerbated patients by reducing airway inflammation.