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Cost containment in the EU: an overview
Published in Elias Mossialos, Julian Le Grand, Health Care and Cost Containment in the European Union, 2019
Elias Mossialos, Julian Le Grand
There were, however, additional effects which diminished the extent to which financial savings were achieved. It was estimated that deletion of cough and cold preparations was associated with a threefold increase in the prescription of carbocisteine (a mucolytic agent of doubtful efficacy) which was retained on the list. Similarly the exclusion of antacids from the list resulted in a major rise in prescriptions for H2-histamine antagonists.101
Information on level of drugs into breastmilk
Published in Wendy Jones, Breastfeeding and Medication, 2018
Carbocisteine is used for its mucolytic activity in respiratory disorders associated with productive cough. Mucolytics may be useful in some patients with COPD but such use is unlikely in the age group generally considered to be breastfeeding mothers.
Management
Published in Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay, COPD in Primary Care, 2018
Anita Sharma, David Pitchforth, Gail Richards, Joyce Barclay
These agents affect mucus-producing cells and reduce hyper-secretion and viscosity of secretions, thus aiding the elimination of mucus.They can be used in patients in whom cough and sputum are troublesome, and in those who suffer from frequent exacerbations (at least two per year).Start with a high dose of carbocisteine, i.e. three 375 mg capsules twice daily. Once a satisfactory response has been achieved (e.g. after 4–6 weeks), reduce to a lower maintenance dose of two capsules twice daily.
Management of COPD patients during COVID: difficulties and experiences
Published in Expert Review of Respiratory Medicine, 2021
Mario Cazzola, Josuel Ora, Andrea Bianco, Paola Rogliani, Maria Gabriella Matera
N-acetylcysteine, carbocysteine, and erdosteine are thiol-based drugs that significantly reduce the risk of AECOPD [62]. Although thiol-based drugs are considered mucolytic agents, they induce multiple other effects ranging from the antioxidant activity that is carried out by delivering sulfhydryl moieties and restoring the levels of intracellular glutathione, to those anti-inflammatory, antibacterial, which manifests itself through the reduction of bacterial adhesion to the surface of respiratory epithelial cells and the biofilm disruption that leads to greater efficacy of antibiotic therapy, and antiviral, which is expressed by influencing viral replication and infectivity [63]. Because of these pharmacological actions, N-acetylcysteine has the potential to attenuate the risk of developing COVID-19 [64].
The pharmacological management of asthma-chronic obstructive pulmonary disease overlap syndrome (ACOS)
Published in Expert Opinion on Pharmacotherapy, 2020
Timothy E. Albertson, James A. Chenoweth, Skyler J. Pearson, Susan Murin
A large clinical trial of 1006 Chinese patients with moderate-to-severe COPD studied the effects of 600 mg twice daily oral NAC versus placebo (the PANTHEON trial) [80]. A RR of 0.78 (95% CI 0.67–0.90, P = 0.0011) was found for COPD exacerbations in those patients on oral NAC after one year. Several other Chinese studies using oral NAC in the treatment of COPD patients have shown promising results [79]. In a pair-wise, network meta-analysis, Cazzola [81] found that 1200 mg/day of NAC was associated with reduced COPD exacerbations compared to placebo (odds ratio (OR) 0.56, 65% CI 0.35–0.92, P < 0.05). The lower dose of NAC (600 mg/day) and similar compounds including carbocisteine and erdosteine either failed to demonstrate improvement or failed to reach a statistically significant level of improvement in the reduction in the frequency of COPD exacerbation [81]. No significant clinical data on the use of these mucolytic agents on asthma or ACOS exacerbations were found.
Challenges in the management of asthma associated with smoking-induced airway diseases
Published in Expert Opinion on Pharmacotherapy, 2018
Oxidative stress is implicated in the pathogenesis of COPD [78] and asthma [79]. Exposure to tobacco smoke is a major exogenous factor inducing oxidative stress. Small molecule thiol drugs, such as N-acetyl-L-cysteine (NAC), carbocisteine, and erdosteine decrease oxidant activity and reduce disulphide bonds in mucus glycoproteins to produce mucolytic effects. Thiol compounds, particularly NAC, reduce symptoms of chronic bronchitis and mild exacerbations of COPD and produce small improvements in quality of life [80–83]. The benefits of thiol drugs could be due to their mucolytic properties alone or to a combination of antioxidant and mucolytic actions. Evidence is lacking for effectiveness of thiols drugs in the treatment of asthma, particularly in individuals with chronic bronchitis. Future clinical trials need to assess the efficacy of thiol compounds in current and former smokers with asthma or ACO who have symptoms of chronic bronchitis [6,63].