CLINICAL AND IMMUNOLOGICAL EFFECTS OF CARBOCYSTEINE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Cover Page


Cite item

Full Text

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is one of the commonest diseases characterized by persistent distal airways inflammation. Thus, anti-inflammatory therapy should be the basis of COPD treatment. There is only limited evidence supporting the efficacy of mucolytics like carbocysteine in the preventing COPD exacerbations in inhaled corticosteroid-naïve patients. Aim: To study clinical and immunological effects of carbocysteine in COPD. Materials and methods: During first 2 months, 30 patients with stage II COPD (mean age 55.9±1.2  years old) were treated with inhaled glucocorticosteroids and beta2-adrenoceptor agonists ‘as required’. Thereafter, the standard therapy was continued in 15 patients; in other 15 patients carbocysteine 1500 mg/day was added. Immune status was studied bi-monthly in all patients: to detect lymphocytes with expression of CD3, CD4, CD8, CD72-antigens and CD23, CD71, CD95 and HLA-DR activation markers, monoclonal antibodies were used. Quality of life was assessed using adapted Russian version of St. George’s Respiratory Questionnaire (SGRQ). Results: Compared with the anti-inflammatory therapy, adding carbocysteine to standard therapy of COPD was associated with significantly better quality of life after 4 months of therapy (less negative changes of symptoms and activity scores and improvement of psycho-social function: changes of relevant SGRQ scores were -3.4 and -8.0; -1.9 and -3.8; 0.4 and -0.76, respectively). After 4 months, carbocysteine-treated patients demonstrated better improvements in shortness of breath, cough and sputum scores compared with the control group (2 and 2.2; 1.5 and 1.9; 0.8 and 1.2, respectively). In carbocysteine group, clinical symptoms improvement correlated with positive changes of immunological status. The patients demonstrated greater significant elevation of total T-lymphocytes (especially CD8+-cells), decreased B-cells and increased expression of CD95-antigen compared with the standard therapy group. Conclusion: Carbocysteine may be recommended as an obligate part of therapy in COPD patients.

About the authors

E. G. Shuganov

Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation

Author for correspondence.
Email: shuganov.evgeny@yandex.ru
MD, PhD, Professor, Internal Diseases Department, Postgraduate Medical School Russian Federation

Zh. M. Salmasi

N.I. Pirogov Russian National Research Medical University; 1 Ostrovityanova ul., Moscow, 117997, Russian Federation

Email: fake@neicon.ru
MD, PhD, Professor, Department of Pathophysiology and Clinical Pathophysiology Russian Federation

A. E. Shuganov

Fellow, Internal Diseases Department, Postgraduate Medical School

Email: fake@neicon.ru
Moscow Regional Research and Clinical Institute (MONIKI); 61/2 Shchepkina ul., Moscow, 129110, Russian Federation Russian Federation

References

  1. Глобальная стратегия диагностики, лечения и профилактики хронической обструктивной болезни легких (пересмотр 2011 г.). [Пер. с англ.]. М.: Российское респираторное общество; 2012. 80 с. (Global Initiative for Chronic Obstruction Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease (Updated 2011). Moscow: Rossiyskoe respiratornoe obshchestvo; 2012. 80 p. Russian).
  2. Шмелев ЕИ. Хронический обструктивный бронхит. В: Чучалин АГ, ред. Хронические обструктивные болезни легких. М.: Бином; 1998. с. 39–56.
  3. (Shmelev EI. Сhronic obstructive bronchitis. In: Chuchalin AG, editor. Chronic lung diseases. Moscow: Binom; 1998. p. 39–56. Russian).
  4. Jones PW. Quality of life measurements; the value of standartization. Eur Respir Rev. 1997;7(42):46–9.
  5. Jones PW. Quality of life measurement for patients with diseases of the airways. Thorax. 1991;46(9):676–82.
  6. Gan WQ, Man SF, Senthilselvan A, Sin DD. Association between chronic obstructive pulmonary disease and systemic inflammation: a systematic review and a meta-analysis. Thorax. 2004;59(7):574–80.
  7. Saetta M, Di Stefano A, Turato G, Facchini FM, Corbino L, Mapp CE, Maestrelli P, Ciaccia A, Fabbri LM. CD8+ T-lymphocytes in peripheral airways of smokers with chronic obstructive pulmonary disease. Am J Respir Crit Care Med. 1998;157(3 Pt 1):822–6.
  8. Montes de Oca M. Impact of chronic bronchitis on chronic obstructive pulmonary disease. Hot Topics Respir Med. 2010;5(15):13–7.
  9. Мещерякова НН, Чикина СЮ. Муколитиче-ская терапия для больных ХОБЛ. Consilium medicum. 2008;10(10):71–6.(Meshcheryakova NN, Chikina SYu. [Mucolytic therapy in COPD]. Consilium medicum. 2008;10(10):71–6. Russian).
  10. Зильбер ИЕ, Распопина НА, Шуганов АЕ, Салмаси ЖМ, Казимирский АН. Анализ активационного профиля лимфоцитов у больных ХОБЛ в период ремиссии и обострения. Земский врач. 2012;(1):42–5. (Zil’ber IE, Raspopina NA, Shuganov AE, Salmasi ZhM, Kazimirskiy AN. [The analysis of a profile of lymphocyte activation in patients with chronic obstructive pulmonary disease exacerbation and remission]. Zemskiy vrach. 2012;(1):42–5. Russian).
  11. Порядин ГВ, Салмаси ЖМ, Зильбер ИЕ. Особенности поверхностного фенотипа лимфоцитов при ХОБЛ. В: Материалы Х Международного конгресса «Современные проблемы аллергологии, иммунологии и иммунофармакологии». Казань, 20–23 мая 2009 г. с. 304. (Poryadin GV, Salmasi ZhM, Zil’ber IE. Characteristic of surface lymphocytes phenotype in COPD. In: Proceedings of the X International Congress “Contemporary issues of allergology, immunology and immunopharmacology”; 2009 May 20–23; Kazan, Russia. p. 304. Russian).
  12. Порядин ГВ, Салмаси ЖМ, Макарков АИ. Механизмы регуляции экспрессии поверхностных структур дифференцированного лимфоцита. Иммунология. 1997;(3): 4–8. (Poryadin GV, Salmasi ZhM, Makarkov AI. [Surface structures expression regulatory mechanisms in differentiated lymphocyte]. Immunologiya. 1997;(3):4–8. Russian).
  13. Фримель Г, ред. Иммунологические методы. [Перевод с нем.]. М.: Медицина; 1987. 472 с. (Friemel H, editor. Immunological working methods. Moscow: Meditsina; 1987. 472 p. Russian).
  14. Chung KF. Measurement and assessment of cough and of the cough reflex. Eur Respir Rev. 2002;12(85):226–30.
  15. Клячкина ИЛ. Еще раз о муколитиках. Consilium medicum. 2008;10(3):124–8. (Klyachkina IL. [Mucolytics revisited]. Consili-um medicum. 2008;10(3):124–8. Russian).
  16. Овчаренко СИ. Муколитические (мукорегуляторные) препараты в лечении хронической обструктивной болезни легких. Русский медицинский журнал. 2002;10(4):153–7. (Ovcharenko SI. [Mucolytic (mucoregulatory) agents in the treatment of chronic obstructive pulmonary disease]. Russkiy meditsinskiy zhurnal. 2002;10(4):153–7. Russian).
  17. Yasuda H, Yamaya M, Sasaki T, Inoue D, Nakayama K, Tomita N, Yoshida M, Sasaki H. Carbocisteine reduces frequency of common colds and exacerbations in patients with chronic obstructive pulmonary disease. J Am Geriatr Soc. 2006;54(2):378–80.
  18. Синопальников АИ, Клячкина ИЛ. Место муколитических препаратов в комплексной терапии болезней органов дыхания. Российские медицинские вести. 1997;2(4): 9–18. (Sinopal’nikov AI, Klyachkina IL. [The role of mucolytic agents in the comprehensive treatment of respiratory diseases]. Rossiyskie meditsinskie vesti. 1997;2(4):9–18. Russian).
  19. Самсыгина ГА. Современные муколитические средства: вопросы выбора терапии. Фарматека. 2005;(2):7. (Samsygina GA. [Modern mucolytic agents: the problem of treatment choice]. Farmateka. 2005;(2):7. Russian).
  20. Yamaya M, Yasuda H, Yoshida M, Nishimura H, Nakayama K. Treatment and prevention of COPD exacerbation. Nihon Rinsho. 2007;65(4):734–9.
  21. Zheng JP, Kang J, Huang SG, Chen P, Yao WZ, Yang L, Bai CX, Wang CZ, Wang C, Chen BY, Shi Y, Liu CT, Chen P, Li Q, Wang ZS, Huang YJ, Luo ZY, Chen FP, Yuan JZ, Yuan BT, Qian HP, Zhi RC, Zhong NS. Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study. Lancet. 2008;371(9629):2013–8.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 Shuganov E.G., Salmasi Z.M., Shuganov A.E.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies