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Wednesday, December 22, 2010

The latest wisdom on mucolytics

We don't see much mucomyst being ordered anymore here at Shoreline. Of all the days I've worked, I can only remember one patient since January who was ordered to get 1cc of Mucomyst with every other breathing treatment.

This observation of mine makes sence, considering a recent review of Mucomyst, according to this, "Best Evidence Review: Mucolytics -- An Update on Their Use in COPD: Discussion," notes that the rate of Mucolytic (such as Mucomyst) has declined by as much as 50% since a previous review in 1996.

The reason for this, as the article notes, "Two significant factors may have contributed to the apparent decrease in efficacy of mucolytics over the years. First, the quality of the studies has improved, with larger trials completed recently. Second, the routine use of inhaled corticosteroids may have blunted the effect of mucolytics in improving COPD outcomes."

Still, studies have consistently shown that the use of mucolytics may reduce the risk of COPD exacerbations by as much as 56%, and "significantly effective in reducing patient symptoms," according to the review.

The article concludes that, "Nonetheless, mucolytics can be a safe, effective, and inexpensive option to improve chronic bronchitis and COPD. The collective research suggests that mucolytics do not need to be used year-round. They might be most effective among more symptomatic patients and used in anticipation of more exacerbations during the winter. Mucolytics might also be particularly helpful for patients who are intolerant of inhaled corticosteroids or have difficulty with handheld inhalers. Overall, mucolytics deserve consideration to improve the lives of patients with COPD and chronic bronchitis."

I know we RTs tend to complain when the pulmonary toilet is ordered, yet there continues to be supportive evidence that at least Mucomyst shows some merit as an effective therapy for treating COPD patients.

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