Does carbocisteine have a role in the treatment of Chronic Obstructive Pulmonary Disease (COPD) or other chronic lung diseases?

From the Guidelines

Carbocisteine has a potential role in the treatment of Chronic Obstructive Pulmonary Disease (COPD) in reducing acute exacerbations.

Key Points

• The American College of Chest Physicians and Canadian Thoracic Society guideline suggests that oral carbocysteine could be used to prevent acute exacerbations of COPD where this therapy is available 1.
• A study published in the journal Chest found that carbocysteine reduced the number of exacerbations in patients with COPD compared to placebo, with a significant reduction in exacerbations after 6 months of therapy 1.
• The European Respiratory Society/American Thoracic Society guideline states that mucolytic therapy, including carbocisteine, reduces the likelihood of hospitalization and may also reduce COPD exacerbations 1.
• The Global Initiative for Chronic Obstructive Lung Disease (GOLD) report suggests that regular treatment with mucolytics, such as carbocysteine, may reduce exacerbations and modestly improve health status in patients not receiving inhaled corticosteroids 1.

Mechanism of Action

• Carbocisteine is a mucolytic agent that reduces sputum viscosity and increases mucociliary transport, making it easier for patients to clear mucus from their airways.

Important Considerations

• The evidence for the use of carbocisteine in COPD is not yet conclusive, and more research is needed to fully establish its benefits and potential side effects.
• Carbocisteine may be beneficial in reducing acute exacerbations of COPD, but its effect on mortality and quality of life is not well established 1.

From the FDA Drug Label

ACETYLCYSTEINE AS A MUCOLYTIC AGENT CLINICAL PHARMACOLOGY The viscosity of pulmonary mucous secretions depends on the concentrations of mucoprotein and, to a lesser extent, deoxyribonucleic acid (DNA). INDICATIONS AND USAGE Acetylcysteine is indicated as adjuvant therapy for patients with abnormal, viscid, or inspissated mucous secretions in such conditions as: Chronic bronchopulmonary disease (chronic emphysema, emphysema with bronchitis, chronic asthmatic bronchitis, tuberculosis, bronchiectasis and primary amyloidosis of the lung)

The drug label does not mention carbocisteine, it mentions acetylcysteine. However, based on the information provided about acetylcysteine, it can be inferred that a mucolytic agent may have a role in the treatment of Chronic Obstructive Pulmonary Disease (COPD) or other chronic lung diseases.

• Key points:
  • Mucolytic agents can help reduce the viscosity of pulmonary mucous secretions.
  • Acetylcysteine is indicated for use in patients with abnormal, viscid, or inspissated mucous secretions in conditions such as chronic bronchopulmonary disease. However, without direct information about carbocisteine, no conclusion can be drawn about its specific role in the treatment of COPD or other chronic lung diseases 2.

From the Research

Role of Carbocisteine in COPD Treatment

• Carbocisteine is a muco-active drug with free radical scavenging and anti-inflammatory properties, approved for clinical use as adjunctive therapy of respiratory tract disorders characterized by excessive, viscous mucus, including chronic obstructive airways disease (COPD) 3.
• It has been recognized as an effective and safe treatment for the long-term management of COPD, able to reduce the incidence of exacerbations and improve patient quality of life 3, 4, 5.

Mechanism of Action

• The antioxidant and anti-inflammatory properties of carbocisteine are more important than mucolysis itself for its therapeutic efficacy 3.
• Carbocisteine can modify circulating miR-21, IL-8, sRAGE, and fAGEs levels in mild acute exacerbated COPD patients, and improve symptoms, FEV1 and FEF25-75% 6.
• It exhibits free-radical scavenging and anti-inflammatory properties, which have stimulated interest in the potential that this and other mucoactive drugs may offer for modification of the disease processes present in COPD 7.

Clinical Evidence

• A randomised, double-blind, placebo-controlled study of 709 patients with COPD found that carbocisteine reduced the yearly exacerbation rate, with a risk ratio of 0.75 (95% CI 0.62-0.92, p=0.004) 4.
• An observational study of 85 out-patients with COPD found that daily administration of carbocisteine for 12 months reduced exacerbation frequency and improved quality of life 5.
• Another study found that carbocisteine improved symptoms, FEV1 and FEF25-75%, increased sRAGE, and reduced miR-21, IL-8, and fAGEs in mild AECOPD patients 6.