From the Guidelines
Medications to decrease mucous excess in patients with recurrent infections in the lungs include inhaled antibiotics such as colistin, gentamicin, and macrolides like azithromycin or erythromycin, as recommended by the British Thoracic Society guideline for bronchiectasis in adults 1. To manage excessive mucous production, it's essential to consider the underlying cause, such as chronic Pseudomonas aeruginosa infection.
- Inhaled colistin is a first-line treatment for patients with bronchiectasis and chronic P. aeruginosa infection, as it has been shown to be effective in reducing bacterial load and improving symptoms 1.
- Inhaled gentamicin can be considered as a second-line alternative to colistin for patients who do not tolerate or respond to colistin 1.
- Macrolides like azithromycin or erythromycin can be used as an alternative or additive treatment to inhaled antibiotics for patients with bronchiectasis and chronic P. aeruginosa infection, particularly those with a high exacerbation frequency 1. In addition to these medications, other treatments such as mucolytics, expectorants, and anti-inflammatory agents may be used to enhance bronchodilation and improve mucociliary clearance, as well as to prevent and treat recurrent infection 1.
- Mucolytic agents like N-acetylcysteine can help break down mucus, while expectorants like guaifenesin can increase respiratory tract fluid to thin mucus.
- Anti-inflammatory agents like inhaled corticosteroids can reduce airway inflammation, and bronchodilators like albuterol can help open airways and facilitate mucus clearance. It's crucial to note that the goal of treatment is to improve symptoms, prevent the progression of airway damage, and enhance health-related quality of life, rather than just focusing on reducing sputum production or clearing radiolabeled aerosol from the lung 1.
From the FDA Drug Label
bromhexine The medication bromhexine is used to decrease mucous excess 2.
From the Research
Medications for Excessive Mucous Production
To address excessive mucous production causing recurrent infections in the lungs, several medications can be considered:
- Dornase alfa: This mucolytic agent has been shown to reduce pulmonary exacerbations and improve lung function in patients with cystic fibrosis 3.
- Bromhexine: High doses of bromhexine, combined with antibiotics, may help with sputum production and clearance in patients with bronchiectasis 4.
- Erdosteine: This mucolytic agent may be a useful adjunct to physiotherapy in stable patients with mucus hypersecretion, although robust longer-term trials are required 4.
- N-acetylcysteine: Although its effectiveness as a mucolytic agent in cystic fibrosis is debated 3, N-acetylcysteine may be beneficial in other chronic inflammatory and fibrotizing respiratory diseases due to its antioxidative and anti-inflammatory effects 5.
- Recombinant human DNase (RhDNase): While effective in cystic fibrosis, RhDNase should be avoided in non-cystic fibrosis bronchiectasis due to potential harmful effects 4.
Inhaled Antibiotics
In addition to mucolytic agents, inhaled antibiotics can be used to treat lung infections in patients with cystic fibrosis: