What are the treatment options for cough and mucous expectoration in Chronic Obstructive Pulmonary Disease (COPD)?

From the Guidelines

Treatment of cough and mucous expectoration in COPD should focus on bronchodilators, mucoactive agents, and anti-inflammatory medications, with first-line therapy including long-acting bronchodilators such as tiotropium or salmeterol, as recommended by the Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Lung Disease 2017 report 1. The goal of treatment is to minimize the negative impact of the current exacerbation and to prevent subsequent events. Key points to consider in the treatment of cough and mucous expectoration in COPD include:

• The use of short-acting inhaled β2-agonists, with or without short-acting anticholinergics, as initial bronchodilators to treat an acute exacerbation 1
• The initiation of maintenance therapy with long-acting bronchodilators as soon as possible before hospital discharge 1
• The use of systemic corticosteroids to improve lung function, oxygenation, and shorten recovery time and hospitalization duration 1
• The use of antibiotics, when indicated, to shorten recovery time and reduce the risk of early relapse, treatment failure, and hospitalization duration 1
• The avoidance of methylxanthines due to side effects 1 Some studies suggest that mucokinetic agents and inhaled corticosteroids may not be effective in controlling cough in patients with chronic bronchitis 1. However, combined therapy with a long-acting β-agonist and an inhaled corticosteroid has been shown to reduce the exacerbation rate in patients with COPD and also to reduce cough in long-term trials in patients 1. It is essential to consider the individual patient's needs and medical history when selecting a treatment plan. Adequate hydration and airway clearance techniques can also enhance mucus clearance and improve symptoms. Overall, the treatment of cough and mucous expectoration in COPD requires a comprehensive approach that addresses the underlying inflammation, reduces mucus hypersecretion, and improves ciliary function to facilitate expectoration, ultimately improving symptoms and quality of life for COPD patients.

From the FDA Drug Label

The primary efficacy endpoint was the rate of moderate to severe exacerbations during the first year of treatment, defined as worsening of COPD symptoms (dyspnea, cough, sputum) for at least 2 consecutive days that required treatment with antibiotics and/or systemic corticosteroids or resulted in hospitalization or led to death. TUDORZA PRESSAIR demonstrated a statistically significant reduction in the rate of on-study moderate to severe COPD exacerbations during the first year by 17% compared to placebo (rate ratio [RR] 0.83; 95% CI 0.73 to 0.94; p=0. 003).

The treatment of cough and mucous expectoration in COPD can be managed with Aclidinium (INH), which has been shown to reduce the rate of moderate to severe COPD exacerbations, including those characterized by worsening of symptoms such as cough and sputum 2.

From the Research

Treatment of Cough and Mucous Expectoration in COPD

• The treatment of cough and mucous expectoration in COPD often involves the use of bronchodilators, which are the mainstays of pharmacological treatment of stable COPD 3.
• Inhaled long-acting beta-agonists (LABA) and anticholinergics are the bronchodilators primarily used in the chronic treatment of COPD, with anticholinergics acting as muscarinic acetylcholine receptor antagonists 3.
• Long-acting muscarinic antagonists (LAMAs) have been shown to improve sputum production and cough in moderate to severe COPD, suggesting that they may have a role in modifying mucus hypersecretion and cough 4.
• The combination of a LABA plus LAMA seems to play an important role in the management of patients with COPD, providing superior bronchodilation compared with individual agents given alone 5.
• Other treatment options for COPD, including short-acting beta-agonists, short-acting muscarinic antagonists, inhaled corticosteroids, and phosphodiesterase inhibitors, may also be used to manage symptoms such as cough and mucous expectoration 6, 7.

Mechanisms of Action

• LAMAs work by antagonizing the ACh-induced bronchoconstriction of the airways and limiting the production of mucus secreted in response to ACh by airway goblet cells and/or submucosal glands 4.
• Anticholinergics, such as ipratropium bromide, oxitropium bromide, and tiotropium bromide, act as muscarinic acetylcholine receptor antagonists, providing bronchodilation and potentially modifying mucus hypersecretion and cough 3.

Clinical Evidence

• Clinical trials have shown that LAMAs, such as tiotropium and aclidinium, improve sputum production and cough in moderate to severe COPD 4.
• The combination of a LABA plus LAMA has been shown to provide superior bronchodilation compared with individual agents given alone 5.
• Other studies have reviewed the clinical evidence supporting the use of various pharmacotherapies for COPD, including bronchodilators, inhaled corticosteroids, and phosphodiesterase inhibitors 6, 7.