Effect of 5 years of treatment with mucoactive drugs on COPD exacerbations in the Czech Republic: a real-life study

<bold>BACKGROUND:</bold> The aim of this real-life, multicenter, prospective, observational study was to determine the effect of long-term mucoactive treatment on the reduction of exacerbations over a 5-year period in patients with COPD. <bold>METHODS:</bold> 452 patients from the Czech Multicenter Research Database of COPD were included in this real-life study. All patients had COPD with FEV1 ≤60% of predicted value, 81 of them were on treatment with thiol-based mucoactive drugs for 24 months (77 erdosteine, 4 N-acetylcysteine) and 371 patients were off mucoactive treatment for 24 months. All patients were followed up for 5 years. <bold>RESULTS:</bold> Patients with mucoactive treatment had a significantly greater reduction compared to baseline in all exacerbations in all five years than patients without mucoactive treatment (−0.605 vs −0.177, p=0.026; −0.544 vs −0.090, p=0.007; −0.444 vs 0.039, p=0.018; −0.674 vs 0.134, p=0.002; −0.526 vs 0.103, p=0.019 in the first to fifth year) and in moderate exacerbations (−0.383 vs −0.117, p=0.049; −0.342 vs −0.044, p=0.014; −0.286 vs 0.075, p=0.015; −0.522 vs 0.162, p<0.001; −0.395 vs 0.034, p=0.015). The reduction of exacerbations with mucoactive treatment was higher in patients with cough, in patients with stage 3 to 4 COPD and it was independent of the use of inhaled corticosteroids (ICS). <bold>CONCLUSION:</bold> The use of mucoactive treatment for two years showed a statistically significant reduction in the number of COPD exacerbations over the five years, for both all exacerbations and moderate exacerbations. The reduction in exacerbations was more pronounced in patients with cough and in patients with stage 3 to 4 COPD and was independent of the use of ICS.