Mucolytic Therapy in COPD: Patient Usage and Preferences in Real-World Italian Settings

Salvatore D’Antonio,1 Alfio Pennisi,2 Mario Cazzola3 1Italian COPD Patients Association, Rome, Italy; 2Department of Respiratory Medicine, Hospital Clinic ‘Casa di Cura Riabilitativa Calaciura’, Catania, Italy; 3Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome ‘Tor Vergata’, Rome, ItalyCorrespondence: Mario Cazzola, Department of Experimental Medicine, University of Rome ‘Tor Vergata’, Rome, Italy, Email [email protected]: The Italian COPD Patient Association (Associazione Pazienti BPCO) conducted an online survey among its 2814 members with COPD to investigate the reasons for the widespread use of mucolytic therapies by patients, often including self-prescription using over the counter (OTC) alternatives.Methods: After consulting with several respiratory specialists, the Association’s steering committee developed a list of nine questions with possible answers that was posted on the website of the Association. The survey was open to all members of the Association, with responses to be e-mailed to the Association.Results: Approximately 78% the 502 participants surveyed reported having used mucolytics in the previous six months, with 54.5% using prescribed medications and 23.5% opting for OTC medications. Usage patterns revealed that 43.4% utilized mucolytics during episodes of excessive mucus, while 35.5% used them regardless of the presence of mucus. In terms of formulation preferences, water-soluble granulated sachets (34.9%) and effervescent/dispersible tablets (22.8%) were the most preferred, followed by capsules (14.1%) and aerosol ampoules (11.2%). The factors influencing these preferences were the hydration benefits of sachets and tablets, the portability and taste advantages of capsules, and the swallowing difficulties of aerosol formulations. The data showed that 26.5% of survey participants consumed the entire contents of the prescribed or OTC package, while 19.9% utilised it for a minimum of 10 days, 31.5% for a period between 5 and 10 days, and 10.2% for less than 5 days. Cost was cited as a reason for discontinuation by 8.3% of participants. Notably, 29.5% of respondents believed that mucolytic efficacy was dependent on the amount of mucus. Most patients (66.3%) used mucolytics at home, and 57.4% took the medication once daily and 24.3% twice daily. Additionally, 41.8% were aware of the dual antioxidant and mucolytic properties of the medication.Conclusion: These findings emphisise the need for a patient-centred approach, encouraging healthcare providers to consider individual preferences and offer personalised advice that has the potential to improve adherence and overall outcomes for COPD patients.Keywords: adherence, antioxidants, COPD, formulation, mucolytics, preference