136 A review of the use of mucolytic agents in Motor Neurone Disease (MND). Is there benefit to using multiple agents over mono-therapy?

Abstract

Background/Aims In MND, progressive bulbar and diaphragmatic weakness cause weak cough and difficulty expectorating. This can cause difficulty in managing the amount of saliva produced, which can lead to sore skin, wet clothes, embarrassment and precipitation of choking episodes. Thicker sputum can compound this issue. Mucolytics can be useful here, however guidelines for their use tend to be based around anecdotal experience rather than using higher level evidence. This particularly applies to the use of multiple mucolytics. We aimed to learn more about the benefits and harms of multiple mucolytic therapy versus single mucolytic therapy in MND. We hoped to develop a guideline outlining when each, or multiple, agents are appropriate in MND. Methods We reviewed the notes of all patients with MND under the care of a Shropshire Palliative Care Team over a one year period and identified those on multiple mucolytic therapy. We noted outcomes of symptom improvement and side effects reported following initiation of multiple mucolytic therapy. Results Of 64 patients identified, 32 patients required mucolytic therapy, with 31/32 being started on Carbocisteine initially. Of these, 12/32(37.5%) went on to receive multiple mucolytics. Symptom improvement was reported in 2/12(16.67%) with multiple mucolytic therapy - in both cases the benefit followed the addition of Erdosteine. Worsening of symptoms was reported in 1/12(8.33%) patients. In 9/12(75%) patients, there was either no symptom improvement or no data describing outcomes. Conculsions In most patients receiving multiple mucolytic there was either no symptom improvement or no recorded evidence of outcome. Where multiple mucolytic therapy is used, Erdosteine may be the most effective second line agent, however larger numbers are needed to determine this. Prospective research to collect outcome data to assess the effect of mucolytic therapy in a wider cohort of patients with MND would be useful in ascertaining more definitive conclusions.