CLINICAL AND IMMUNOLOGICAL EFFECTS OF CARBOCYSTEINE IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE

Abstract

Background: Chronic obstructive pulmonary disease (COPD) is one of the commonest diseases characterized by persistent distal airways inflammation. Thus, anti-inflammatory therapy should be the basis of COPD treatment. There is only limited evidence supporting the efficacy of mucolytics like carbocysteine in the preventing COPD exacerbations in inhaled corticosteroid-naive patients. Aim: To study clinical and immunological effects of carbocysteine in COPD. Materials and methods: During first 2 months, 30 patients with stage II COPD (mean age 55.9±1.2 years old) were treated with inhaled glucocorticosteroids and beta2-adrenoceptor agonists ‘as required’. Thereafter, the standard therapy was continued in 15 patients; in other 15 patients carbocysteine 1500 mg/day was added. Immune status was studied bi-monthly in all patients: to detect lymphocytes with expression of CD3, CD4, CD8, CD72-antigens and CD23, CD71, CD95 and HLA-DR activation markers, monoclonal antibodies were used. Quality of life was assessed using adapted Russian version of St. George’s Respiratory Questionnaire (SGRQ). Results: Compared with the anti-inflammatory therapy, adding carbocysteine to standard therapy of COPD was associated with significantly better quality of life after 4 months of therapy (less negative changes of symptoms and activity scores and improvement of psycho-social function: changes of relevant SGRQ scores were -3.4 and -8.0; -1.9 and -3.8; 0.4 and -0.76, respectively). After 4 months, carbocysteine-treated patients demonstrated better improvements in shortness of breath, cough and sputum scores compared with the control group (2 and 2.2; 1.5 and 1.9; 0.8 and 1.2, respectively). In carbocysteine group, clinical symptoms improvement correlated with positive changes of immunological status. The patients demonstrated greater significant elevation of total T-lymphocytes (especially CD8+-cells), decreased B-cells and increased expression of CD95-antigen compared with the standard therapy group. Conclusion: Carbocysteine may be recommended as an obligate part of therapy in COPD patients.