| Summary: | Several national and international guidelines acknowledge the potential value of mucolytics/ antioxidants N-acetylcysteine (NAC), carbocysteine and erdosteine, which are thiol- based drugs, in the treatment of stable chronic obstructive pulmonary disease (COPD). Thiols are also known to possess potentially important antioxidant and anti-inflammatory properties and exhibit antibacterial activity which may contribute to their effectiveness in treating patients with bronchitis or COPD. A careful evaluation of the results of pivotal randomized clinical trials and systematic reviews and meta-analyses supports the use of thiols in patients with stable COPD when added to standard maintenance therapy, but to date, there is no convincing evidence for their use to treat acute exacerbation of COPD. However, in the absence of head-to-head comparative studies, it is not easy to establish which thiol is preferable, although a consensus of international experts and data from a recent network meta-analysis suggest that the efficacy/safety profile of erdosteine is better than that of NAC and carbocysteine.
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