Erdosteine improves airflow in patients with severe exacerbation of COPD (AECOPD)

Introduction: Recently we published (Moretti M et al Int J Chron Obstruct Pulmon Dis 2015;10:2319), a randomized, controlled trial on erdosteine (E), a new thiol compound with anti-oxidant, anti-inflammatory, antibacterial adhesiveness and muco-active properties, in AECOPD. Results: confirmed that the addition of E to standard treatment in patients with AECOPD improved symptoms, reduced airway inflammation and prolonged time to first exacerbation compared with controls. Objective: We performed a post-hoc analysis of the data evaluating the effect of E on the small airway impairment at days 10 and 30 post-treatment. Methods: Patients admitted to hospital with AECOPD were randomized to receive either oral E 900mg daily (n=20) or a matching control (n=20) for 10 days till hospital discharge. Lung function parameters were measured at hospital admission and at days 10 and 30 post-treatment. Results: Mean increase in FEF _25%-75%,L/s was significantly greater in the E group both at Day 10 (p=0.029) and Day 30 (p=0.019) (from 0.46±0.17 L/s to 0.65±0.18 and 0.80±0.20 respectively) compared with controls (respectively from 0.42±0.10 L/s to 0.44±0.15 and 0.55±0.18). Mean increase in FEV₁,L and FVC,L was greater in patients treated with E compared with control group, both at day 10 and 30, significant at Day 10 (p=0.035 and p=0.039 respectively). Conclusions: Addition of E to standard treatment in AECOPD patients improved significantly their airflow limitation, especially in FEF _25%-75% at Day 10 and at Day 30 post-treatment. Reduction of airflow limitation was associated with prolonged beneficial effect on disease outcome.