Summary: Agents that increase mucous excretion. Mucolytic agents, that is drugs that liquefy mucous secretions, are also included here.

Top Publications

  1. Boogaard R, de Jongste J, Merkus P. Pharmacotherapy of impaired mucociliary clearance in non-CF pediatric lung disease. A review of the literature. Pediatr Pulmonol. 2007;42:989-1001 pubmed
    ..We present an overview of the current literature reporting clinical outcome measures of treatment with NAC, rhDNase, and hypertonic saline in children. ..
  2. Poole P, Black P. Preventing exacerbations of chronic bronchitis and COPD: therapeutic potential of mucolytic agents. Am J Respir Med. 2003;2:367-70 pubmed
    ..Those with more frequent and severe exacerbations appear to have the most to gain. ..
  3. Zheng J, Kang J, Huang S, Yao W, Yang L, Bai C, et al. Effect of carbocisteine on acute exacerbation of chronic obstructive pulmonary disease (PEACE Study): a randomised placebo-controlled study. Lancet. 2008;371:2013-8 pubmed publisher
    ..Carbocisteine was well tolerated. Mucolytics, such as carbocisteine, should be recognised as a worthwhile treatment for prevention of exacerbations in Chinese patients with COPD. ..
  4. Rogers D. Mucoactive agents for airway mucus hypersecretory diseases. Respir Care. 2007;52:1176-93; discussion 1193-7 pubmed
    ..Consequently, although it is possible to categorize them according to putative mechanisms of action, as expectorants (aid and/or induce cough), mucolytics (thin mucus), mucokinetics (facilitate cough transportability), and ..
  5. Kagan L, Lavy E, Hoffman A. Effect of mode of administration on guaifenesin pharmacokinetics and expectorant action in the rat model. Pulm Pharmacol Ther. 2009;22:260-5 pubmed publisher
    ..It was demonstrated that expectorant action of guaifenesin is mediated by stimulation of the gastrointestinal tract and not by the systemic exposure to the drug. ..
  6. Yuta A, Baraniuk J. Therapeutic approaches to mucus hypersecretion. Curr Allergy Asthma Rep. 2005;5:243-51 pubmed
    ..Mucokinetic agents are thiols with a blocked sulfhydryl group. Expectorants such as guaifenesin increase mucus secretion...
  7. Morris C, Mullan B. Use of dornase alfa in the management of ARDS. Anaesthesia. 2004;59:1249 pubmed
  8. Wedzicha J, Donaldson G. Exacerbations of chronic obstructive pulmonary disease. Respir Care. 2003;48:1204-13; discussion 1213-5 pubmed
    ..Antibiotics have some efficacy in treating exacerbations. Exacerbation frequency increases with progressive airflow obstruction; so patients with chronic respiratory failure are particularly susceptible to exacerbation. ..
  9. Balsamo R, Lanata L, Egan C. Mucoactive drugs. Eur Respir Rev. 2010;19:127-33 pubmed publisher
    ..Mucoactive medications include expectorants, mucoregulators, mucolytics and mucokinetics...

More Information


  1. Koyama I, Matsunaga T, Harada T, Kikuno A, Hokari S, Komoda T. Ambroxol reduces LPS toxicity mediated by induction of alkaline phosphatases in rat lung. Clin Biochem. 2004;37:688-93 pubmed
    ..Maintenance of high AP activity level in the lung suggests APs to have physiological significant effects against the inflammatory events induced by LPS...
  2. Huynh H, Couper R, Tran C, Moore L, Kelso R, Butler R. N-acetylcysteine, a novel treatment for Helicobacter pylori infection. Dig Dis Sci. 2004;49:1853-61 pubmed
    ..This study demonstrates that NAC inhibits the growth of H. pylori in both agar and broth susceptibility tests and in H. pylori-infected mice. NAC did not alter the severity of H. pylori- or H. felis-induced gastritis. ..
  3. Malerba M, Ragnoli B. Ambroxol in the 21st century: pharmacological and clinical update. Expert Opin Drug Metab Toxicol. 2008;4:1119-29 pubmed
    Belonging to the group of expectorants, ambroxol is an active substance with a long history that influences parameters considered to be the basis for the physiological production and the transport of the bronchial mucus...
  4. Tatsumi K, Fukuchi Y. Carbocisteine improves quality of life in patients with chronic obstructive pulmonary disease. J Am Geriatr Soc. 2007;55:1884-6 pubmed
  5. Rubin B. Mucolytics, expectorants, and mucokinetic medications. Respir Care. 2007;52:859-65 pubmed
    ..Retention of this airway pus leads to ongoing inflammation and airway damage. Mucoactive medications include expectorants, mucolytics, and mucokinetic drugs...
  6. Hasegawa I, Niisato N, Iwasaki Y, Marunaka Y. Ambroxol-induced modification of ion transport in human airway Calu-3 epithelia. Biochem Biophys Res Commun. 2006;343:475-82 pubmed
  7. van Overveld F, Demkow U, Gorecka D, De Backer W, Zielinski J. New developments in the treatment of COPD: comparing the effects of inhaled corticosteroids and N-acetylcysteine. J Physiol Pharmacol. 2005;56 Suppl 4:135-42 pubmed
    ..Treatment with NAC decreased some inflammatory parameters and had indirectly an inhibitory effect on the expression of adhesion molecules. ..
  8. Dicpinigaitis P, Gayle Y. Effect of guaifenesin on cough reflex sensitivity. Chest. 2003;124:2178-81 pubmed
    ..Possible mechanisms include a central antitussive effect, or a peripheral effect by increased sputum volume serving as a barrier shielding cough receptors within the respiratory epithelium from the tussive stimulus. ..
  9. Malerba M, Ponticiello A, Radaeli A, Bensi G, Grassi V. Effect of twelve-months therapy with oral ambroxol in preventing exacerbations in patients with COPD. Double-blind, randomized, multicenter, placebo-controlled study (the AMETHIST Trial). Pulm Pharmacol Ther. 2004;17:27-34 pubmed
  10. Erden E, Kirkil G, Deveci F, Ilhan N, Cobanoglu B, Turgut T, et al. [Effects of erdosteine on inflammation and fibrosis in rats with pulmonary fibrosis induced by bleomycin]. Tuberk Toraks. 2008;56:127-38 pubmed
    ..01). We conclude that erdosteine may prevent the acute lung inflammation and fibrosis by suppressing the accumulation of neutrophils, inhibition of lipid peroxydation, chemokine production, and release...
  11. Rubin B. An in vitro comparison of the mucoactive properties of guaifenesin, iodinated glycerol, surfactant, and albuterol. Chest. 1999;116:195-200 pubmed
    ..However, there could be an effect of some of these agents after oral administration, especially if there is a secondary effect of the agent on an effector cell. ..
  12. Gerrits C, Herings R, Leufkens H, Lammers J. N-acetylcysteine reduces the risk of re-hospitalisation among patients with chronic obstructive pulmonary disease. Eur Respir J. 2003;21:795-8 pubmed
    ..In conclusion it was observed that N-acetylcysteine reduces the risk of rehospitalisation for chronic obstructive pulmonary disease by approximately 30% and that this risk reduction is dose-dependent. ..
  13. Nagy A, Vanderbist F, Parij N, Maes P, Fondu P, Neve J. Effect of the mucoactive drug nacystelyn on the respiratory burst of human blood polymorphonuclear neutrophils. Pulm Pharmacol Ther. 1997;10:287-92 pubmed
    ..As those radicals are highly cytotoxic, NAL appears as a promising agent in the prevention of oxidative lung damage caused by an active inflammatory response. ..
  14. Poole P, Black P. Oral mucolytic drugs for exacerbations of chronic obstructive pulmonary disease: systematic review. BMJ. 2001;322:1271-4 pubmed
    ..As these drugs have to be taken long term, they could be most useful in patients who have repeated, prolonged, or severe exacerbations of chronic obstructive pulmonary disease. ..
  15. King M, Rubin B. Pharmacological approaches to discovery and development of new mucolytic agents. Adv Drug Deliv Rev. 2002;54:1475-90 pubmed
    ..Further studies are required to confirm these findings, to perform direct assessments of mucus clearability, and to extend the observations to patients with various types of pulmonary diseases where mucoactive treatments are required. ..
  16. App E, Baran D, Dab I, Malfroot A, Coffiner M, Vanderbist F, et al. Dose-finding and 24-h monitoring for efficacy and safety of aerosolized Nacystelyn in cystic fibrosis. Eur Respir J. 2002;19:294-302 pubmed
    ..No adverse effects were observed. The drug was well tolerated in both studies. Sputum results were predictive of improved clearability by ciliary and cough transport mechanisms. ..
  17. Rubin B. The pharmacologic approach to airway clearance: mucoactive agents. Respir Care. 2002;47:818-22 pubmed
    ..b>Expectorants are thought to increase the volume or hydration of airway secretions...
  18. Ishibashi Y, Okamura T, Masumoto Y, Tachiiri T, Momo K. [Effects of carbocisteine on airway inflammation and related events in SO2-exposed rats]. Nihon Kokyuki Gakkai Zasshi. 2001;39:17-23 pubmed
    ..In conclusion, carbocisteine has a unique mucoregulant action and inhibits SO2-induced airway inflammation in a manner different from that of ambroxol. ..
  19. Ishiura Y, Fujimura M, Yamamori C, Nobata K, Myou S, Kurashima K, et al. Effect of carbocysteine on cough reflex to capsaicin in asthmatic patients. Br J Clin Pharmacol. 2003;55:504-10 pubmed
    ..047) and placebo (P = 0.047), respectively. These findings indicate that carbocysteine administration may be a novel therapeutic option for asthmatic patients, especially with cough variant asthma. ..
  20. Disse B. Clinical evaluation of new therapies for treatment of mucus hypersecretion in respiratory diseases. Novartis Found Symp. 2002;248:254-72; discussion 272-6, 277-82 pubmed
    ..Proof for no depression of lung mucociliary clearance is an important safety endpoint. ..
  21. Chalumeau M, Cheron G, Assathiany R, Moulin F, Bavoux F, Breart G, et al. [Mucolytic agents for acute respiratory tract infections in infants: a pharmacoepidemiologic problem?]. Arch Pediatr. 2002;9:1128-36 pubmed
    ..In infants, mucolytics agents efficacy has never been demonstrated and some elements suggest poor safety (paradoxical bronchial congestion). ..
  22. Yankaskas J, Marshall B, Sufian B, Simon R, Rodman D. Cystic fibrosis adult care: consensus conference report. Chest. 2004;125:1S-39S pubmed
  23. Krouse J. Allergic rhinitis--current pharmacotherapy. Otolaryngol Clin North Am. 2008;41:347-58, vii pubmed publisher
    ..Through an appreciation of these various physiological mechanisms, the physician can select the treatment option or options that will be most likely to effectively manage symptoms. ..
  24. Xu D, Luo Z, Mei X, Ma H, Zeng J, Xu S. [Effects of alligator Zhikegao on relieving cough dispelling phlegm and anti-inflammation]. Zhongguo Zhong Yao Za Zhi. 2007;32:961-5 pubmed
    ..05) and the hemolysin level in serum (P <0.01). Alligator Zhikegao has significant effects on relieving cough, dispelling phlegm, anti-inflammation and immunological regulation. ..
  25. Keizer R, Beijnen J, Baas P. 'Flooding' of the lungs and severe dyspnea in a patient with bronchoalveolar carcinoma. J Oncol Pharm Pract. 2011;17:270-3 pubmed publisher
    ..As the patient suffered from hyperhomocysteinemia, we speculate that an additive or synergistic interaction with homocysteine may have been involved as well. ..
  26. Sprenger L, Goldmann T, Vollmer E, Steffen A, Wollenberg B, Zabel P, et al. Dexamethasone and N-acetyl-cysteine attenuate Pseudomonas aeruginosa-induced mucus expression in human airways. Pulm Pharmacol Ther. 2011;24:232-9 pubmed publisher
    ..These results support the use of steroids and NAC in clinical practice to treat PA-induced mucus hypersecretion. ..
  27. Sun J, Qian J, Zhao J, Liu L. [Clinical observation of mucoregulatory agents' application after chronic rhinosinusitis surgery]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2011;25:922-4 pubmed
    ..It can also improve the success rate of functional endoscope sinus surgery, and may play a promising role in clinical application. ..
  28. Mohapatra P, Aggarwal D. Carbocisteine for acute exacerbations of COPD. Lancet. 2008;372:1630-1; author reply 1631-2 pubmed publisher
  29. Denaro V, Di Martino A, Longo U, Costa V, Papalia R, Forriol F, et al. Effectiveness of a mucolythic agent as a local adjuvant in revision lumbar spine surgery. Eur Spine J. 2008;17:1752-6 pubmed publisher
  30. Ozdil B, Kece C, Cosar A, Akkiz H, Sandikci M. Potential benefits of combined N-acetylcysteine and ciprofloxacin therapy in partial biliary obstruction. J Clin Pharmacol. 2010;50:1414-9 pubmed publisher
    ..001), whereas a significant decrease did not occur in the placebo group. The combined usage of NAC and ciprofloxacin can be an alternative therapeutic option until ERCP is performed in partial cholestatic patients. ..
  31. Leite B, Gomes F, Teixeira P, Souza C, Pizzolitto E, Oliveira R. Staphylococcus epidermidis biofilms control by N-acetylcysteine and rifampicin. Am J Ther. 2013;20:322-8 pubmed publisher
    ..Considering their different modes of action, the association of NAC with rifampicin constitutes a promising therapeutic strategy in the treatment of infections associated to S. epidermidis biofilms. ..
  32. Sharfstein J, North M, Serwint J. Over the counter but no longer under the radar--pediatric cough and cold medications. N Engl J Med. 2007;357:2321-4 pubmed
  33. Zhao K, Dong T, Cui X, Tu P, Tsim K. Genetic distinction of radix adenophorae from its adulterants by the DNA sequence of 5S-rRNA spacer domains. Am J Chin Med. 2003;31:919-26 pubmed
    ..Diversity in DNA sequence and restriction enzyme mapping among various species were found in their 5S-rRNA spacer domains, which could serve as markers for authentic identification of Radix Adenophorae. ..
  34. Henke M, Shah S, Rubin B. The role of airway secretions in COPD--clinical applications. COPD. 2005;2:377-90 pubmed
    ..Carefully conducted studies of interventions to improve airway clearance, similar to those done in cystic fibrosis (CF), may help us to identify effective therapies and possibly novel diagnostic tests for the management of COPD. ..
  35. Smith J. Interrupting the cough reflex in asthma. Curr Opin Allergy Clin Immunol. 2010;10:77-81 pubmed publisher
    ..Cough in some asthma patients is a significant problem, deserving further attention in both clinical practice and clinical research. ..
  36. Dreger H, Schaumann B, Gromann T, Hetzer R, Melzer C. Fast-track pulmonary conditioning before urgent cardiac surgery in patients with insufficiently treated chronic obstructive pulmonary disease. J Cardiovasc Surg (Torino). 2011;52:587-91 pubmed
    ..If surgery can be delayed for several days, pulmonary conditioning should be considered for patients with insufficiently treated COPD. ..
  37. Ege E, Ilhan A, Gurel A, Akyol O, Ozen S. Erdosteine ameliorates neurological outcome and oxidative stress due to ischemia/reperfusion injury in rabbit spinal cord. Eur J Vasc Endovasc Surg. 2004;28:379-86 pubmed
    ..The present study demonstrated that erdosteine treatment before aortic cross clamping ameliorates neurological outcome, neuronal injury and oxidative stress in the rabbit spinal cord. ..
  38. Pokupec R, Petricek I, Sikic J, Bradić M, Popović Suić S, Petricek G. [Comparison of local acetylcysteine and artificial tears in the management of dry eye syndrome]. Acta Med Croatica. 2005;59:337-40 pubmed
  39. Sharpe S, Qin X, Lu Q, Feketeova E, Palange D, Dong W, et al. Loss of the intestinal mucus layer in the normal rat causes gut injury but not toxic mesenteric lymph nor lung injury. Shock. 2010;34:475-81 pubmed publisher
  40. Lüth J, Luft F. Recurrent paroxysms of metabolic acidosis in a haemodialysis patient. Nephrol Dial Transplant. 2006;21:811-2 pubmed
  41. Dal Negro R. Erdosteine: antitussive and anti-inflammatory effects. Lung. 2008;186 Suppl 1:S70-3 pubmed publisher
  42. Yoshida M, Nakayama K, Yasuda H, Kubo H, Kuwano K, Arai H, et al. Carbocisteine inhibits oxidant-induced apoptosis in cultured human airway epithelial cells. Respirology. 2009;14:1027-34 pubmed publisher
    ..L-carbocisteine may have antioxidant effects, as well as mucolytic activity, in inflamed airways. ..
  43. Yamada T, Takemura Y, Niisato N, Mitsuyama E, Iwasaki Y, Marunaka Y. Action of N-acylated ambroxol derivatives on secretion of chloride ions in human airway epithelia. Biochem Biophys Res Commun. 2009;380:586-90 pubmed publisher
  44. Kelley R, Reynders A, Seidberg N. Nonsurgical management of pediatric tracheal perforation. Ann Otol Rhinol Laryngol. 2006;115:408-11 pubmed
    ..In clinically stable pediatric patients, nonsurgical management of tracheal perforations should be considered. ..
  45. Alexandroaie B, Huţuleac L, Costin G, Constantinescu G. Diagnostic approach of pneumonia in an elderly patient with comorbidities--case report. Rev Med Chir Soc Med Nat Iasi. 2011;115:781-7 pubmed
    ..Although the diagnosis can be easy, the physician must also investigate for less obvious causes of dyspnea such as the presence of comorbidities and fragility of the elderly patient. ..
  46. Luan Z, Li L, Higaki K, Nanba E, Suzuki Y, Ohno K. The chaperone activity and toxicity of ambroxol on Gaucher cells and normal mice. Brain Dev. 2013;35:317-22 pubmed publisher
    ..These characteristics of ambroxol would make it a potential therapeutic chaperone in the treatment of GD with neurological manifestations...
  47. Nogueiras Nieto L, Gómez Amoza J, Delgado Charro M, Otero Espinar F. Hydration and N-acetyl-l-cysteine alter the microstructure of human nail and bovine hoof: implications for drug delivery. J Control Release. 2011;156:337-44 pubmed publisher
    ..Further refinement of the technique will allow fast screening of penetration enhancers to be used in ungual drug delivery. ..
  48. Mazer Amirshahi M, Reid N, van den Anker J, Litovitz T. Effect of cough and cold medication restriction and label changes on pediatric ingestions reported to United States poison centers. J Pediatr. 2013;163:1372-6 pubmed publisher
    ..There has also been a decline in ingestions in 2- to 5-year-old children. ..
  49. Unuvar E, Tamay Z, Yildiz I, Toprak S, Kilic A, Aydin S, et al. Effectiveness of erdosteine, a second generation mucolytic agent, in children with acute rhinosinusitis: a randomized, placebo controlled, double-blinded clinical study. Acta Paediatr. 2010;99:585-9 pubmed publisher
    ..There were no clinically detected serious side effects or complications in both groups. Use of erdosteine as a mucolytic agent in children with acute rhinosinusitis does not directly affect the success of treatment. ..
  50. Waller P, Suissa S. Carbocisteine for acute exacerbations of COPD. Lancet. 2008;372:1630; author reply 1631-2 pubmed publisher
  51. van der Deen M, Homan S, Timmer Bosscha H, Scheper R, Timens W, Postma D, et al. Effect of COPD treatments on MRP1-mediated transport in bronchial epithelial cells. Int J Chron Obstruct Pulmon Dis. 2008;3:469-75 pubmed
    ..Further studies are required to assess whether stimulation of MRP1 activity is beneficial for long-term treatment of COPD. ..
  52. Qin X, Caputo F, Xu D, Deitch E. Hydrophobicity of mucosal surface and its relationship to gut barrier function. Shock. 2008;29:372-6 pubmed
    ..These results suggest that mucosal hydrophobicity can be a reliable method of measuring the barrier function of the unstirred mucus layer and a useful parameter in evaluating the pathogenesis of gut barrier dysfunction. ..
  53. Matsuyama T, Morita T, Horikiri Y, Yamahara H, Yoshino H. Enhancement of nasal absorption of large molecular weight compounds by combination of mucolytic agent and nonionic surfactant. J Control Release. 2006;110:347-52 pubmed
    ..The combination of NAC and laureth-25 appears suitable for use in development of nasal products for poorly absorbable drugs, especially peptide and protein drugs. ..