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Diluting and Hydrating Agents |   |
Sodium bicarbonate (NaHCO3) helps break up large mucoid molecular chains because of its alkalinity. Some patients benefit from occasional aerosolized 2% sodium bicarbonate, which is a readily available solution for home use by simply putting a teaspoonful of the soda in a cup of sterile water. However, with the availability of more potentent mucolytics like acetylcysteine, it is rarely used.
In addition to these most commonly used mucus-controlling agents, other mucoactive agents that have been or are now being explored include:
Beta andrenergic agonists can aid in mucokinesis, possibly by increasing the beat frequency of cilia. Active transport of the chloride ion into the airway lumen, augmented with a resulting water flux, may produce a less viscous, thinner mucus and enhance ciliary movement.
S-Carboxymethylcysteine (Mucodyne), an oral mucokinetic investigated in Britain, decreases sputum viscosity in vitro, but is not considered effective for mucolysis when administered orally. It is chemically related to garlic, a common home remedy mucokinetic, and other home remedies for mucokinesis including chicken soup, horseradish, pepper, and mustard.
Glyceryl guaiacolate, which is generally considered an expectorant, also has shown potential for improving mucociliary clearance in chronic bronchitis.
Potassium iodide, which is also generally considered an expectorant, has also shown potential for decreasing mucus elasticity, but has also shown a potential for harmful effects on cilia.
Sodium 2-mercaptoethane sulfonate, a compound containing a sulfhydril group that is being explored in Britain, acts similar to acetylcysteine in reducing mucous viscosity.
Several enzymes have been shown to reduce the viscosity of mucus by breaking down the mucoprotein and deoxyribonucleic acid, which contribute to mucus viscosity. One example is the previously discussed dornase alfa. These continue to be explored as mucus controlling agents, but to date have generally proven to be too costly, irritating, and toxic.
Ambroxol is another orally administered drug that has been investigated as a mucokinetic agent. It stimulates ciliary beat frequency, but its ability to increase mucociliary clearance by result from stimulation of pulmonary surfactant or bronchial secretion.
Given the nature of inflammation in disease states of mucus hypersecretion, the use of mucolytic agents alone is not considered an adequate program of mucus control. Other therapeutic options that are considered necessary for controlling mucus hypersecretion include:
- Remove causative factors where possible, including cessation of smoking, and avoidance of pollution and allergens.
- Optimize tracheobronchial clearance by: using a bronchodilator, taking bronchial hygiene measures (like hydration, coughing, deep breathing, postural drainage), using mucolytics and expectorants.
- Reduce inflammation by treating infection with antibiotics, and using corticosteroids.