How to Cope with Mucus Print E-mail



COPD patients with a significant asthma component to their disease have a big problem with the heavy flow of thick bronchial mucus that typically accompanies their bronchospasm episodes. Because bronchospasm's temporary narrowing on top of COPD's permanent narrowing constricts their bronchi to an exceptional degree during these episodes, additional mucus blocks them very easily. We know that severely narrowed, obstructed airways weaken expiratory airflow. Then coughing is less effective in bringing this mucus up.

During an asthma attack, then, drugs that make this outpouring of thick mucus easier to expel are a major help. Over the years, a large number of pharmacologic agents have been tried in this regard. They are called mucokinetic drugs. The entire process of easing the mucus-clearing difficulty is called mucokinesis.

Several of the antiasthma drugs are also somewhat mucokinetic: the beta-2 stimulators, theophylline, and the glucocorticoid steroids. Seven other kinds of drugs are devoted exclusivelywith greater and lesser successto mucokinesis.

Antibiotics: Mucus becomes thicker and stickier (more viscous) during an infection. Because antibiotics fight infection, they ensure a mucus that is less viscous, and therefore more easily cleared from the airways.

Diluents: Diluents work on the theory that increasing the water content of mucushydrating itmakes it less viscous. Hydration is a wise precaution for the COPD patient with asthma. Some diluents, such as water or a salt solution, can be administered directly into the airways with a nebulizer.

Surfactants: Surfactants act as a detergent or wetting agent, somewhat like dishwashing soap. Soap weakens the sticky hold of fats and food adhering to dirty dishes. Surfactants weaken the sticky hold of mucus adhering to the airway walls. Sodium bicarbonate, a surfactant, is delivered directly to the airways via aerosol.

Bronchomucotropics: Bronchomucotropics increase two things. One is the amount of mucus, the other is the amount of respiratory tract fluid that is secreted. Familiar examples are eucalyptus and menthol, the aromatic inhalants found in Vicks VapoRub. Although these products have an amazingly large following, there is no proof of their effectiveness. But since they have not been disproved either, we should not automatically equate lack of proof with lack of value. Any COPD patient with asthma who finds bronchomucotropics useful should not let himself be dissuaded from using them.

Mucolytics: These agents make mucus less viscous by breaking down mucus molecules. The most effective mucolytics are the amino acid L-cysteine and its derivative, acetylcysteine. This derivative is marketed as Mucomyst, or as Airbron, Mucolyticum and Nac. This agent, however, may cause problems as well as solve them. Because the solution smells like a cross between rotting eggs and burning hair, the aerosol may be so irritating that it actually causes a bronchospasm.

Expectorants: Expectoration means bringing up mucus from your airways. Expectorants are taken by mouth to produce a greater amount of mucus of a consistency that can be coughed up more easily. Although expectorants were the mainstay of the nineteenth-century version of asthma therapy, there has been little hard evidenceuntil recentlythat these drugs actually do increase an easily cleared mucus. The most effective expectorants may actually combine the characteristics of the bronchomucotropics and the mucolytics. This list includes iodide, terpin hydrate, and various salts, herbs, and plant derivatives.

Mucoregulators: Mucoregulators alter the action of the mucous glands so that they produce less viscous mucus. (These drugs may also affect the airways directly to reduce bronchospasm.) Many of the herbs and plants used in folk medicine have been studied in this context.

A long list of items has been tried over the years in the continuing search for a good mucokinetic agent. Some continue in use although there is little, if any, proof of their effectiveness. Some run more risks than benefits, and many others have long ago fallen by the wayside.

But two items from Grandmas pharmacopoeia are still successful after hundreds of years. One is garlic. Folk tradition considers this potent herb of great value in treating asthma and bronchitis. And many formal pharmacopoeias throughout the world list garlic among the expectorants.

The primary component of garlic is the nonodiforous compound alliin (S-allyl-L-cysteine sulfoxide). When garlic is crushed, an enzyme breaks down the alliin into allicin, the aroma of which we all know. Interestingly, the alliin molecule bears a remarkable resemblance to S-carboxy-methylcysteine. Similar molecules exist in horseradish, radishes, onions, hot peppers, and mustardall edibles that stimulate respiratory mucus production. Garlic, and other pungent herbs and spices, may act by stimulating mucus-producing vagus nerve reflexes. The odiforous component of garlic obviously leaves the body via the lungs, where it may have a local broncho mucoregulatory effect.

The second itemhot chicken soupwas first prescribed in writing centuries ago by Maimonides. His twelfth-century Treatise on Asthma contained his humble apology for not being able to cure the disease, plus his suggestion that "the soup of fat hens is (an) effective remedy." Chicken soup (also known as "Jewish penicillin" and "Bubbemycin") is a proven potent mucociliary stimulant. So it is reasonable to regard a pungent, peppery, garlic-laden, onion-enriched chicken broth to be the ultimate in mucokinesis. This is obviously the standard against which all potential candidates for the honor must be compared.


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