Addresses:
| LURIE A, HOP COCHIN,ECLIMED INST RECH THERAPEUT,27 RUE FAUBOURG ST JACQUES,F-75674 PARIS 14,FRANCE UNIV RENE DESCARTES,HOP AMBROISE PARE,SERV PNEUMOL,BOULOGNE,FRANCE HOP INTERCOMMUNAL CRETEIL,CRETEIL,FRANCE HOP ANTOINE BECLERE,CLAMART,FRANCE HOP BEAUJON,CLICHY,FRANCE CTR HOSP REG BRABOIS,VANDOEUVRE NANCY,FRANCE FAC MED VANDOEUVRE NANCY,VANDOEUVRE NANCY,FRANCE HOP COCHIN,SERV PNEUMOL,F-75674 PARIS 14,FRANCE HOP BICHAT,F-75877 PARIS 18,FRANCE INSERM,U21,F-94800 VILLEJUIF,FRANCE CTR HOSP LE MANS,LE MANS,FRANCE HOP HENRI MONDOR,F-94010 CRETEIL,FRANCE INSERM,U314,REIMS,FRANCE GRP HOSP PITIE SALPETRIERE,DEPT PHARMACOL CLIN,F-75634 PARIS 13,FRANCE INSERM,U16,F-59045 LILLE,FRANCE HOP CANTONAL GENEVA,CH-1211 GENEVA 4,SWITZERLAND
|
Abstract:
| The purpose of the paper is to discuss some aspects of the methods that are most appropriate for the clinical assessment of new expectorants. Expectorants are drugs devised to help in the removal of bronchial secretions. The evaluation of these drugs is aimed at demonstrating, in controlled trials, their efficacy, safety and, if possible, mechanism of action. Unfortunately, there is no universally accepted assessment technique available. Evaluation of symptoms with the use of self-reported measures is imprecise. Studies of quality of life can assist as a means of assessing the usefulness of this class of drug for patients. Lung function tests evaluate only the possible indirect effects of expectorants; the changes observed are often minor and they do not correlate with other methods of evaluation. Mucociliary clearance studies evaluate bronchial drainage by mucociliary transport and cough. They are a useful pharmacological approach but they cannot replace therapeutic trials. In vitro and ex vivo studies of bronchial secretion, while improving knowledge of the mechanisms of bronchial secretion, fail to predict the modifications of bronchial drainage produced in vivo by cough or mucociliary transport. To be considered efficient, expectorants should not only ease the removal of bronchial secretions, but also improve the patient's condition for the duration of treatment.
|