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Effects of Drugs on Mucus Clearance

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Eur Respir J 1999; 14: 452±467 Printed in UK ± all rights reserved

Copyright #ERS Journals Ltd 1999 European Respiratory Journal ISSN 0903-1936

SERIES "CHEST PHYSIOTHERAPY" Edited by S.L. Hill and B. Webber
Number 3 in this Series

Effects of drugs on mucus clearance
E. Houtmeyers, R. Gosselink, G. Gayan-Ramirez, M. Decramer
Effects of drugs on mucus clearance. E. Houtmeyers, R. Gosselink, G. Gayan-Ramirez, M. Decramer. #ERS Journals Ltd 1999. ABSTRACT: Mucociliary clearance (MCC), the process in which airway mucus together with substances trapped within are moved out of the lungs, is an important defence mechanism of the human body. Drugs may alter this process, such that it is necessary to know the effect of the drugs on MCC. Indeed, agents stimulating MCC may be used therapeutically in respiratory medicine, especially in patients suspected of having an impairment of their mucociliary transport system. In contrast, caution should be taken with drugs depressing MCC as an undesired side-effect, independently of their therapeutic indication. Since cough clearance (CC) serves as a back-up system when MCC fails, the influence of drugs must be examined not only on MCC but also on CC. Ultimately, the clinical repercussions of alterations in mucus transport induced by drug administration must be studied. Tertiary ammonium compounds (anticholinergics), aspirin, anaesthetic agents and benzodiazepines have been shown to be capable of depressing the mucociliary transport system. Cholinergics, methylxanthines, sodium cromoglycate, hypertonic saline, saline as well as water aerosol have been shown to increase MCC. Adrenergic antagonists, guaifenesin, S-carboxymethylcysteine, sodium 2-mercapto-ethane sulphonate and frusemide have been reported not to alter the mucociliary transport significantly. Amiloride, uridine 5'-triphosphate (UTP), quaternary ammonium compounds

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