Chronic obstructive pulmonary disease expectorants

Acetylcysteine (Mucomyst) Acetylcysteine is the expectorant prescribed for chronic obstructive pulmonary disease. Acetylcysteine is administered by nebulizer 5 minutes after bronchodilators are administered. Acetylcysteine should not be mixed with other medication. Acetylcysteine is also an antidote for acetaminophen overdose if given within 12 to 24 hours after the overdose. 

The male client diagnosed with chronic obstructive pulmonary disease (COPD) tells the nurse that he has been expectorating rusty-colored sputum. Which medication would the nurse anticipate the HCP prescribing ... 

Bronchial asthma is characterized by an increased responsiveness of the trachea and bronchi to various stimuli and is manifested by a widespread narrowing of the airways that changes in severity either spontaneously or as a result of therapy (91). Chronic bronchitis is defined as a condition with chronic or recurrent bronchial hypersecretion, cough and expectoration during at least 3 months for at least 2 successive years (92). Chronic bronchitis is often associated with chronic airways obstruction with minimal reversibility it is then called chronic obstructive pulmonary disease (COPD). Chronic airways obstruction in COPD is believed to be caused by either emphysema or irreversible obstructive changes in the peripheral airways, or both. There is an overlap between asthma and COPD, and many patients may have features of both diseases (93). Asthma is considered an important risk factor for the development of COPD. Bronchial hyperresponsiveness is a hallmark of asthma, whereas its importance in COPD is more obscure. Airway inflammation is a key factor for the development of bronchial hyperresponsiveness (94). Table 4 shows the main pathophysiological features of airways obstruction in asthma, chronic bronchitis, and emphysema. 

Accretion of a viscid mucus is the hallmark of the more chronic forms of obstructive pulmonary disease. The presence of the mucus exacerbates the pathology both by providing a mechanical block to the inspiration and expiration of air and by preventing topical drugs from reaching the distal bronchi. Although not universally accepted, therapy which will liquify the mucus so that It can be expectorated should have a place in the treatment of COPD. Sulfhydryl drugs such as N-acetylcysteine are available for this use. 

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