Aerosol Inhalation of Ambroxol for Pneumonia: A Systematic Review_Chinese Journal of Evidence-Based Medicine

Authors：

LOU Honggang ¹² , LIU Fang ¹ ,  ZHAI Suodi ¹

1.Department of Pharmacy, Peking University Third Hospital, Beijing 100083, China 2.Department of Pharmacy, Second Affiliated Hospital,ZheJiang University College of Medicine, Hangzhou 310009, China;

Corresponding author：

ZHAI Suodi, Email: zhaisuodi@263.net

Keywords：

Ambroxol; Pneumonia; Systematic review

Video：

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Objective 　To assess the effectiveness and safety of an aerosol inhalation of ambroxol in accessory treatment of pneumonia.
Methods 　Biomedical databases, including MEDLINE, EMbase, The Cochrane Central Register of Controlled Trials (CENTRAL), CBM-disk and CNKI were searched. Randomized controlled trials (RCTs) and quasi-RCTs that compare aerosol inhalation of ambroxol with placebo or other aerosol inhalation regimens were collected. A critical quality assessment and Meta-analysis were performed for included studies.
Results 　Thirteen RCTs were included and all of them were carried out in China. None of the trials described the method of randomization, allocation concealment, blind, and follow-up. With Juni scales, 13 trials scored C degree. Compared with the control group, aerosol inhalation of ambroxol improved total improvement rate and symptoms, and shortened hospital stay. Although statistical difference was not found in some comparisons, all trials showed beneficial tendency. We didn’t find any RCTs describing the safety of ambroxol aerosol inhalation.
Conclusion 　Because of the low quality of RCTs on ambroxol aerosol inhalation for pneumonia, no reliable conclusion can be drawn from our Meta-analysis. Well-designed RCTs and economic evaluation are urgently needed to evaluate the value and safety of aerosol inhalation of ambroxol in treating pneumonia.

Citation： LOU Honggang,LIU Fang,ZHAI Suodi. Aerosol Inhalation of Ambroxol for Pneumonia: A Systematic Review. Chinese Journal of Evidence-Based Medicine, 2006, 06(6): 421-429. doi: Copy

1.	杨惠娣, 徐彬. 氨溴索的作用机制及临床应用. 中国医院药学杂志, 2002; 22(1): 44.
2.	中华医学会呼吸分会. 社区获得性肺炎诊断和治疗指南 (草案). 中华结核和呼吸杂志, 1999; 22(4): 199~201.
3.	胡亚美, 江载芳. 诸福棠实用儿科学. 第7版, 北京: 人民卫生出版社; 2002. 1144.
4.	吴俊峰, 吴明娥. 沐舒坦雾化吸入辅助治疗60例婴幼儿支气管肺炎疗效观察. 福建医药杂志, 2003; 25(2): 177.
5.	郑敬阳, 陈志宏, 杨俭治, 等. 氨溴索雾化吸入佐治婴幼儿肺炎. 实用儿科临床杂志, 2001; 16(5): 377~378.
6.	黄萍, 罗社声, 汪天林, 等. 沐舒坦雾化吸入辅助治疗婴幼儿肺炎. 复旦学报 (医学科学版), 2001; 28(5): 453~454.
7.	黄灿成. 沐舒坦雾化吸入辅助治疗重症肺炎. 中国现代医学杂志, 2002; 12(9): 98.
8.	张丽. 沐舒坦雾化治疗小儿喘憋性肺炎疗效观察. 小儿急救医学, 2004; 11(增): 63.
9.	何金英. 沐舒坦雾化佐治小儿肺炎的疗效观察. 青海医药杂志, 2003; 33(supple 11): 13.
10.	王素香, 郑忠实, 许嘉玲. 盐酸氨溴索注射液泵雾化吸入佐治新生儿肺炎86例. 海峡药学, 2003; 15(3): 58-59.
11.	潘晓芸. 盐酸氨溴索佐治婴幼儿肺炎疗效观察. 浙江中西医结合杂志, 2004; 14(12): 774.
12.	何淑贞, 郑萍. 沐舒坦氧气雾化吸入治疗小儿支气管肺炎疗效观察. 临床医药实践, 2003; 12(9): 683.
13.	王桂兰, 周群扬. 沐舒坦雾化吸入辅助治疗婴幼儿肺炎疗效观察. 海峡药, 2003; 15(3): 61～62.
14.	鞠淑芬, 韩晓家, 张艳秋. 沐舒坦雾化吸入佐治病毒性肺炎38例疗效观察. 中华实用中西医杂志, 2003; 16(3): 388.
15.	菅卫中. 沐舒坦注射液雾化吸入治疗婴幼儿重症肺炎. 医药论坛杂志, 2003; 24(12): 68.
16.	耿建梅, 刁士燕, 刘孝霞, 等. 氧气驱动雾化沐舒坦治疗新生儿肺炎疗效观察. 中国优生与遗传杂志, 2005; 13(6): 73~74.
17.	Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest, 2005; 127(1): 335-371.
18.	Labiris NR, Dolovich MB. Pulmonary drug delivery. Part II: the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications. Br J Clin Pharmacol, 2003; 56(6):600-612.
19.	Yang HD, Xu B. Mechanism and clinical application of ambroxol. Chinese Journal of Hospital Pharmacy, 2002; 22(1): 44.
20.	Respiration branch of Chinese Medical Association.Diagnostic and therapeutic guideline of community acquired pneumonia(protocol).Chinese journal of tuberculosis and respiration disease,1999,22(4):199-201.
21.	Hu YM, Jiang ZF. Zhu FT Practical paidonosology of Zhu Futang. 7th edition. Beijing: People’s Medical Publishing House; 2002. 1144.
22.	Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ, 2001; 323(7303):42-46.
23.	Wu JF,Wu ME.Clinical effects of aerosol inhalating mucosolvan as a adjuvant therapy for infants with bronchopneumonia. Fujian medical journal, 2003,25(2):177.
24.	Zheng JY, Chen ZH, Yang JZ, et al. Effects of aerosol inhalating ambroxol as adjuvant therapy for infants with pneumonia. Journal of applied Clinical Pediatrics, 2001,16(5): 377-378.
25.	Huang P, Luo SS, Wan TL, et al. Adjuvant therapy of aerosol inhalating ambroxol for infants with pneumonia. Journal of Fudan university (medical science). 2001; 28(5): 453-454.
26.	Wang CC. Adjuvant therapy of aerosol inhalating ambroxol for severe pneumonia. China Journal of Modern Medicine, 2002; 12(9): 98.
27.	Zhang L. Effects of ambroxol by aerosol inhalation for infants with asthmatic suffocating pneumonia. Pediatric Emergency Medicine, 2004, 11(supply): 63.
28.	He JY. Effects of aerosol inhalating ambroxol as adjuvant therapy for infants with pneumonia. Qinghai medical Journal , 2003, 33(11): 13.
29.	Wang SX, Zheng ZS, Xu JL. Effects of 86 cases newborn’s pneumonia with inhalating ambroxol hydrochloride injection nebulized by pump. Strait Pharmaceutical Journal, 2003, 15(3): 58-59.
30.	Pan XY. Effects of Ambroxol Hydrochloride as adjuvant therapy for infants with pneumonia. Zhejiang Journal of Integrated Traditional Combined Western Medicine, 2004; 14(12): 774.
31.	He SZ, Zheng P. Effects of inhalating mucosolvan nebulized by oxygen for infants with bronchopneumonia. Clinical Medical Practice, 2003; 12(9): 683.
32.	Wang GL, Zhou QY. Effects of aerosol inhalating ambroxol as adjuvant therapy for infants with pneumonia. Strait Pharmaceutical Journal, 2003; 15(3): 61-62.
33.	Ju SF, Han XJ, Zhang YQ. Observation on treating viral pneumonia by aerosol inhalating mucosolvan in 38 cases. Chinese Journal of the practical of Chinese with Modern Medicine, 2003; 16(3): 388.
34.	Jian WZ. Therapy of aerosol inhalating ambroxol injection for infants with severe pneumonia. Journal of Medical Forum, 2003; 24(12): 68.
35.	Geng JM, Diao SY, Liu SX, et al. Observation on treating newborn’s pneumonia by aerosol inhalating mucosolvan drived by oxygen. Chinese Journal of aristogenesis and heredity, 2005; 13(6): 73-74.
36.	Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA, 1995; 273(5): 408-412.
37.	Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet, 1998; 352(9128): 609-613.
38.	Merkus P, Romeijn SG, Verhoef JC, et al. Classification of cilio-inhibiting effects of nasal drugs. Laryngoscope, 2001; 111(4 Pt 1): 595-602.
39.	Haidl P. Nebulized treatment-What is evidence-based? Atemwegs- und Lungenkrankheiten, 2004; 30(9): 432-439.

1. 杨惠娣, 徐彬. 氨溴索的作用机制及临床应用. 中国医院药学杂志, 2002; 22(1): 44.
2. 中华医学会呼吸分会. 社区获得性肺炎诊断和治疗指南 (草案). 中华结核和呼吸杂志, 1999; 22(4): 199~201.
3. 胡亚美, 江载芳. 诸福棠实用儿科学. 第7版, 北京: 人民卫生出版社; 2002. 1144.
4. 吴俊峰, 吴明娥. 沐舒坦雾化吸入辅助治疗60例婴幼儿支气管肺炎疗效观察. 福建医药杂志, 2003; 25(2): 177.
5. 郑敬阳, 陈志宏, 杨俭治, 等. 氨溴索雾化吸入佐治婴幼儿肺炎. 实用儿科临床杂志, 2001; 16(5): 377~378.
6. 黄萍, 罗社声, 汪天林, 等. 沐舒坦雾化吸入辅助治疗婴幼儿肺炎. 复旦学报 (医学科学版), 2001; 28(5): 453~454.
7. 黄灿成. 沐舒坦雾化吸入辅助治疗重症肺炎. 中国现代医学杂志, 2002; 12(9): 98.
8. 张丽. 沐舒坦雾化治疗小儿喘憋性肺炎疗效观察. 小儿急救医学, 2004; 11(增): 63.
9. 何金英. 沐舒坦雾化佐治小儿肺炎的疗效观察. 青海医药杂志, 2003; 33(supple 11): 13.
10. 王素香, 郑忠实, 许嘉玲. 盐酸氨溴索注射液泵雾化吸入佐治新生儿肺炎86例. 海峡药学, 2003; 15(3): 58-59.
11. 潘晓芸. 盐酸氨溴索佐治婴幼儿肺炎疗效观察. 浙江中西医结合杂志, 2004; 14(12): 774.
12. 何淑贞, 郑萍. 沐舒坦氧气雾化吸入治疗小儿支气管肺炎疗效观察. 临床医药实践, 2003; 12(9): 683.
13. 王桂兰, 周群扬. 沐舒坦雾化吸入辅助治疗婴幼儿肺炎疗效观察. 海峡药, 2003; 15(3): 61～62.
14. 鞠淑芬, 韩晓家, 张艳秋. 沐舒坦雾化吸入佐治病毒性肺炎38例疗效观察. 中华实用中西医杂志, 2003; 16(3): 388.
15. 菅卫中. 沐舒坦注射液雾化吸入治疗婴幼儿重症肺炎. 医药论坛杂志, 2003; 24(12): 68.
16. 耿建梅, 刁士燕, 刘孝霞, 等. 氧气驱动雾化沐舒坦治疗新生儿肺炎疗效观察. 中国优生与遗传杂志, 2005; 13(6): 73~74.
17. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: Evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest, 2005; 127(1): 335-371.
18. Labiris NR, Dolovich MB. Pulmonary drug delivery. Part II: the role of inhalant delivery devices and drug formulations in therapeutic effectiveness of aerosolized medications. Br J Clin Pharmacol, 2003; 56(6):600-612.
19. Yang HD, Xu B. Mechanism and clinical application of ambroxol. Chinese Journal of Hospital Pharmacy, 2002; 22(1): 44.
20. Respiration branch of Chinese Medical Association.Diagnostic and therapeutic guideline of community acquired pneumonia(protocol).Chinese journal of tuberculosis and respiration disease,1999,22(4):199-201.
21. Hu YM, Jiang ZF. Zhu FT Practical paidonosology of Zhu Futang. 7th edition. Beijing: People’s Medical Publishing House; 2002. 1144.
22. Juni P, Altman DG, Egger M. Systematic reviews in health care: Assessing the quality of controlled clinical trials. BMJ, 2001; 323(7303):42-46.
23. Wu JF,Wu ME.Clinical effects of aerosol inhalating mucosolvan as a adjuvant therapy for infants with bronchopneumonia. Fujian medical journal, 2003,25(2):177.
24. Zheng JY, Chen ZH, Yang JZ, et al. Effects of aerosol inhalating ambroxol as adjuvant therapy for infants with pneumonia. Journal of applied Clinical Pediatrics, 2001,16(5): 377-378.
25. Huang P, Luo SS, Wan TL, et al. Adjuvant therapy of aerosol inhalating ambroxol for infants with pneumonia. Journal of Fudan university (medical science). 2001; 28(5): 453-454.
26. Wang CC. Adjuvant therapy of aerosol inhalating ambroxol for severe pneumonia. China Journal of Modern Medicine, 2002; 12(9): 98.
27. Zhang L. Effects of ambroxol by aerosol inhalation for infants with asthmatic suffocating pneumonia. Pediatric Emergency Medicine, 2004, 11(supply): 63.
28. He JY. Effects of aerosol inhalating ambroxol as adjuvant therapy for infants with pneumonia. Qinghai medical Journal , 2003, 33(11): 13.
29. Wang SX, Zheng ZS, Xu JL. Effects of 86 cases newborn’s pneumonia with inhalating ambroxol hydrochloride injection nebulized by pump. Strait Pharmaceutical Journal, 2003, 15(3): 58-59.
30. Pan XY. Effects of Ambroxol Hydrochloride as adjuvant therapy for infants with pneumonia. Zhejiang Journal of Integrated Traditional Combined Western Medicine, 2004; 14(12): 774.
31. He SZ, Zheng P. Effects of inhalating mucosolvan nebulized by oxygen for infants with bronchopneumonia. Clinical Medical Practice, 2003; 12(9): 683.
32. Wang GL, Zhou QY. Effects of aerosol inhalating ambroxol as adjuvant therapy for infants with pneumonia. Strait Pharmaceutical Journal, 2003; 15(3): 61-62.
33. Ju SF, Han XJ, Zhang YQ. Observation on treating viral pneumonia by aerosol inhalating mucosolvan in 38 cases. Chinese Journal of the practical of Chinese with Modern Medicine, 2003; 16(3): 388.
34. Jian WZ. Therapy of aerosol inhalating ambroxol injection for infants with severe pneumonia. Journal of Medical Forum, 2003; 24(12): 68.
35. Geng JM, Diao SY, Liu SX, et al. Observation on treating newborn’s pneumonia by aerosol inhalating mucosolvan drived by oxygen. Chinese Journal of aristogenesis and heredity, 2005; 13(6): 73-74.
36. Schulz KF, Chalmers I, Hayes RJ, et al. Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. JAMA, 1995; 273(5): 408-412.
37. Moher D, Pham B, Jones A, et al. Does quality of reports of randomised trials affect estimates of intervention efficacy reported in meta-analyses? Lancet, 1998; 352(9128): 609-613.
38. Merkus P, Romeijn SG, Verhoef JC, et al. Classification of cilio-inhibiting effects of nasal drugs. Laryngoscope, 2001; 111(4 Pt 1): 595-602.
39. Haidl P. Nebulized treatment-What is evidence-based? Atemwegs- und Lungenkrankheiten, 2004; 30(9): 432-439.

Chinese Journal of Evidence-Based Medicine

Aerosol Inhalation of Ambroxol for Pneumonia: A Systematic Review

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