We read the paper by Poole and Black(1)with interest but would like
to make the following comments having discussed the paper for critical
appraisal.
The study quotes twenty three trials that were predominantly
performed in a secondary care setting in Europe and we would wonder if
this result was generalisable to primary care in the United Kingdom? In
addition, the author suggests the cost of oral mucolytics in the United
Kingdom may be high exceeding £200 a year. However, they also quote a
further study(2) which looked at cost effectiveness of acetyl cysteine and
again suggested that this treatment may not be cost effective in the
United Kingdom.
We were confused in the presentation of the results which suggested
that twenty three studies were to be included in the review. However,
only twenty results are presented in tabulated form. In addition, they
only provide references for twenty two randomised controlled trials rather
than twenty three that were mentioned.
Finally, no mention is made of how acute exacerbations or days of
illness were assessed and we feel this would be important information to
exclude observer bias in these trials.
Yours faithfully
Dr A Williams
Research GP
Dr A Mander
GP Registrar
References:
Poole PJ, Black PN. Oral mucolytic drugs for exacerbations of chronic
obstructive pulmonary disease: a systematic review. BMJ 2001;322:1271-4.
Grandjean EM, Berthert P, Ruffman R, Leuenberger P. Cost - effectiveness
analysis of oral N-acetyl cysteine as a preventative treatment in chronic
bronchitis. Pharmacol Res S 2000;42:39-50.
Rapid Response:
A critical appraisal
We read the paper by Poole and Black(1)with interest but would like
to make the following comments having discussed the paper for critical
appraisal.
The study quotes twenty three trials that were predominantly
performed in a secondary care setting in Europe and we would wonder if
this result was generalisable to primary care in the United Kingdom? In
addition, the author suggests the cost of oral mucolytics in the United
Kingdom may be high exceeding £200 a year. However, they also quote a
further study(2) which looked at cost effectiveness of acetyl cysteine and
again suggested that this treatment may not be cost effective in the
United Kingdom.
We were confused in the presentation of the results which suggested
that twenty three studies were to be included in the review. However,
only twenty results are presented in tabulated form. In addition, they
only provide references for twenty two randomised controlled trials rather
than twenty three that were mentioned.
Finally, no mention is made of how acute exacerbations or days of
illness were assessed and we feel this would be important information to
exclude observer bias in these trials.
Yours faithfully
Dr A Williams
Research GP
Dr A Mander
GP Registrar
References:
Poole PJ, Black PN. Oral mucolytic drugs for exacerbations of chronic
obstructive pulmonary disease: a systematic review. BMJ 2001;322:1271-4.
Grandjean EM, Berthert P, Ruffman R, Leuenberger P. Cost - effectiveness
analysis of oral N-acetyl cysteine as a preventative treatment in chronic
bronchitis. Pharmacol Res S 2000;42:39-50.
Competing interests: No competing interests