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This real-world, multicenter, prospective, observational study aimed to determine the effect of long-term mucoactive treatment on exacerbations in patients with COPD in the Czech Republic.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      452 adult patients on the Czech Multicenter Research Database of COPD with post-bronchodilator FEV\n                      <jats:sub>1<\/jats:sub>\n                      \u2009\u2264\u200960% of predicted value received standard of care and were followed up for 5\u00a0years. For the first 24\u00a0months, 81 patients received regular thiol-based mucoactive drugs (77 erdosteine, 4 N-acetylcysteine) at the discretion of the treating physician and 371 patients had no mucoactive treatment (control group). Erdosteine was fully reimbursed, and NAC was partially reimbursed for COPD patients. The annual number\/rate of COPD exacerbations over 5\u00a0years was monitored.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Patients receiving mucoactive treatment for 24\u00a0months had a significantly larger reduction from baseline in all exacerbations compared to the control group (\u2212\u00a00.61 vs \u2212\u00a00.18,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.026; \u2212\u00a00.54 vs \u2212\u00a00.09,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007; \u2212\u00a00.55 vs 0.04,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.005; \u2212\u00a00.67 vs 0.13,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002; \u2212\u00a00.53 vs 0.10,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.019 in the first to fifth year, respectively). The reduction in moderate exacerbations was also significantly larger in those receiving mucoactive treatment versus no mucoactive treatment. The exacerbation rate was reduced to a greater extent in the subgroups with cough or with stage 3\u20124 COPD who received mucoactive treatment but was independent of the use of inhaled corticosteroids (ICS).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Mucoactive treatment for two years reduced the number of COPD exacerbations (all, moderate) over five years of follow-up. The reduction in exacerbations was more pronounced in patients with cough or with stage 3\u20124 COPD but was independent of the use of ICS.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00408-025-00813-7","type":"journal-article","created":{"date-parts":[[2025,5,6]],"date-time":"2025-05-06T09:48:05Z","timestamp":1746524885000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Effect of Treatment with Mucoactive Drugs on COPD Exacerbations During 5\u00a0years of Follow-up in the Czech Republic: A Real-World Study"],"prefix":"10.1007","volume":"203","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3207-6355","authenticated-orcid":false,"given":"Jarom\u00edr","family":"Zatloukal","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9358-3799","authenticated-orcid":false,"given":"Clive","family":"Page","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1674-228X","authenticated-orcid":false,"given":"Kristi\u00e1n","family":"Brat","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0312-2524","authenticated-orcid":false,"given":"Michal","family":"Svoboda","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6388-8022","authenticated-orcid":false,"given":"Eva","family":"Vol\u00e1kov\u00e1","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1723-3794","authenticated-orcid":false,"given":"Marek","family":"Plutinsk\u00fd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1191-2967","authenticated-orcid":false,"given":"Michal","family":"Kopeck\u00fd","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2446-2790","authenticated-orcid":false,"given":"Vladim\u00edr","family":"Kobl\u00ed\u017eek","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,5,6]]},"reference":[{"key":"813_CR1","unstructured":"Global Initiative for Chronic Obstructive Lung Disease (2025) Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. https:\/\/goldcopd.org\/goldreports\/. 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JAMA 329(21):1832\u20131839. https:\/\/doi.org\/10.1001\/jama.2023.2065","journal-title":"JAMA"}],"container-title":["Lung"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-025-00813-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00408-025-00813-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00408-025-00813-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T04:42:50Z","timestamp":1766378570000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00408-025-00813-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,5,6]]},"references-count":25,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2025,12]]}},"alternative-id":["813"],"URL":"https:\/\/doi.org\/10.1007\/s00408-025-00813-7","relation":{},"ISSN":["0341-2040","1432-1750"],"issn-type":[{"value":"0341-2040","type":"print"},{"value":"1432-1750","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,5,6]]},"assertion":[{"value":"30 January 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 April 2025","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"6 May 2025","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"JZ received fees for presentation at symposia and or publications from Angelini CZ, AstraZeneca CZ, Sanofi CZ, GlaxoSmithKline CZ, received fees for advisory board participation from Berlin-Chemie CZ, AstraZeneca CZ, Sanofi CZ, GlaxoSmithKline CZ and reports travel grant from Angelini CZ. All above mentioned is outside the submitted work. CP received fees for presentation at symposia from Recipharm and Eurodrug; received fees for Advisory Board participation from Recipharm, Eurodrug, MicroA, EpiEndo and Ananda Developments; received fees as a Non Executive Director of Ananda Developments. VK reports non-financial support from Meditech Media, UK, Boehringer Ingelheim RCV Vienna, AUT, Charles University, Czechia, and Ministry of the Health, Czechia, during the conduct of the study. He gave presentations at symposia and sponsored and received fees for advisory board participation and travel grants from Angelini, AstraZeneca, Berlin-Chemie CZ, Boehringer Ingelheim CZ, Chiesi CZ and Menarini IL. He received research grants from Angelini CZ, AstraZeneca CZ, Boehringer Ingelheim CZ, RCV, and Chiesi CZ. Moreover, VK received an honorarium from the Roche Europe advisory board and Sanofi CZ advisory board. All above mentioned is outside the submitted work. KB reports non-financial support from Angelini CZ and Ministry of the Health, Czechia, during the study, sponsored presentations at congresses and symposia and fees for advisory boards from Chiesi CZ, Angelini CZ, AstraZeneca CZ, Sanofi CZ and Menarini. All the above are outside the submitted work. EV has received COPD research funding\/travel grants from AstraZeneca CZ and consulting\/lectures\/advisory board payment from AstraZeneca CZ, GlaxoSmithKline CZ and Sanofi CZ. MP received fees for presentation at symposia from AstraZeneca CZ, fees for advisory board participation from GlaxoSmithKline CZ. All above mentioned is outside the submitted work. MS and MK have nothing to disclose.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interests"}},{"value":"This observational study was conducted in accordance with the laws of the Czech Republic and the ethical principles of the Declaration of Helsinki. Institutional Multicenter Ethic Committee of University Hospital Hradec Kralove (Charles University, Czechia, EU) approved study protocol with informed consent on 12 February 2013; approval number 201303 501P.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"All participants provided written consent prior to enrollment on the Czech Multicenter Research Database of COPD.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to Participate"}}],"article-number":"61"}}