{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,26]],"date-time":"2026-03-26T14:56:48Z","timestamp":1774537008798,"version":"3.50.1"},"reference-count":19,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T00:00:00Z","timestamp":1767139200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ARM"],"abstract":"<jats:p>This systematic review and meta-analysis aimed to evaluate the efficacy and safety of carbocisteine in reducing chronic obstructive pulmonary disease (COPD) exacerbations based on evidence from randomized controlled trials (RCTs). A comprehensive literature search was conducted across PubMed, Embase, Cochrane Library, and ClinicalTrials.gov. RCTs comparing carbocisteine (1500 mg\/day) with placebo in COPD patients, with a minimum follow-up of six months, were included. Data on exacerbation rates and adverse events were extracted and analyzed using a random-effects model. Four RCTs involving 1746 patients met inclusion criteria. Pooled analysis showed that carbocisteine significantly reduced the annual rate of acute exacerbations compared to placebo (WMD = \u22120.40; 95% CI: \u22120.69 to \u22120.11), with no significant increase in adverse events (OR = 1.02; 95% CI: 0.76 to 1.37). Mechanistically, carbocisteine improves mucociliary clearance, suppresses airway inflammation, reduces oxidative stress, and may hinder bacterial colonization. Carbocisteine is associated with a significant reduction in COPD exacerbations and demonstrates a favorable safety profile. It may serve as an effective adjunctive therapy in patients with frequent exacerbations and mucus hypersecretion.<\/jats:p>","DOI":"10.3390\/arm94010002","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:33:25Z","timestamp":1767191605000},"page":"2","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Efficacy of Carbocisteine in Reducing Exacerbations in Chronic Obstructive Pulmonary Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials"],"prefix":"10.3390","volume":"94","author":[{"given":"Chia","family":"Kow","sequence":"first","affiliation":[{"name":"School of Pharmacy, Sunway University, Petaling Jaya 47500, Selangor, Malaysia"},{"name":"Sunway Biofunctional Molecules Discovery Centre, Faculty of Medical and Life Sciences, Sunway University, Petaling Jaya 47500, Selangor, Malaysia"},{"name":"School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4058-2215","authenticated-orcid":false,"given":"Syed","family":"Hasan","sequence":"additional","affiliation":[{"name":"School of Applied Sciences, University of Huddersfield, Huddersfield HD1 3DH, UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3754-1690","authenticated-orcid":false,"given":"Kaeshaelya","family":"Thiruchelvam","sequence":"additional","affiliation":[{"name":"School of Pharmacy, IMU University, Bukit Jalil 57000, Kuala Lumpur, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1016\/S0140-6736(04)16900-6","article-title":"Pathophysiology of airflow limitation in chronic obstructive pulmonary disease","volume":"364","author":"Hogg","year":"2004","journal-title":"Lancet"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1183\/09059180.00002610","article-title":"Impact of exacerbations on COPD","volume":"19","author":"Anzueto","year":"2010","journal-title":"Eur. 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