Ambroxol is a mucus-modifying
drug with a known ability to stimulate
surfactant secretion and inhibit, in vitro, the production of proinflammatory
cytokines, neutrophil chemotaxis, and Na+ absorption by the airway epithelium. In dogs inhaling
ozone,
bronchial hyperreactivity can be inhibited by aerosolized
Ambroxol. To verify the possibility of producing anti-inflammatory effects in a clinically relevant condition, 20 patients with
chronic bronchitis, randomly divided into two balanced matched groups, were submitted to a 14 day trial with
Ambroxol, 150 mg.day-1, or placebo, according to a double-blind design. A bronchoalveolar lavage (BAL) was performed the day before starting treatment (T0) and at the 14th day (T14). The analysis of the cellular and soluble (total
proteins,
albumin,
immunoglobulin G and A (
IgG and
IgA)) BAL components demonstrated no clear modifications. In particular, neutrophil values from the bronchial aliquot showed a large dispersion, with no significant differences (
Ambroxol: T0 = 13.7 +/- 5.2%, T14 = 14.0 +/- 6.8%; placebo: T0 = 3.6 +/- 1.1%, T14 = 5.5 +/- 2.2%). We found a nonsignificant increase of
phospholipids in BAL supernatants from
Ambroxol-treated patients (2.5 +/- 1.9 vs 3.0 +/- 1.9 micrograms.mg-1 of
protein); whilst in the placebo group data before and
after treatment were superimposable (2.2 +/- 1.5 vs 2.3 +/- 1.9 micrograms.mg-1 of
protein). In conclusion, we have failed to demonstrate that conventional treatment with oral
Ambroxol can modify
surfactant and BAL cell populations in the airways of patients with
chronic bronchitis.