Targeting chronic mucus hypersecretion in respiratory diseases - focus on OPEP devices.

Chronic respiratory diseases pose an ever-increasing health burden in India. Chronic mucus hypersecretion (CMH) is a hallmark feature of many chronic obstructive respiratory diseases (CRDs). CMH is associated with impaired mucociliary clearance, recurrent infections, and disease progression. Effective airway clearance is therefore a key component of management. Several pharmacological and non-pharmacological strategies are used in CMH for clearing airways. Of these mucoactive drugs, N-acetylcysteine (NAC) and erdosteine are commonly used in India to manage CMH. Further, oscillating positive expiratory pressure (OPEP) devices have emerged as a non-pharmacological adjunct designed to enhance mucus clearance through the combined effects of positive expiratory pressure and oscillatory airflow. These mechanisms help stabilize airways, reduce mucus viscosity, and promote the mobilization of secretions toward the central airways for expectoration. Together, both mucoactive agents and OPEP devices prevent recurrent infections and exacerbations in chronic respiratory conditions and improve lung function and quality of life. The present review focuses on the prevalence of CMH in various CRDs, its impact on the natural history and disease progression in CRDs as well as various pharmacological and non-pharmacological therapies for CMH including published evidences. Special focus has been given to OPEP devices and therapeutic recommendations for practising clinicians have been provided.