A double-blind parallel study in patients with asthma compared the safety and efficacy of saline-isoproterenol (SI) and acetylcysteine-isoproterenol (AI), when administered at home as an aerosol, over a one-week period, using a conventional nebulizer compressor. Measurements of pulmonary function revealed statistically significant differences between the two therapies for FEV1 and FVC in favour of AI. In the group treated with AI, the average sputum viscosity after six days of treatment was significantly less than pre-treatment values, or when compared to the results with SI treatment. No serious side-effects were reported during treatment with either therapy. These results indicate that acetylcysteine combined with a bronchodilator, such as isoproterenol, may be safe and of significant value in the treatment of patients with asthma who are also sputum producers.
Acetylcysteine (Mucomyst) mu* reduces the viscosity of tracheobronchial secretions in a number of acute and chronic bronchopulmonary conditions. Reasl. noted that acetylcysteine produced a marked reduction in viscosity of the secretions obtained from the tracheobronchial tree in tracheotomized children with cystic fibrosis of the pancreas.A. L. Sheffner3 reported that the free sulfhydryl group in acetylcysteine produced its mucolytic effect, apparently by acting upon the disulfide bonds present in mucus. A specific sulfhydryldisulfide interchange reaction occurs which is concentration and p H dependent with the activity increasing with increased pH from 4.0 to 9.0. Acetylcysteine markedly reduced the viscosity of human pulmonary secretions in vitro.Webb4 found acetylcysteine particularly effective in tracheotomy care, and was also impressed by its usefulness when used during anesthesia and surgery and following surgery to prevent pulmonary complications such as atelectasis and pneumonia. He reported dramatic improvements in patients with acute and chronic bronchopulmonary disease such as pneumonia, lung abscess, emphysema, chronic bronchitis, bronchitis siccus, bronchiectasis and atelectasis due to mucus obstruction. He administered acetylcysteine by various methods such as nebulization into a face mask or mouth piece, instillation directly into an endotracheal tube or tracheostomy, or instillation into the trachea via a percutaneous endotracheal catheter using the technique of Radigan and King.bBernstein6 reported that acetylcysteine produced bronchospasm in asthmatic children but not in normal controls or others with non-asthmatic obstructive pulmonary conditions. He postulated that this iatrogenic bronchospasm was an irritative phenomenon. It probably resulted from the minute concentration of H2S liberated from acetylcysteine which is noxious only to asthmatics. The concomitant administration of isoproterenol prevented or greatly diminished bronchospasm in these asthmatic children.Most patients with bronchial asthma and prolonged bronchiolar obstruction experience bronchospasm, and also have a thick, sticky mucus in their bronchopulmonary tree. As the asthma increases in severity, the more prolonged and poorly controlled the bronchiolar obstruction becomes. The patient also becomes more dehydrated and the bronchopulmonary secretions *Studies performed under the auspices of the San Diego Bio-Medical Research ** Mucomyst-Mead Johnson Labs., Evansville, Indiana. Institute. 199 J Asthma Downloaded from informahealthcare.com by University of North Carolina on 11/04/14 For personal use only.
2.Agents administered into the tracheobronchial tree were as follows: plus three to six drops of isoproterenol 1 : 200.proterenol.
Pulmonary function studies:J Asthma Downloaded from informahealthcare.com by University of North Carolina on 11/04/14For personal use only.
This Case Report is that of a young woman followed for 21 years, whose life was saved repeatedly by bronchoscopy and lavage to remove mucous plugs and casts from the tracheobronchial tree. In 1982, after again having a respiratory crisis and not having a bronchoscopy and lavage, she died. The pathology revealed a thickened hyalinized basement membrane and numerous mucous plugs filling the larger bronchi and bronchioles.
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