Airway Clearance in Bronchiectasis: A Randomized Control Trial of N-Acetylcysteine with 3% hypertonic saline

Abstract

Background: N-Acetylcysteine and 3% hypertonic saline are being used effectively for sputum clearance in chronic cases of bronchiectasis for quite some time. However, their use in acute condition of the disease seems to be underexplored. The objective of our study is to compare the role of nebulized N-acetylcysteine and 3% hypertonic saline in clearing the airway in patients with acute exacerbation of bronchiectasis.
 Material and Methods: A total of 136 confirmed cases of bronchiectasis were enrolled in this study. This randomized controlled trial was done in chest ward of Nishtar Hospital Multan from January 2015 to March 2017. Sampling was done by non-probability consecutive sampling and patients were divided into two groups A and B by lottery method. Verbal informed consent was taken from all participants. Group A participants received nebulization of N acetylcysteine mixed in normal saline for ten minutes, while group B participants were nebulized with 10ml of 3% hypertonic saline for ten minutes. Group B was active control group in the study. Data was collected on pre-designed Proforma, and analyzed by SPSS version 22. Numerical variables such as saturation, weight of sputum, age and blood pressure was analyzed by using t test. These were considered significant if the p value was equal or less than 0 .05. For qualitative variables chi square test was applied.
 Results: The mean O2 saturation of Group A, before and after treatment, was 92.11±3.07% and 94.47±2.18%, respectively. The difference was statistically significant (p value =0.001). The sputum weight of Group A, before and after treatment, was 2.63±2.39 g and 7.41±1.38 g, respectively. The difference was statistically significant (p value =0.001). The frequency of rhonchi of Group A, before and after treatment, was 52% and 76%, respectively. The difference was statistically significant (p value =0.003). While, for Group B, the mean O2 saturation, before and after treatment, was 92.36±3.13% and 93.49±2.27%, respectively. The difference was statistically significant (p value =0.012). The sputum weight, before and after treatment, was 3.11±2.01 g and 5.56±1.02 g, respectively. The frequency of rhonchi, before and after treatment, was 45% and 74% respectively. Again, the difference was statistically significant.
 Conclusion: Both nebulized N-acetylcysteine and 3% hypertonic saline cause airway clearance by enhancing sputum expectoration in patients with acute exacerbation of bronchiectasis equally. Both these agents also improve oxygen saturation in acute exacerbation of bronchiectasis significantly.

The efficacy and safety of inhaled acetylcysteine in comparison with oral acetylcysteine in chronic obstructive pulmonary disease: A randomized single-center study

“…29 In patients with bronchiectatic disease, inhaled NAC not only improved airway clearance but also significantly increased oxygen saturation. 11 Our research of the positive effects of a 10-day NAC treatment with a nebulizer, such as reducing disease symptoms, improving quality of life, and reducing the severity of bronchial obstruction, generally coincides with previous studies, although they were performed in a different contingent of patients with a pulmonary profile. Interestingly, similar to our results for cough reduction after NAC treatment were obtained in one of the experimental studies, 31 which researched the effect of the drug on the protective mechanisms of respiratory tract in animals.…”

“…6 The number of studies examining the efficacy and safety of administration of the mucolytic drugs, in particular NAC and its derivatives, by a nebulizer in patients with respiratory diseases, is small. [9][10][11][12] These studies were performed in patients with bronchiectasis, cystic fibrosis, patients undergoing mechanical ventilation and in healthy subjects. Inhalation of NAC resulted in positive outcomes in all these patient categories.…”

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“…Pada banyak penyakit pernapasan kronis, uji klinis N-acetylcysteine telah dilakukan dan hasilnya menunjukkan bahwa N-acetylcysteine meringankan gejala dan meningkatkan kualitas hidup. 26 Efek N-acetylcysteine dalam membersihkan jalan napas dan ekspektorasi dahak telah diamati dalam berbagai penelitian. Nebulasi dengan N-acetylcysteine menyebabkan penipisan sputum yang menyebabkan peningkatan ekspektorasi.…”

“…Nacetylcysteine juga menyebabkan peningkatan pertukaran gas setelah bronkospasme yang disebabkan oleh tes tantangan metakolin. 26 Terdapat konsekuensi yang signifikan dari batuk pada pasien dan berkontribusi pada kelelahan dan penurunan kualitas hidup pada bronkiektasis, oleh karena itu dibutuhkan adanya fisioterapi dada. 15 Fisioterapi dada merupakan rangkaian tindakan keperawatan yang terdiri dari perkusi, vibrasi, drainase, nafas dalam, dan latihan batuk efektif.…”