Effect of inhaled and oral n-acetylcysteine on airway defense mechanism

Pappová, L.; Kazimierová, Ivana; Kočmálová, Michaela

doi:10.1515/afpuc-2017-0002

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…18 In a study by Pappová et al showed that nebulization with Nacetylcysteine caused bronchospasm by increasing airway reactivity. 19 Similarly, in our study nebulization with both 3% hypertonic saline and N-acetylcysteine caused increased airway reactivity and rhonchi. We recommend further research in this regard.…”

Section: Discussionsupporting

confidence: 79%

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

Shehzad¹,

Mannan

Alam³

et al. 2019

JIMDC

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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.

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Section: Discussionsupporting

confidence: 79%

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

Shehzad¹,

Mannan

Alam³

et al. 2019

JIMDC

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“…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. The argument for the use of NAC with a nebulizer can be connected to the higher potential of its mucolytic action during direct contact with mucus, which due to the presence of a sulfhydryl group in the molecule.…”

Section: Discussionsupporting

confidence: 90%

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

et al. 2020

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Introduction: One-third of all the patients with chronic obstructive pulmonary disease (COPD) additionally take mucolytics as per GOLD recommendation due to complaints of productive cough despite their compliance with the basic treatment regimen. Aim: To assess the efficacy and safety of inhaled N-acetylcysteine (NAC) in comparison with oral NAC in patients with COPD. Material and methods: The study included 46 patients with stable COPD and difficult expectoration of sputum who were divided into two groups. The first group (n = 22) took 600 mg/day NAC orally, and the second one (n = 24) inhaled 600 mg/day NAC by a nebulizer for 10 days. In the beginning and after the 10-day treatment the questionnaires (CAT, mMRC, CCQ, SGRQ, SF-36), 6-minute walk distance test and day and night cough symptoms were evaluated, spirometry and sputum analysis were performed. Results and discussion: In the first group, CCQ showed improvement in the status of patients (by 9.7%). The severity of night cough also decreased. Other indices were not changed statistically. In the other group, positive changes in the CAT (by 13.1%) and SF-36 were reported, night cough decreased. Additionally, forced expiratory volume in 1 s (FEV1) values increased (by 10.3%). No changes in FEV1 2 hours after the first oral usage or inhalation of NAC were found. Conclusions: Both oral administration and inhalation of NAC by a nebulizer for 10 days has a similar positive effect on the manifestations of COPD, but the inhalation route of the drug is also accompanied by improved quality of life and lung function test (FEV1) as well.

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“…Similarly, less risk for exacerbations of chronic bronchitis or chronic obstructive pulmonary disease (COPD) has been recently confirmed in patients taking mucolytics probably due to reduced mucus viscosity making it easier to expectorate (Poole et al, 2019). Mucolytics provide also additional direct cilio-stimulatory and bronchodilator effects without impact on the cough sensitivity, anti-inflammatory (Pappova et al, 2017;Frañováet al, 2019), antioxidant (Miyake et al, 1999) or immunomodulatory properties, in addition to the ability to reduce bacterial adhesiveness (Braga et al, 1999, Pappová et al, 2018.…”

Section: Cilia In Mucociliary Clearancementioning

confidence: 98%

“…The mucokinetic agents may influence mucociliary clearance directly by acting on the cilia. There is evidence that bronchodilators SABA and LABA improve beating kinematics via increase in the CBF in in vitro conditions (Devalia et al, 1992;Kanthakumar et al, 1994;Frohock et al, 2002;Pappova et al, 2017). However, in patients with moderate and severe bronchial asthma, the CBF significantly declines despite treatment with long-acting bronchodilators (Thomas et al, 2010).…”

Section: Other Drugs With Cilio-stimulatory Properties (Mucokinetics)mentioning

confidence: 99%

Respiratory Cilia as a Therapeutic Target of Phosphodiesterase Inhibitors

2020

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Mucociliary clearance is an essential airway defense mechanism dependent predominantly on the proper ciliary function and mucus rheology. The crucial role of cilia is evident in`a variety of respiratory diseases, as the ciliary dysfunction is associated with a progressive decline in lung function over time. The activity of cilia is under supervision of multiple physiological regulators, including second messengers. Their role is to enable a movement in coordinated metachronal waves at certain beat frequency. Ciliary function can be modulated by various stimuli, including agents from the group of beta 2 agonists, cholinergic drugs, and adenosine triphosphate (ATP). They trigger cilia to move faster in response to elevated cytoplasmic Ca 2+ originated from intracellular sources or replenished from extracellular space. Well-known cilia-stimulatory effect of Ca 2+ ions can be abolished or even reversed by modulating the phosphodiesterase (PDE)-mediated breakdown of cyclic adenosine monophosphate (cAMP) since the overall change in ciliary beating has been dependent on the balance between Ca 2+ ions and cAMP. Moreover, in chronic respiratory diseases, high ATP levels may contribute to cAMP hydrolysis and thus to a decrease in the ciliary beat frequency (CBF). The role of PDE inhibitors in airway cilia-driven transport may help in prevention of progressive loss of pulmonary function often observed despite current therapy. Furthermore, administration of selective PDE inhibitors by inhalation lowers the risk of their systemic effects. Based on this review we may conclude that selective (PDE1, PDE4) or dual PDE inhibitors (PDE3/4) increase the intracellular level of cyclic nucleotides in airway epithelial cells and thus may be an important target in the development of new inhaled mucokinetic agents. Further research is required to provide evidence of their effectiveness and feasibility regarding their cilia-modulating properties.

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Effect of inhaled and oral n-acetylcysteine on airway defense mechanism

Cited by 3 publications

References 11 publications

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

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

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

Respiratory Cilia as a Therapeutic Target of Phosphodiesterase Inhibitors

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