Effect of N-Acetylcysteine on Air Trapping in COPD

Stav, David; Raz, Meir

doi:10.1378/chest.09-0421

Cited by 69 publications

(52 citation statements)

References 18 publications

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“…Unexpectedly, a significant reduction in functional residual capacity (374 mL; p,0.001) was observed in the N-acetylcysteine group, indicating that Nacetylcysteine might reduce hyperinflation in COPD patients. Such an effect was recently confirmed during exercise in a smaller study [51].…”

Section: Treatment Of Copd With Mucolytic Drugsmentioning

confidence: 57%

Mucoactive therapy in COPD

Decramer¹,

Janssens²

2010

Eur Respir Rev

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It has been shown that mucus hypersecretion is associated with greater susceptibility for chronic obstructive pulmonary disease (COPD), excess forced expiratory volume in 1 s decline, hospitalisations and excess mortality. The effects of mucoactive drugs on outcomes have been reviewed in several meta-analyses, the largest one including 26 studies. 21 studies were performed in patients with chronic bronchitis and five in patients with COPD. The majority of these trials were performed with N-acetylcysteine (n513) and carbocysteine (n53).Overall, there was a significant reduction in exacerbations (0.05 per patient per month) and the number of days with disability (0.56 days per patient per month). Mucolytics were well tolerated and the number of adverse events was lower than with placebo (odds ratio 0.78). In the largest and best designed study with N-acetylcysteine in 523 patients with COPD, the reduction in exacerbations was only observed in patients not taking inhaled corticosteroids. In addition, a 374 mL reduction in functional residual capacity was found. A recent large study (n5709) with high-dose carbocysteine (1,500 mg?day -1 ) demonstrated a significant effect on exacerbations (25% reduction) and also reported an improvement in health-related quality of life (-4.06 units in St George's Respiratory Questionnaire).It is unclear what the mechanisms underlying these effects may be and which phenotypes benefit from this treatment. On the basis of this evidence mucoactive drugs may deserve consideration in the long-term treatment of COPD.

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Section: Treatment Of Copd With Mucolytic Drugsmentioning

confidence: 57%

Mucoactive therapy in COPD

Decramer¹,

Janssens²

2010

Eur Respir Rev

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“…Secondary analysis revealed that FRC was reduced (-0.374 l) in the N-acetyl cysteine group, a finding suggestive of an effect on hyperinflation [167]. In a randomised, double-blind, cross-over study that included 24 moderate-to-severe COPD subjects, STAV et al [168] evaluated the effects of a 6-week treatment with N-acetyl cysteine (1,200 mg?day -1 ) versus placebo on lung hyperinflation at rest and after exercise. The authors reported that IC and FVC were higher especially after exercise following N-acetyl cysteine treatment; furthermore, RV/TLC was reduced and endurance time was longer after N-acetyl cysteine treatment.…”

Section: Oral Drugsmentioning

confidence: 95%

Update on the roles of distal airways in COPD

Burgel

Bourdin²,

Chanez³

et al. 2011

European Respiratory Review

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This review is the summary of a workshop on the role of distal airways in chronic obstructive pulmonary disease (COPD), which took place in 2009 in Vence, France.The evidence showing inflammation and remodelling in distal airways and the possible involvement of these in the pathobiology, physiology, clinical manifestations and natural history of COPD were examined. The usefulness and limitations of physiological tests and imaging techniques for assessing distal airways abnormalities were evaluated.Ex vivo studies in isolated lungs and invasive measurements of airway resistance in living individuals have revealed that distal airways represent the main site of airflow limitation in COPD. Structural changes in small conducting airways, including increased wall thickness and obstruction by muco-inflammatory exudates, and emphysema (resulting in premature airway closure), were important determinants of airflow limitation. Infiltration of small conducting airways by phagocytes (macrophages and neutrophils), dendritic cells and T and B lymphocytes increased with airflow limitation. Distal airways abnormalities were associated with patient-related outcomes (e.g. dyspnoea and reduced health-related quality of life) and with the natural history of the disease, as reflected by lung function decline and mortality.These data provide a clear rationale for targeting distal airways in COPD.

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“…However, a more recent controlled randomised clinical trial did not demonstrate a reduction in the frequency of exacerbations with NAC in patients with COPD, but only in the subgroup not taking inhaled corticosteroids [62]. Furthermore, NAC treatment of patients with stable, moderate-tosevere COPD has been shown to benefit physical performance, which may be attributed to air trapping [63]. However, like carbocysteine, little evidence is currently available in humans showing that NAC exerts its action by direct effects on mucus.…”

Section: Mucolyticsmentioning

confidence: 97%

Mucoactive drugs

Balsamo¹,

Lanata²,

Egan³

2010

Eur Respir Rev

121

102

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Mucus hypersecretion is a clinical feature of severe respiratory diseases such as asthma, cystic fibrosis and chronic obstructive pulmonary disease. Airway mucosal infection and/ or inflammation associated with these diseases often gives rise to inflammatory products, including neutrophil-derived DNA and filamentous actin, in addition to bacteria, apoptotic cells and cellular debris, that may collectively increase mucus production and viscosity. Mucoactive agents have been the medication of choice for the treatment of respiratory diseases in which mucus hypersecretion is a clinical complication. The main purpose of mucoactive drugs is to increase the ability to expectorate sputum and/or decrease mucus hypersecretion. Many mucoactive drugs are currently available and can be classified according to their putative mechanism of action. Mucoactive medications include expectorants, mucoregulators, mucolytics and mucokinetics. By developing our understanding of the specific effects of mucoactive agents, we may result in improved therapeutic use of these drugs. The present review provides a summary of the most clinically relevant mucoactive drugs in addition to their potential mechanism of action.

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Effect of N-Acetylcysteine on Air Trapping in COPD

Cited by 69 publications

References 18 publications

Mucoactive therapy in COPD

Mucoactive therapy in COPD

Update on the roles of distal airways in COPD

Mucoactive drugs

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