N-Acetyl Cysteine in treatment of COPD

Abstract

In COPD excess expectoration secondary to tracheobronchial secretions contributes to symptoms, airflow obstruction and is diagnostic criterion. It also causes increased mortality, risk of hospitalizations and accelerated decline in FEV1. N-acetylcysteine (NAC) helps in liquefying mucus and DNA (via disruption of disulfide bonds) and has antioxidant effects. Aims: Evaluate add-on effect of NAC on clinical-physiological parameters in COPD patients treated according to GOLD guidelines. Material and Methods: Single labeled, randomized, parallel group prospective Observational study. In 120 stable COPD patients Modified medical research council (MMRC) dyspnoea score, COPD Assessment test (CAT score), number of exacerbations and hospitalizations in the last year were recorded and were randomized into 2 groups of 60 each. Group A received NAC 600mg twice daily along with standard treatment. Group B received standard treatment only. Mean and Standard Deviation was compared between groups using unpaired t-test. After 1 year, changes in above parameters were reassessed. Statistical Analysis: Unpaired t-test and chi square test were used. Statistical significance was set at <0.05 level. Results: MMRC score reduced from 3.37 study group) to 2.91, difference being -0.46, and in control from 3.37 to 1.18, difference of -0.22 and p value of p<.05. CAT score reduced more in test group (-4.4) than control group (-3.1), p=.02. Out of 40 exacerbations, 14 (35%) occurred in test and 26 (65%) in control group, reduction of 30% and p=0.01. Out of 28 hospitalizations 10 (36%) test group 18 (64%) control group. i.e. a reduction of 28% and p=0.06. Conclusions: Use of N-Acetyl Cysteine, 600mg twice daily along with standard treatment can bring clinically significant change in CAT Score and frequency of exacerbations but not in MMRC score and hospitalizations.