Role of N-acetylcysteine in the management of COPD

Abstract

The importance of the underlying local and systemic oxidative stress and inflammation in chronic obstructive pulmonary disease (COPD) has long been established. In view of the lack of therapy that might inhibit the progress of the disease, there is an urgent need for a successful therapeutic approach that, through affecting the pathological processes, will influence the subsequent issues in COPD management such as lung function, airway clearance, dyspnoea, exacerbation, and quality of life. N-acetylcysteine (NAC) is a mucolytic and antioxidant drug that may also influence several inflammatory pathways. It provides the sulfhydryl groups and acts both as a precursor of reduced glutathione and as a direct reactive oxygen species (ROS) scavenger, hence regulating the redox status in the cells. The changed redox status may, in turn, influence the inflammation-controlling pathways. Moreover, as a mucolytic drug, it may, by means of decreasing viscosity of the sputum, clean the bronchi leading to a decrease in dyspnoea and improved lung function. Nevertheless, as successful as it is in the in vitro studies and in vivo studies with high dosage, its actions at the dosages used in COPD management are debatable. It seems to influence exacerbation rate and limit the number of hospitalization days, however, with little or no influence on the lung function parameters. Despite these considerations and in view of the present lack of effective therapies to inhibit disease progression in COPD, NAC and its derivatives with their multiple molecular modes of action remain promising medication once doses and route of administration are optimized.

Effects of Oral Glutathione Supplementation on Systemic Oxidative Stress Biomarkers in Human Volunteers

“…30 Although the clinical use of GSH and GSH precursors is rather limited to the use of N-acetylcysteine in acetaminophen toxicity, as a mucolytic in respiratory disease, and experimentally in the prevention of contrast-induced nephropathy, this study has important clinical implications for consumers and for providers in nonallopathic disciplines, such as complementary and alternative medicine, in which oral nutritional supplementation is commonplace. [31][32][33][34][35] The results of this study determined that short-term, oral intake of GSH does not improve glutathione status, nor reduce markers of oxidative stress in healthy adults, and thus routine supplementation may not offer health benefits in the absence of disease or oxidative challenge.…”

Clinical and pharmacological aspects of bath salt use: A review of the literature and case reports

“…Some systematic reviews and meta-analyses have suggested that NAC prevents exacerbations and improves symptoms in Chronic obstructive pulmonary disease (COPD) patients [94][95][96][97][98] (Table 2), however, probably with little or no effect on the lung function parameters [96].…”

Pharmacologic Agents That Promote Airway Clearance in Hospitalized Subjects: A Systematic Review

“…1,2 Mucus hypersecretion is associated with declines in pulmonary function and quality of life, excess cough, discomfort, and exacerbation of conditions such as COPD. 3,4 Mucoactive agents may increase sputum expectoration or decrease hypersecretion of mucus. 1,5,6 Mucolytic agents such as N-acetylcysteine alter disulfide bonds that comprise mucus proteins and may decrease mucus viscosity.…”