The efficacy of N-acetylcysteine in chronic obstructive pulmonary disease patients: a meta-analysis

Abstract

Background: N-acetylcysteine (NAC) may reduce acute exacerbations of chronic obstructive pulmonary disease through an antioxidant effect. Due to the heterogeneity in studies, the currently available data do not confirm the efficacy of oral NAC therapy in chronic obstructive pulmonary disease patients. We hypothesize that chronic obstructive pulmonary disease patients receiving regular oral NAC therapy do not achieve improved clinical outcomes. Objectives: The purpose of this meta-analysis was to determine the efficacy of long-term oral NAC therapy in chronic obstructive pulmonary disease patients. Data sources and methods: The literature search was performed using the PubMed, Web of Science, and Cochrane Library databases to identify all included clinical studies. Studies were eligible for inclusion only if they directly compared the outcomes of NAC versus placebo in adults with chronic obstructive pulmonary disease between 1 January 2000 and 30 May 2022. All studies were included if they reported one or more of the following outcomes: number of patients with no acute exacerbations, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), St George’s Respiratory Questionnaire score, glutathione level, and adverse events. Results: Nine randomized controlled trials were included in the meta-analysis. There were 1061 patients in the NAC group and 1076 patients in the placebo group. The current meta-analysis provides evidence that the number of patients with no acute exacerbations (965 patients receiving NAC therapy, 979 control group patients), change in FEV1 (433 patients receiving NAC therapy, 447 control group patients), change in FVC (177 patients receiving NAC therapy, 180 control group patients), change in St George’s Respiratory Questionnaire score (128 patients receiving NAC therapy, 131 control group patients), change in glutathione levels (38 patients receiving NAC therapy, 40 control group patients), and adverse events (832 patients receiving NAC therapy, 846 control group patients) were not significantly different between the two groups. Conclusion: NAC did not reduce the risk of acute exacerbation or ameliorate the decline in lung volume in chronic obstructive pulmonary disease patients.

Effect of Cigarette Smoking on Clinical and Molecular Endpoints in COPD Patients

“…However, in the present study, we did not find any differences in oxidative markers such as MDA, 8-Oxo-dG, or IL6 by smoking status. The interpretation of these results should take into account that all patients were under treatment with known antioxidant drugs such as corticosteroids and N-Acetyl-L-cysteine [ 40 , 41 , 42 ].…”

Post-Stroke Infections: Insights from Big Data Using Clinical Data Warehouse (CDW)

“…Other drugs also not included as variables in this study associated with infection risk include immunomodulatory drugs, chemotherapy agents, and inhaled corticosteroids or mucolytics. The latter (e.g., N-acetylcysteine agents) have not shown certain effectiveness in preventing the exacerbation of chronic obstructive pulmonary disease [ 72 , 73 , 74 , 75 ], although their use has been linked to improved outcome in stroke models [ 76 , 77 ].…”