Use of Acetylcysteine in Bronchial Asthma and Emphysema

Abstract

Acetylcysteine (Mucomyst) mu* reduces the viscosity of tracheobronchial secretions in a number of acute and chronic bronchopulmonary conditions. Reasl. noted that acetylcysteine produced a marked reduction in viscosity of the secretions obtained from the tracheobronchial tree in tracheotomized children with cystic fibrosis of the pancreas.A. L. Sheffner3 reported that the free sulfhydryl group in acetylcysteine produced its mucolytic effect, apparently by acting upon the disulfide bonds present in mucus. A specific sulfhydryldisulfide interchange reaction occurs which is concentration and p H dependent with the activity increasing with increased pH from 4.0 to 9.0. Acetylcysteine markedly reduced the viscosity of human pulmonary secretions in vitro.Webb4 found acetylcysteine particularly effective in tracheotomy care, and was also impressed by its usefulness when used during anesthesia and surgery and following surgery to prevent pulmonary complications such as atelectasis and pneumonia. He reported dramatic improvements in patients with acute and chronic bronchopulmonary disease such as pneumonia, lung abscess, emphysema, chronic bronchitis, bronchitis siccus, bronchiectasis and atelectasis due to mucus obstruction. He administered acetylcysteine by various methods such as nebulization into a face mask or mouth piece, instillation directly into an endotracheal tube or tracheostomy, or instillation into the trachea via a percutaneous endotracheal catheter using the technique of Radigan and King.bBernstein6 reported that acetylcysteine produced bronchospasm in asthmatic children but not in normal controls or others with non-asthmatic obstructive pulmonary conditions. He postulated that this iatrogenic bronchospasm was an irritative phenomenon. It probably resulted from the minute concentration of H2S liberated from acetylcysteine which is noxious only to asthmatics. The concomitant administration of isoproterenol prevented or greatly diminished bronchospasm in these asthmatic children.Most patients with bronchial asthma and prolonged bronchiolar obstruction experience bronchospasm, and also have a thick, sticky mucus in their bronchopulmonary tree. As the asthma increases in severity, the more prolonged and poorly controlled the bronchiolar obstruction becomes. The patient also becomes more dehydrated and the bronchopulmonary secretions *Studies performed under the auspices of the San Diego Bio-Medical Research ** Mucomyst-Mead Johnson Labs., Evansville, Indiana. Institute. 199 J Asthma Downloaded from informahealthcare.com by University of North Carolina on 11/04/14 For personal use only. 2.Agents administered into the tracheobronchial tree were as follows: plus three to six drops of isoproterenol 1 : 200.proterenol. Pulmonary function studies:J Asthma Downloaded from informahealthcare.com by University of North Carolina on 11/04/14For personal use only.

OralN‐acetylcysteine attenuates the rat pulmonary inflammatory response to antigen

“…In contrast with the activity reported in various inflammatory pulmonary diseases, the influence of NAC in clinical asthma remains uncertain [3,4] but has not been evaluated recently. Experimental studies demonstrate the capacity of NAC to inhibit various inflammatory elements related to oxidant stress and involved in the pathophysiology of asthma, such as nuclear factor (NF)-kB, tumour necrosis factor (TNF)-a, inducible nitric oxide synthase (iNOS) and cell adhesion molecules [5][6][7][8].…”

Pharmacotherapy of impaired mucociliary clearance in non‐CF pediatric lung disease. A review of the literature

“…Uncontrolled observations in adults with acute severe asthma, unresponsive to regular therapy, nevertheless showed beneficial clinical effects of nebulized or bronchoscopically instilled NAC. 33,34 Kyncl et al 35 reported improved blood gas values and chest X-ray pictures after bronchial lavage with Mesna in 14 children with status asthmaticus. However, RCTs are lacking and so are studies on NAC in stable asthmatic children.…”

The assessment and management of adults with status asthmaticus.

“…Unfortunately, other strategies to mobilize mucus such as chest physiotherapy or treatment with mucolytics or expectorants have not proved efficacious in controlled trials (211,212). BAL, on the other hand, using either saline or acetylcysteine, may be useful to remove mucus plugs in some patients with refractory SA (213)(214)(215)(216)(217). Lang and colleagues (214) recently demonstrated that BAL improved airflow obstruction in nonintubated patients with stable but refractory acute asthma.…”