Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Clinical Drug Investigation
Published in: Clinical Drug Investigation 6/2005

01-06-2005 | Original Research Article

High-Dose N-Acetylcysteine in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease

Authors: Dr R. Zuin, A. Palamidese, R. Negrin, L. Catozzo, A. Scarda, M. Balbinot

Published in: Clinical Drug Investigation | Issue 6/2005

Login to get access

Abstract

Objective: To investigate the efficacy and tolerability of high-dose N-acetylcysteine (NAC) in the treatment of patients with exacerbations of chronic obstructive pulmonary disease (COPD).
Design and patients: Randomised, double-blind, double-dummy, placebo-controlled study in 123 patients experiencing an acute exacerbation of COPD.
Interventions: NAC 1200 mg/day, 600 mg/day or placebo administered once daily for 10 days.
Main outcome measures: The primary objective was to assess the proportion of patients with normalised C-reactive protein (CRP) levels. Also assessed were effects on interleukin (IL)-8 levels, lung function and symptoms. Results: Both NAC 600 and 1200 mg/day were associated with a significantly higher proportion of patients achieving normalised CRP levels compared with placebo (52% and 90% vs 19% of patients; p ≤ 0.01); however, NAC 1200 mg/day was superior to NAC 600 mg/day (p = 0.002). Furthermore, treatment with NAC 1200 mg/day was more efficacious than NAC 600 mg/day in reducing IL-8 levels and difficulty of expectoration, while the two active regimens had similar beneficial effects on lung function and other clinical outcomes (cough intensity and frequency, and lung auscultation). Treatments were well tolerated with one adverse event reported in NAC 1200 mg/day recipients and two reported in placebo recipients.
Conclusion: Treatment with NAC 1200 mg/day improved biological markers and clinical outcomes in patients with COPD exacerbations. It is speculated that the effect of NAC on inflammatory markers may be due to both mucolytic and antioxidant properties.
Literature
1.
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease. American Thoracic Society. Am J Respir Crit Care Med 1995; 152 (5 Pt 2): S77–121
2.
Siafakas NM, Vermeire P, Pride NB, et al. Optimal assessment and management of chronic obstructive pulmonary disease (COPD). The European Respiratory Society Task Force. Eur Respir J 1995; 8(8): 1398–420PubMedCrossRef
3.
4.
Murphy TF, Sethi S. Bacterial infection in chronic obstructive pulmonary disease. Am Rev Respir Dis 1992; 146(4): 1067–83PubMed
5.
Dekhuijzen PN, Aben KK, Dekker I, et al. Increased exhalation of hydrogen peroxide in patients with stable and unstable chronic obstructive pulmonary disease. Am J Respir Crit Care Med 1996; 154 (3 Pt 1): 813–6PubMed
6.
Heffner JE, Repine JE. Pulmonary strategies of antioxidant defense. Am Rev Respir Dis 1989; 140(2): 531–54PubMedCrossRef
7.
Stey C, Steurer J, Bachmann S, et al. The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. Eur Respir J 2000; 16(2): 253–62PubMedCrossRef
8.
Grandjean EM, Berthet P, Ruffmann R, et al. Efficacy of oral long-term N-acetylcysteine in chronic bronchopulmonary disease: a meta-analysis of published double-blind, placebo-controlled clinical trials. Clin Ther 2000; 22(2): 209–21PubMedCrossRef
9.
Dekhuijzen PN. Antioxidant properties of N-acetylcysteine: their relevance in relation to chronic obstructive pulmonary disease. Eur Respir J 2004; 23(4): 629–36PubMedCrossRef
10.
Kharazmi A. The anti-inflammatory properties of N-acetylcysteine. Eur Respir Rev 1992; 2(7): 32–4
11.
Aruoma OI, Halliwell B, Hoey BM, et al. The antioxidant action of N-acetylcysteine: its reaction with hydrogen peroxide, hydroxyl radical, superoxide, and hypochlorous acid. Free Radic Biol Med 1989; 6(6): 593–7PubMedCrossRef
12.
De Benedetto F, Aceto A, Dragani B, et al. Long-term oral N-acetylcysteine reduces exhaled hydrogen peroxide in stable COPD. Pulm Pharmacol Ther 2005; 18(1): 41–7CrossRef
13.
Kasielski M, Nowak D. Long-term administration of N-acetylcysteine decreases hydrogen peroxide exhalation in subjects with chronic obstructive pulmonary disease. Respir Med 2001; 95(6): 448–56PubMedCrossRef
14.
Pinkus R, Weiner LM, Daniel V. Role of oxidants and antioxidants in the induction of AP-1, NF-κB, and glutathione S-transferase gene expression. J Biol Chem 1996; 271(23): 13422–9PubMedCrossRef
15.
van Beurden WJ, Smeenk FW, Harff GA, et al. Markers of inflammation and oxidative stress during lower respiratory tract infections in COPD patients. Monaldi Arch Chest Dis 2003; 59(4): 273–80PubMed
16.
Malo O, Sauleda J, Busquets X, et al. Systemic inflammation during exacerbations of chronic obstructive pulmonary disease. Arch Bronconeumol 2002; 38(4): 172–6PubMed
17.
Aaron SD, Angel JB, Lunau M, et al. Granulocyte inflammatory markers and airway infection during acute exacerbation of chronic obstructive pulmonary disease. Am J Respir Crit Care Med 2001; 163(2): 349–55PubMed
18.
Vestbo J, Prescott E, Lange P. Association of chronic mucous hypersecretion with FEV1 decline and chronic obstructive pulmonary disease morbidity. Copenhagen City Heart Study Group. Am J Respir Crit Care Med 1996; 153(5): 1530–5PubMed
19.
Allegra L, Blasi F, Capone P, et al. Proprietà mucoattive ed antiossidanti della NAC (N-acetilcisteina) ad alte dosi. G Ital Mal Torace 2002; 56(3): 193–202
Metadata
Title
High-Dose N-Acetylcysteine in Patients with Exacerbations of Chronic Obstructive Pulmonary Disease
Authors
Dr R. Zuin
A. Palamidese
R. Negrin
L. Catozzo
A. Scarda
M. Balbinot
Publication date
01-06-2005
Publisher
Springer International Publishing
Published in
Clinical Drug Investigation / Issue 6/2005
Print ISSN: 1173-2563
Electronic ISSN: 1179-1918
DOI
https://doi.org/10.2165/00044011-200525060-00005

Other articles of this Issue 6/2005

Clinical Drug Investigation 6/2005 Go to the issue

Case Report

Successful Treatment with Colesevelam HCl and Pravastatin in a Patient Previously Hospitalised with Severe Normal CPK Myopathy on Introduction of Simvastatin

Original Research Article

Bioavailability and Bioequivalence of Two Enteric-Coated Formulations of Omeprazole in Fasting and Fed Conditions

Case Report

Nimesulide-Induced Hepatotoxicity in a Previously Healthy Woman

Original Research Article

A Randomised Comparison of the Effects of Nebivolol and Atenolol with and without Chlorthalidone on the Sexual Function of Hypertensive Men

Original Research Article

Effect of Once-Daily Alfuzosin on Urinary Symptoms and Flow Rate in Benign Prostatic Hyperplasia

Original Research Article

Effect of Imidapril and Nifedipine on Left Ventricular Hypertrophy in Untreated Hypertension