Abstract
BackgroundN-acetylcysteine is a classic mucolytic agent. This study aimed to investigate the efficacy of N-acetylcysteine on reducing the risk of exacerbations in bronchiectasis patients.MethodsA prospective, randomized, controlled trial was conducted between April 1, 2014 and December 31, 2016 in five general hospitals in Shandong Province, China. Adult bronchiectasis patients with at least two exacerbations in the past year were potentially eligible. Patients were randomly assigned to receive oral N-acetylcysteine (600 mg, twice daily, 12 months) or on-demand treatment.ResultsA total of 161 patients were eligible for randomization (81 to the N-acetylcysteine group and 80 to the control group). During the 12-month follow-up, the incidence of exacerbations in the N-acetylcysteine group was significantly lower than that in the control group (1.31 vs. 1.98 exacerbations per patient-year; risk ratio, 0.41; 95% CI, 0.17–0.66; P = 0.0011). The median number of exacerbations in the N-acetylcysteine group was 1 (0.5–2), compared with 2 (1–2) in the control group (U = − 2.95, P = 0.003). A total of 24.7% of the N-acetylcysteine group patients and 11.3% of the control group patients remained exacerbation-free throughout the 12-month follow-up (χ2 = 4.924, P = 0.026). Compared with the control group, the volume of 24-h sputum in the N-acetylcysteine group was significantly reduced (t = − 3.091, P = 0.002). Additionally, the N-acetylcysteine group showed a significant improvement in the quality of life. No severe adverse events were reported in the intervention group.ConclusionThe long-term use of N-acetylcysteine is able to reduce the risk of exacerbations for bronchiectasis patients in Shandong Province, China. The results of this study should be verified in a larger randomized controlled trial.Trial registrationClinicalTrials.gov (NCT02088216) (Registered date: March 5, 2014).
Highlights
Bronchiectasis is a chronic suppurative lung disease characterized by permanent dilation of bronchi and bronchioles [1]
Patients were excluded if they fulfilled any of the following criteria: current smokers; cigarette smoking within 6 months; cystic fibrosis or other etiologies; pulmonary function test results showing a forced expiratory volume in 1 s (FEV1) ≤ 30% of the predicted value; primary diagnosis of chronic obstructive pulmonary disease (COPD) or asthma; a history of severe cardiovascular disease; comorbidity with liver disease, kidney disease, malignant tumor, gastric ulcer, or intestinal malabsorption; a known allergy to N-acetylcysteine; pregnancy or lactation; a history of prior macrolide use of more than 1 week; and poor compliance
In the N-acetylcysteine group, one patient died of acute ischemic stroke and one patient died from acute exacerbation of bronchiectasis
Summary
Bronchiectasis is a chronic suppurative lung disease characterized by permanent dilation of bronchi and bronchioles [1]. Qi et al Respiratory Research (2019) 20:73 none of these patients had chronic infections or daily sputum production. The other three clusters of bronchiectasis were characterized by the presence of chronic infection with Pseudomonas aeruginosa or other pathogens and daily sputum production [6]. Mucus production plays an essential role in the other three clusters of bronchiectasis. It has been deduced that reducing the production of mucus or improving the clearance of sputum in the airway is the key to break down this “vicious cycle” and enhance the therapeutic efficacy for bronchiectasis. This study aimed to investigate the efficacy of N-acetylcysteine on reducing the risk of exacerbations in bronchiectasis patients
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