Abstract
IntroductionChronic obstructive pulmonary disease (COPD) is a preventable disease of the airways characterized by limited airflow. Acute exacerbations of COPD (AECOPD) may be precipitated by noxious stimuli. N-acetylcysteine (NAC) has mucolytic, antioxidant, and anti-inflammatory activity. We conducted this study to evaluate the effect of adding high-dose NAC to the protocol treatment of AECOPD.MethodsIn this single-center, prospective, interventional study, patients admitted with AECOPD, airflow obstruction on spirometry, and who were current smokers with 10 or more packs per year were included after attaining informed consent. NAC granules 600 mg twice daily orally (high dose) were included in the regimen of 25 randomly selected patients and the other 25 were managed without NAC. An improvement in clinical and biochemical markers was observed on day three and day seven. For statistical analysis, SPSS for Windows version 21.0 (IBM Corp., Armonk, NY) was utilized.ResultsThe study was completed by 21 patients in the NAC group and 19 in the non-NAC group. In the NAC group, there was a significant improvement in the mean partial pressure of oxygen (PaO2) both on day three (p=0.03) and day seven (p=0.01). The mean partial pressure of carbon dioxide (PaCO2) was at the borderline in the two groups on day three; however, on day seven, the NAC group showed significantly improved PaCO2 as compared to the non-NAC group (p=0.007). There were significant improvements in oxygen saturation of the NAC group on day seven (p=0.02). There were significant improvements in clinical signs, including wheezing and dyspnea and the need for nasal oxygen support (p≤0.05).ConclusionThe addition of 600 mg twice daily NAC (high dose) to the protocol treatment of patients with acute exacerbation of COPD may have beneficial outcomes. In the future, the role of high-dose NAC in AECOPD must be studied through multicenter, double-blinded, placebo-controlled trials with larger sample sizes in order to either establish or invalidate this association.
Highlights
Chronic obstructive pulmonary disease (COPD) is a preventable disease of the airways characterized by limited airflow
In this single-center, prospective, interventional study, patients admitted with Acute exacerbations of COPD (AECOPD), airflow obstruction on spirometry, and who were current smokers with 10 or more packs per year were included after attaining informed consent
The study was completed by 21 patients in the NAC group and 19 in the non-NAC group
Summary
In this single-center, prospective, interventional study, patients admitted with AECOPD, airflow obstruction on spirometry, and who were current smokers with 10 or more packs per year were included after attaining informed consent. Received 10/28/2019 Review began 11/01/2019 Review ended 11/03/2019 Published 11/05/2019. It was a single-center, prospective, interventional study conducted with in-hospital patients of AECOPD. The inclusion criteria comprised patients of both genders, of any age, admitted in the ward with acute exacerbation of COPD, airflow obstruction on spirometry, and who were current smokers with 10 or more packs per year. Patients who had taken any mucolytic drug in the preceding week were excluded. Informed written consent was attained from all patients
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