The efficacy and safety of inhaled acetylcysteine in comparison with oral acetylcysteine in chronic obstructive pulmonary disease: A randomized single-center study

Abstract

Introduction: One-third of all the patients with chronic obstructive pulmonary disease (COPD) additionally take mucolytics as per GOLD recommendation due to complaints of productive cough despite their compliance with the basic treatment regimen. Aim: To assess the efficacy and safety of inhaled N-acetylcysteine (NAC) in comparison with oral NAC in patients with COPD. Material and methods: The study included 46 patients with stable COPD and difficult expectoration of sputum who were divided into two groups. The first group (n = 22) took 600 mg/day NAC orally, and the second one (n = 24) inhaled 600 mg/day NAC by a nebulizer for 10 days. In the beginning and after the 10-day treatment the questionnaires (CAT, mMRC, CCQ, SGRQ, SF-36), 6-minute walk distance test and day and night cough symptoms were evaluated, spirometry and sputum analysis were performed. Results and discussion: In the first group, CCQ showed improvement in the status of patients (by 9.7%). The severity of night cough also decreased. Other indices were not changed statistically. In the other group, positive changes in the CAT (by 13.1%) and SF-36 were reported, night cough decreased. Additionally, forced expiratory volume in 1 s (FEV1) values increased (by 10.3%). No changes in FEV1 2 hours after the first oral usage or inhalation of NAC were found. Conclusions: Both oral administration and inhalation of NAC by a nebulizer for 10 days has a similar positive effect on the manifestations of COPD, but the inhalation route of the drug is also accompanied by improved quality of life and lung function test (FEV1) as well.