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The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review.

Abstract

The role of N-acetylcysteine (NAC) in the treatment of chronic bronchitis is unclear. Since a number of studies have been published on this topic, a systematic review of published studies seems justified. A systematic search (Medline, Embase, Cochrane Library, bibliographies, no language restriction) for published randomized trials comparing oral NAC with placebo in patients with chronic bronchitis was performed. Dichotomous data on prevention of exacerbation, improvement of symptoms and adverse effects were extracted from original reports. The relative benefit and number-needed-to-treat were calculated for both individual trials and combined data. Thirty-nine trials were retrieved; eleven (2,011 analysed patients), published 1976-1994, were regarded as relevant and valid according to preset criteria. In nine studies, 351 of 723 (48.5%) patients receiving NAC had no exacerbation compared with 229 of 733 (31.2%) patients receiving placebo (relative benefit 1.56 (95% confidence interval (CI) 1.37-1.77), number-needed-to-treat 5.8 (95% CI 4.5-8.1). There was no evidence of any effect of study period (12-24 weeks) or cumulative dose of NAC on efficacy. In five trials, 286 of 466 (61.4%) patients receiving NAC reported improvement of their symptoms compared with 160 of 462 (34.6%) patients receiving placebo (relative benefit 1.78 (95% CI 1.54-2.05), number-needed-to-treat 3.7 (95% CI 3.0-4.9)). With NAC, 68 of 666 (10.2%) patients reported gastrointestinal adverse effects compared with 73 of 671 (10.9%) taking placebo. With NAC, 79 of 1,207 (6.5%) patients withdrew from the study due to adverse effects, compared with 87 of 1,234 (7.1%) receiving placebo. In conclusion, with treatment periods of approximately 12-24 weeks, oral N-acetylcysteine reduces the risk of exacerbations and improves symptoms in patients with chronic bronchitis compared with placebo, without increasing the risk of adverse effects. Whether this benefit is sufficient to justify the routine and long-term use of N-acetylcysteine in all patients with chronic bronchitis should be addressed in further studies and cost-effectiveness analyses.

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  • Authors+Show Affiliations

    ,

    Dept of Internal Medicine, Medical Polyclinic, University Hospital Zurich, Switzerland.

    , , ,

    Source

    The European respiratory journal 16:2 2000 Aug pg 253-62

    MeSH

    Acetylcysteine
    Administration, Oral
    Bronchitis
    Chronic Disease
    Expectorants
    Humans
    Randomized Controlled Trials as Topic
    Treatment Outcome

    Pub Type(s)

    Journal Article
    Meta-Analysis
    Research Support, Non-U.S. Gov't
    Systematic Review

    Language

    eng

    PubMed ID

    10968500

    Citation

    Stey, C, et al. "The Effect of Oral N-acetylcysteine in Chronic Bronchitis: a Quantitative Systematic Review." The European Respiratory Journal, vol. 16, no. 2, 2000, pp. 253-62.
    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):253-62.
    Stey, C., Steurer, J., Bachmann, S., Medici, T. C., & Tramèr, M. R. (2000). The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. The European Respiratory Journal, 16(2), pp. 253-62.
    Stey C, et al. The Effect of Oral N-acetylcysteine in Chronic Bronchitis: a Quantitative Systematic Review. Eur Respir J. 2000;16(2):253-62. PubMed PMID: 10968500.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The effect of oral N-acetylcysteine in chronic bronchitis: a quantitative systematic review. AU - Stey,C, AU - Steurer,J, AU - Bachmann,S, AU - Medici,T C, AU - Tramèr,M R, PY - 2000/9/1/pubmed PY - 2001/2/28/medline PY - 2000/9/1/entrez SP - 253 EP - 62 JF - The European respiratory journal JO - Eur. Respir. J. VL - 16 IS - 2 N2 - The role of N-acetylcysteine (NAC) in the treatment of chronic bronchitis is unclear. Since a number of studies have been published on this topic, a systematic review of published studies seems justified. A systematic search (Medline, Embase, Cochrane Library, bibliographies, no language restriction) for published randomized trials comparing oral NAC with placebo in patients with chronic bronchitis was performed. Dichotomous data on prevention of exacerbation, improvement of symptoms and adverse effects were extracted from original reports. The relative benefit and number-needed-to-treat were calculated for both individual trials and combined data. Thirty-nine trials were retrieved; eleven (2,011 analysed patients), published 1976-1994, were regarded as relevant and valid according to preset criteria. In nine studies, 351 of 723 (48.5%) patients receiving NAC had no exacerbation compared with 229 of 733 (31.2%) patients receiving placebo (relative benefit 1.56 (95% confidence interval (CI) 1.37-1.77), number-needed-to-treat 5.8 (95% CI 4.5-8.1). There was no evidence of any effect of study period (12-24 weeks) or cumulative dose of NAC on efficacy. In five trials, 286 of 466 (61.4%) patients receiving NAC reported improvement of their symptoms compared with 160 of 462 (34.6%) patients receiving placebo (relative benefit 1.78 (95% CI 1.54-2.05), number-needed-to-treat 3.7 (95% CI 3.0-4.9)). With NAC, 68 of 666 (10.2%) patients reported gastrointestinal adverse effects compared with 73 of 671 (10.9%) taking placebo. With NAC, 79 of 1,207 (6.5%) patients withdrew from the study due to adverse effects, compared with 87 of 1,234 (7.1%) receiving placebo. In conclusion, with treatment periods of approximately 12-24 weeks, oral N-acetylcysteine reduces the risk of exacerbations and improves symptoms in patients with chronic bronchitis compared with placebo, without increasing the risk of adverse effects. Whether this benefit is sufficient to justify the routine and long-term use of N-acetylcysteine in all patients with chronic bronchitis should be addressed in further studies and cost-effectiveness analyses. SN - 0903-1936 UR - https://www.unboundmedicine.com/medline/citation/10968500/full_citation L2 - http://erj.ersjournals.com/cgi/pmidlookup?view=long&pmid=10968500 DB - PRIME DP - Unbound Medicine ER -