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Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis.
Eur Respir Rev 2015; 24(137):451-61ER

Abstract

In order to clarify the possible role of N-acetylcysteine (NAC) in the treatment of patients with chronic bronchitis and chronic obstructive pulmonary disease (COPD), we have carried out a meta-analysis testing the available evidence that NAC treatment may be effective in preventing exacerbations of chronic bronchitis or COPD and evaluating whether there is a substantial difference between the responses induced by low (≤ 600 mg per day) and high (> 600 mg per day) doses of NAC. The results of the present meta-analysis (13 studies, 4155 COPD patients, NAC n = 1933; placebo or controls n = 2222) showed that patients treated with NAC had significantly and consistently fewer exacerbations of chronic bronchitis or COPD (relative risk 0.75, 95% CI 0.66-0.84; p < 0.01), although this protective effect was more apparent in patients without evidence of airway obstruction. However, high doses of NAC were also effective in patients suffering from COPD diagnosed using spirometric criteria (relative risk 0.75, 95% CI 0.68-0.82; p = 0.04). NAC was well tolerated and the risk of adverse reactions was not dose-dependent (low doses relative risk 0.93, 95% CI 0.89-0.97; p = 0.40; high doses relative risk 1.11, 95% CI 0.89-1.39; p = 0.58). The strong signal that comes from this meta-analysis leads us to state that if a patient suffering from chronic bronchitis presents a documented airway obstruction, NAC should be administered at a dose of ≥ 1200 mg per day to prevent exacerbations, while if a patient suffers from chronic bronchitis, but is without airway obstruction, a regular treatment of 600 mg per day seems to be sufficient.

Authors+Show Affiliations

Dept of Systems Medicine, University of Rome Tor Vergata, Rome, Italy mario.cazzola@uniroma2.it.Dept of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.Sackler Institute of Pulmonary Pharmacology, Institute of Pharmaceutical Science, King's College London, London, UK.Respiratory Diseases, Escola Paulista de Medicina of Federal University of Sao Paulo, Sao Paulo, Brazil.Institute of Pulmonology, Federal Medical and Biological Agency, Moscow, Russia.Dept of Systems Medicine, University of Rome Tor Vergata, Rome, Italy.Dept of Experimental Medicine, Second University of Naples, Naples, Italy.

Pub Type(s)

Journal Article
Meta-Analysis
Review

Language

eng

PubMed ID

26324807

Citation

Cazzola, Mario, et al. "Influence of N-acetylcysteine On Chronic Bronchitis or COPD Exacerbations: a Meta-analysis." European Respiratory Review : an Official Journal of the European Respiratory Society, vol. 24, no. 137, 2015, pp. 451-61.
Cazzola M, Calzetta L, Page C, et al. Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. Eur Respir Rev. 2015;24(137):451-61.
Cazzola, M., Calzetta, L., Page, C., Jardim, J., Chuchalin, A. G., Rogliani, P., & Matera, M. G. (2015). Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. European Respiratory Review : an Official Journal of the European Respiratory Society, 24(137), pp. 451-61. doi:10.1183/16000617.00002215.
Cazzola M, et al. Influence of N-acetylcysteine On Chronic Bronchitis or COPD Exacerbations: a Meta-analysis. Eur Respir Rev. 2015;24(137):451-61. PubMed PMID: 26324807.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of N-acetylcysteine on chronic bronchitis or COPD exacerbations: a meta-analysis. AU - Cazzola,Mario, AU - Calzetta,Luigino, AU - Page,Clive, AU - Jardim,Josè, AU - Chuchalin,Alexander G, AU - Rogliani,Paola, AU - Matera,Maria Gabriella, PY - 2015/9/2/entrez PY - 2015/9/2/pubmed PY - 2016/6/9/medline SP - 451 EP - 61 JF - European respiratory review : an official journal of the European Respiratory Society JO - Eur Respir Rev VL - 24 IS - 137 N2 - In order to clarify the possible role of N-acetylcysteine (NAC) in the treatment of patients with chronic bronchitis and chronic obstructive pulmonary disease (COPD), we have carried out a meta-analysis testing the available evidence that NAC treatment may be effective in preventing exacerbations of chronic bronchitis or COPD and evaluating whether there is a substantial difference between the responses induced by low (≤ 600 mg per day) and high (> 600 mg per day) doses of NAC. The results of the present meta-analysis (13 studies, 4155 COPD patients, NAC n = 1933; placebo or controls n = 2222) showed that patients treated with NAC had significantly and consistently fewer exacerbations of chronic bronchitis or COPD (relative risk 0.75, 95% CI 0.66-0.84; p < 0.01), although this protective effect was more apparent in patients without evidence of airway obstruction. However, high doses of NAC were also effective in patients suffering from COPD diagnosed using spirometric criteria (relative risk 0.75, 95% CI 0.68-0.82; p = 0.04). NAC was well tolerated and the risk of adverse reactions was not dose-dependent (low doses relative risk 0.93, 95% CI 0.89-0.97; p = 0.40; high doses relative risk 1.11, 95% CI 0.89-1.39; p = 0.58). The strong signal that comes from this meta-analysis leads us to state that if a patient suffering from chronic bronchitis presents a documented airway obstruction, NAC should be administered at a dose of ≥ 1200 mg per day to prevent exacerbations, while if a patient suffers from chronic bronchitis, but is without airway obstruction, a regular treatment of 600 mg per day seems to be sufficient. SN - 1600-0617 UR - https://www.unboundmedicine.com/medline/citation/26324807/full_citation L2 - http://err.ersjournals.com/cgi/pmidlookup?view=long&amp;pmid=26324807 DB - PRIME DP - Unbound Medicine ER -