N-acetylcysteine – a drug for basic and symptomatic therapy of chronic bronchitis/chronic obstructive pulmonary disease
https://doi.org/10.18093/0869-0189-2024-34-5-756-765
Abstract
Prevention and successful treatment of the disease exacerbations are crucial for patients with chronic bronchitis (CB) and chronic obstructive pulmonary disease (COPD). At present, a sufficient number of efforts are being made to improve both prevention of exacerbations in patients with stable disease progression and treatment of the exacerbations. According to international and domestic recommendations, mucolytic drugs are among the key therapies for both bronchitis phenotype of COPD and chronic bronchitis, the main clinical manifestation of which is a long-term productive cough. The aim of the review is to analyze modern literature data that reflect the role of N-acetylcysteine (NAC) in prevention of exacerbations during the stable course and treatment of exacerbations of chronic bronchitis and COPD.
About the Authors
I. V. LeshchenkoRussian Federation
Igor V. Leshсhenko - Doctor of Medicine, Professor; Professor, Department of Infectious Diseases, Phthisiology and Pulmonology, Ural State Medical University; Chief Researcher, Ural Federal Research Institute of Phthisiology and Pulmonology – a Branch of NMRC for Phthisiology, Pulmonology and Infectious Diseases, Healthcare Ministry of Russia; Scientific Director, Limited Liability Company “Novaya bol’nitsa” Clinical Association, Chief Freelance Pulmonologist, Healthcare Ministry of the Sverdlovsk Region, Honored Doctor of the RF.
Ul. Repina 3, Ekaterinburg, 620028; ul. 22-go Parts’ezda 50, Ekaterinburg, 620039; ul. Zavodskaya 29, Ekaterinburg, 620109; tel.: (912) 288-28-23
Competing Interests:
The authors declare no conflict of interest
A. A. Zaytsev
Russian Federation
Andrey A. Zaicev - Doctor of Medicine, Professor, Head of the Department of Pulmonology (with a course of allergology), Medical Institute of Continuing Education, Institution of Higher Education Russian Biotechnological University; Professor, Department of Hospital Therapy No.2, Russian University of Medicine.
Volokolamskoye shosse 11, Moscow, 125080; 5 ul. Dolgorukovskaya 4, Moscow, 127006; tel.: (495) 263-55-55
Competing Interests:
The authors declare no conflict of interest
References
1. Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management and Prevention of COPD. 2024. Available at: http://www.goldcopd.org/
2. Roche N., Huchon G. Epidemiology of chronic obstructive pulmonary disease. Rev. Prat. 2004; 54 (13): 1408–1413.
3. Russian Respiratory Society. [Clinical guidelines: Chronic obstructive pulmonary disease (draft)]. 2024. Available at: https://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/ (in Russian).
4. Sinopalnikov A.I., Zaitsev A.A. [A modern view on pharmacotherapy of exacerbations of chronic obstructive pulmonary disease]. Lechashchiy vrach. 2009; (10): 45–49. Available at: https://www.lvrach.ru/2009/10/10866825?ysclid=m10phdljja332982069 (in Russian).
5. Donaldson G., Seemungal T., Bhowmik A., Wedzicha J. Relationship between exacerbation frequency and lung function decline in chronic obstructive pulmonary disease. Thorax. 2002; 57 (10): 847–852. DOI: 10.1136/thorax.57.10.847.
6. Soler-Cataluña J., Martínez-García M., Román Sánchez P. et al. Severe acute exacerbations and mortality in patients with chronic obstructive pulmonary disease. Thorax. 2005; 60 (11): 925–31. DOI: 10.1136/thx.2005.040527.
7. Russian Respiratory Society. [Clinical recommendations: Chronic bronchitis (project). 2024. Available at: https://spulmo.ru/obrazovatelnye-resursy/federalnye-klinicheskie-rekomendatsii/ (in Russian).
8. Zaitsev A.A., Okovity S.V., Miroshnichenko N.A. et al. [Cough: guidelines for doctors]. Moscow, 2021. Available at: https://www.researchgate.net/publication/354162540_Kasel_Metodiceskie_rekomendacii_dla_vracej_Cough_Guidelines_for_physicians (in Russian).
9. Sinopalnikov A.I., Zaitsev A.A. [Compliance of patients with respiratory tract infections]. Klinicheskaya mikrobiologiya i antimikrobnaya khimioterapiya. 2008; 10 (I1): 50–59. Available at: https://cmac-journal.ru/publication/2008/1/cmac-2008-t10-n1-p015/cmac-2008-t10-n1-p015.pdf?ysclid=m10q499hj8977130372 (in Russian).
10. Gerrits C., Herings R., Leufkens H., Lammers J. N-acetylcysteine reduces the risk of re-hospitalisation among patients with chronic obstructive pulmonary disease. Eur. Respir. J. 2003; 21 (5): 795–798. DOI: 10.1183/09031936.03.00063402.
11. Tse H., Raiteri L., Wong K. et al. High-dose N-acetylcysteine in stable COPD: the 1-year, double-blind, randomized, placebo-controlled HIACE study. Chest. 2013; 144 (1): 106–118. DOI: 10.1378/chest.12-2357.
12. Tse H.N., Raiteri L., Wong K.Y. et al. Benefits of high-dose N-acetylcysteine to exacerbation-prone patients with COPD. Chest. 2014; 146 (3): 611–623. DOI: 10.1378/chest.13-2784.
13. Santus P., Corsico A., Solidoro P. et al. Oxidative stress and respiratory system: pharmacological and clinical reappraisal of N-acetylcysteine. COPD. 2014; 11 (6): 705–717. DOI: 10.3109/15412555.2014.898040.
14. De Backer J., Vos W., Van Holsbeke C. et al. Effect of high-dose N-acetylcysteine on airway geometry, inflammation, and oxidative stress in COPD patients. Int. J. Chron. Obstruct. Pulmon. Dis. 2013; 8: 569–579. DOI: 10.2147/COPD.S49307.
15. Zheng J., Wen F., Bai C. et al. Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial. Lancet Respir. Med. 2014; 2 (3): 187–194. DOI: 10.1016/S2213-2600(13)70286-8.
16. Papi A., Zheng J., Criner G.J. et al. Impact of smoking status and concomitant medications on the effect of high-dose N-acetylcysteine on chronic obstructive pulmonary disease exacerbations: a post-hoc analysis of the PANTHEON study. Respir. Med. 2019; 147: 37–43. DOI: 10.1016/j.rmed.2018.12.014.
17. Wei J., Pang C.S., Han J., Yan H. Effect of orally administered N-acetylcysteine on chronic bronchitis: a meta-analysis. Adv. Ther. 2019; 36 (12): 3356–3367. DOI: 10.1007/s12325-019-01111-4.
18. Zhu L., Xu F., Kang X. et al. The antioxidant N-Acetylcysteine promotes immune response and inhibits epithelial-mesenchymal transition to alleviate pulmonary fibrosis in chronic obstructive pulmonary disease by suppressing the VWF/p38 MAPK axis. Mol. Med. 2021; 27 (1): 97. DOI: 10.1186/s10020-021-00342-y.
19. Mokra D., Mokry J., Barosova R., Hanusrichterova J. Advances in the Use of N-acetylcysteine in chronic respiratory diseases. Antioxidants (Basel). 2023; 12 (9): 1713. DOI: 10.3390/antiox12091713.
20. Papi A., Alfano F., Bigoni T. et al. N-acetylcysteine treatment in Chronic Obstructive Pulmonary Disease (COPD) and Chronic Bronchitis/Pre-COPD: distinct meta-analyses. Arch. Bronconeumol. 2024; 60 (5): 269–278. DOI: 10.1016/j.arbres.2024.03.010.
21. Poole P., Sathananthan K., Fortescue R. Mucolytic agents versus placebo for chronic bronchitis or chronic obstructive pulmonary disease. Cochrane Database Syst. Rev. 2019; 5 (5): CD001287. DOI: 10.1002/14651858.CD001287.
22. Zuin R., Palamidese A., Negrin R. et al. High-dose N-acetylcysteine in patients with exacerbations of chronic obstructive pulmonary disease. Clin. Drug Investig. 2005; 25 (6): 401–408. DOI: 10.2165/00044011-200525060-00005.
23. Cazzola M., Calzetta L., Facciolo F. et al. Pharmacological investigation on the anti-oxidant and anti-inflammatory activity of N-acetylcysteine in an ex vivo model of COPD exacerbation. Respir. Res. 2017; 18 (1): 26. DOI: 10.1186/s12931-016-0500-y.
24. Calzetta L., Luongo L., Cazzola M. et al. Contribution of sensory nerves to LPS-induced hyperresponsiveness of human isolated bronchi. Life Sci. 2015; 131: 44–50. DOI: 10.1016/j.lfs.2015.03.023.
25. Calzetta L., Soggiu A., Roncada P. et al. Propofol protects against opioid-induced hyperresponsiveness of airway smooth muscle in a horse model of target-controlled infusion anaesthesia. Eur. J. Pharmacol. 2015; 765: 463–471. DOI: 10.1016/j.ejphar.2015.09.007.
26. Cazzola M., Calzetta L., Page C.P. et al. Protein prenylation contributes to the effects of LPS on EFS-induced responses in human isolated bronchi. Am. J. Respir. Cell Mol. Biol. 2011; 45 (4): 704–710. DOI: 10.1165/rcmb.2010-0306OC.
27. De Laurentiis А., Candolfi М., Pisera D., Seilicovich А. Effects of lipopolysaccharide on neurokinin A content and release in the hypothalamic-pituitary axis. Regul. Pept. 2003: 111 (1-3): 91–95. DOI: 10.1016/S0167-0115(02)00258-6.
28. Calzetta L., Rogliani P., Facciolo F. et al. N-Acetylcysteine protects human bronchi by modulating the release of neurokinin A in an ex vivo model of COPD exacerbation. Biomed. Pharmacother. 2018; 103: 1–8. DOI: 10.1016/j.biopha.2018.04.011.
29. Ansari S.F., Memon M., Brohi N., Tahir A. N-acetylcysteine in the management of acute exacerbation of chronic obstructive pulmonary disease. Cureus. 2019; 11 (11): e6073. DOI: 10.7759/cureus.6073.
30. Papadopoulou E., Hansel J., Lazar Z. et al. Mucolytics for acute exacerbations of chronic obstructive pulmonary disease: a meta-analysis. Eur. Respir. Rev. 2023; 32 (167): 22041. DOI: 10.1183/16000617.0141-2022.
31. Leshchenko I.V., Esaulova N.A. [Significance of N-acetylcysteine in clinical practice]. Pul’monologiya. 2023; 33 (5): 679–688. DOI: 10.18093/0869-0189-2023-33-5-679-688 (in Russian).
Supplementary files
Review
For citations:
Leshchenko I.V., Zaytsev A.A. N-acetylcysteine – a drug for basic and symptomatic therapy of chronic bronchitis/chronic obstructive pulmonary disease. PULMONOLOGIYA. 2024;34(5):756-765. (In Russ.) https://doi.org/10.18093/0869-0189-2024-34-5-756-765