N-acetylcysteine in patients with COPD exacerbations associated with increased sputum

Aytemur, Zeynep Ayfer; Baysak, Ayşegül; Özdemir, Özer; Köse, Timur; Sayıner, Abdullah

doi:10.1007/s00508-014-0692-4

Cited by 17 publications

(15 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Defects in MCT have been reported in many airway diseases, including chronic obstructive pulmonary disease, primary ciliary dyskinesia, cystic fibrosis, and asthma (48)(49)(50)(51). Moreover, mucolytic agents have been proposed as treatments (52)(53)(54)(55)(56). Our current studies do not address these issues.…”

Section: Discussionmentioning

confidence: 99%

Mucus strands from submucosal glands initiate mucociliary transport of large particles

Fischer¹,

Pino-Argumedo²,

Hilkin³

et al. 2019

JCI Insight

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Mucus strands from submucosal glands initiate mucociliary transport of large particles

Fischer¹,

Pino-Argumedo²,

Hilkin³

et al. 2019

JCI Insight

View full text Add to dashboard Cite

“…Moreover, the above modalities each demonstrate safety in addition to efficacy in their use 12. In contrast, pharmacologic agents such as mucolytics have been used in chronic COPD patients to reduce exacerbation rates,13,14 but there is a paucity of evidence that agents such as N-acetylcysteine have a significant effect in the setting of AECOPD 15…”

Section: Discussionmentioning

confidence: 99%

<p>Positive Expiratory Pressure Therapy With And Without Oscillation And Hospital Length Of Stay For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease</p>

Milan¹,

Bondalapati²,

Megally³

et al. 2019

COPD

View full text Add to dashboard Cite

Introduction: Pharmacologic management of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is well-established. Our aim in the current study is to determine if therapy with a positive expiratory pressure (PEP) device with or without an oscillatory mechanism (OM) in addition to standard care results in a reduction in hospital length of stay (LOS) among patients hospitalized for AECOPD. Methods: Two studies were performed and are reported here. Study 1: Patients admitted with AECOPD and sputum production were enrolled in a prospective trial comparing PEP therapy versus Oscillatory PEP (OPEP) therapy. Study 2: A retrospective historical cohort, matched in a 2 to 1 manner by age, gender, and season of admission, was compared with the prospectively collected data to determine the effect of PEP ± OM versus standard care on hospital LOS. Results: In the prospective trial (Study 1; 91 subjects), median hospital LOS was 3.2 (95% CI 3.0-4.3) days in the OPEP group and 4.8 (95% CI 3.9-6.1) days in the PEP group (p=0.16). In fully adjusted models comparing the prospective trial data with the retrospective cohort (Study 2; 182 subjects), cases had a median hospital LOS of 4.2 days (95% CI 3.8-5.1) versus 5.2 days (95% CI 4.4-6.0) in controls, consistent with a shorter hospital LOS with adjunctive PEP±OM therapy versus standard care (p=0.04). Conclusion: Adjunctive therapy with a PEP device versus standard care may reduce hospital LOS in patients admitted for AECOPD. Although the addition of an OM component to PEP therapy suggests a further reduction in hospital LOS, comprehensive multicenter randomized controlled trials are needed to confirm these findings. Clinical trial registration number: NCT03094806.

show abstract

“…Two studies with 28 and 12 patients only showed an increase in FEV 1 [ 27 , 41 ], whereas another with 10 patients detected no change [ 42 ]. For N-Acetylcysteine (24 vs. 27; 186 vs. 168 and 19 vs. 19 patients) [ 36 , 43 – 45 ] and mannitol (9 and 12 patients) [ 46 , 47 ], stable or even slightly decreasing lung function has been described. For DNase I, we found two studies stating an increase (20 vs. 21 and 156 vs. 176 patients) [ 48 , 49 ], and one a decrease with 172 vs. 176 patients [ 50 ] in lung function in cystic fibrosis.…”

Section: Discussionmentioning

confidence: 99%

Mucolytic Effectiveness of Tyloxapol in Chronic Obstructive Pulmonary Disease - A Double-Blind, Randomized Controlled Trial

et al. 2016

View full text Add to dashboard Cite

ObjectiveMucoactive drugs should increase the ability to expectorate sputum and, ideally, have anti-inflammatory properties. The aim of the study was to evaluate the mucolytic activity of Tyloxapol compared to saline (0.9%) in COPD.DesignA randomized, placebo-controlled, double-blinded crossover, clinical trial was carried out. Patients were randomly assigned to either inhale 5 ml Tyloxapol 1% or saline 0.9% solution three times daily for 3 weeks and vice versa for another 3 weeks. 28 patients (18 male, 10 female, 47 to 73 years old, median age 63.50) were screened, 21 were treated and 19 patients completed the study per protocol.ResultsA comparison of the two treatment phases showed that the primary endpoint sputum weight was statistically significant higher when patients inhaled Tyloxapol (mean 4.03 g, 95% CI: 2.34–5.73 g at week 3) compared to saline (mean 2.63 g, 95% CI: 1.73–3.53 g at week 3). The p-value at three weeks of treatment was 0.041 between treatment arms. Sputum cells decreased during the Tyloxapol treatment after 3 weeks, indicating that Tyloxapol might have some anti-neutrophilic properties. Lung function parameters (FVC, FEV1, RV, and RV/TLC) remained stable during the study, and no treatment effect was shown. Interestingly, there was a mean increase in all inflammatory cytokines (IL-1β, IL-6, and IL-8) during the saline treatment from day 1 to week 3, whereas during the Tyloxapol treatment, all cytokines decreased. Due to the small sample size and the large individual variation in sputum cytokines, these differences were not significant. However, analyses confirmed that Tyloxapol has significant anti-inflammatory properties in vitro. Despite the high number of inhalations (more than 1000), only 27 adverse events (20 during the Tyloxapol and seven during saline) were recorded. Eleven patients experienced AEs under Tyloxapol and six under saline treatment, which indicates that inhalation of saline or Tyloxapol is a very safe procedure.ConclusionOur study demonstrated that inhalation of Tyloxapol by patients with COPD is safe and superior to saline and has some anti-inflammatory effects.Trial RegistrationClinicalTrials.gov NCT02515799

show abstract

N-acetylcysteine in patients with COPD exacerbations associated with increased sputum

Abstract: NAC does not have any beneficial effect on clinical outcomes in patients with severe COPD exacerbation associated with increased and/or viscous mucus production.

Cited by 17 publications

References 14 publications

Mucus strands from submucosal glands initiate mucociliary transport of large particles

Mucus strands from submucosal glands initiate mucociliary transport of large particles

<p>Positive Expiratory Pressure Therapy With And Without Oscillation And Hospital Length Of Stay For Acute Exacerbation Of Chronic Obstructive Pulmonary Disease</p>

Mucolytic Effectiveness of Tyloxapol in Chronic Obstructive Pulmonary Disease - A Double-Blind, Randomized Controlled Trial

Contact Info

Product

Resources

About