Chronic Obstructive Pulmonary Disease (COPD) is one of the leading causes of death of United States and is associated with a significant number of hospital admissions per year among patients. Goals of therapy for this chronic disease are to improve patient quality of life and reduce COPD related deaths. Inhaled N-acetylcysteine is a mucolytic that has a pharmacologic role in respiratory conditions associated with excessive thick mucus production. N-acetylcysteine has also been studied as an adjunct agent in the clinical management of COPD because of its antioxidant and anti-inflammatory properties. Clinically beneficial effects have not been fully established in the past, most likely due to the low N-acetylcysteine doses utilized and variability among clinical outcome parameters.
The aim of this article is to review recent literature (2004-present) on the effect N-acetylcysteine has on clinical outcomes in stable and acute COPD exacerbations. Two recent clinical trials note a reduction in the frequency of exacerbations in patients with stable COPD managed by 1,200 mg daily of N-acetylcysteine. No clinically significant differences in outcomes were noticed in patients presenting with acute COPD exacerbations. Additional investigation will be needed to establish its use in different stages of COPD based on the Gold Guidelines and to establish if benefits exist in acute exacerbations.
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