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Role of N-Acetylcysteine in the treatment of Acute Respiratory Disorders 11. Conclusions The oral formulation of NAC is convenient and easy-touse, and represents a useful option in the treatment of patients with acute respiratory conditions (figure 1). NAC safely and effectively reduces mucous and cough in adults andchildrenwithacute respiratory disorders. Its mucolytic effects in breaking disulfide bonds in mucous and enhancing mucociliary transport are useful in respiratory conditions associated with dense difficult-to-expectorate mucous. In addition, its antioxidant, anti-inflammatory, and immunomodulatory effects offer protection against inhaled oxidants, are beneficial in attenuating influenzalike symptoms and rejuvenate immune function of neutrophils and lymphocytes in older patients. An overall summary of the clinical benefits of the use of NAC in treating acute respiratory conditions is presented in table XIII. Table XIII Summary of the overall clinical benefits of oral N-acetylcysteine (NAC) in the treatment of acute respiratory conditions • Mucolytic, antioxidant, anti-inflammatory and immunomodulatory effects • Mucolytic effect involves decreasing mucous viscosity and improving mucociliary transport • Antioxidant effects are both direct and indirect • Anti-inflammatory effects involve antioxidant properties, re-establishment of the cellular reductive-oxidative equilibrium and preventing the release of inflammatory cytokines • Immune effects involve antioxidant protection against oxidative stress and improving the function of some immune cells • Effective in a wide range of acute respiratory disorders in adults and children • May be used in combination with antibacterials in patients with acute respiratory infections with mucopurulent sputum • Confers protection against cigarette smoking and air-borne pollution • Decreases the severity and frequency of influenza-like symptoms in high-risk patients • Restores age-related deterioration of immune function • Very well tolerated in adults and children • Tolerability profile similar to that of placebo 25
Current <strong>Therapeutics</strong> 12. References 1. Ziment I. Acetylcysteine: a drug with an interesting past and a fascinating future. Respiration 1986; 50 Suppl. 1: 26-30 2. Richardson PS. The physical and chemical properties of airway mucus and their relation to airway function. Eur J Respir Dis 1980; 61 Suppl. 111: 13-15 3. Van As A. Pulmonary airway defence mechanisms: an appreciation of integrated mucociliary activity. Eur J Respir Dis 1980; 61 Suppl. 111: 21-4 4. Puchelle E, Polu JM, Zahm JM, et al. Role of the rheological properties of bronchial secretions in the mucociliary transport at the bronchial surface. Eur J Respir Dis 1980; 61 Suppl. 111: 29-34 5. Houtmeyers E, Gosselink R, Bayanm-Ramirez G, et al. Effects of drugs on mucous clearance. Eur Respir J 1999; 14: 452-67 6. Barton AD, Lurenço RV. Bronchial secretions and mucociliary clearance: biochemical characteristics. Arch Intern Med 1973; 131: 140-4 7. Tomasi A. 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Role of oxidants in influenza virus-induced gene expression. Am J Physiol 1998; 274 (1 Pt 1): L134-42 21. Stagnaro R, Pierri I, Piovano P, et al. Thiol containing antioxidant drugs and the human immune system. Bull Eur Physiopathol Respir 1987; 23: 303-7 22. Arranz L, Rodríguez A, Fernández C, et al. Un tratamiento de 2 meses con N-acetilcisteína mejora la función leucocitaria en mujeres mayores de 50 años [abstract]. Rev Esp Geriatr Gerontol 2005; 40 (Suppl. 1): 21 23. Arranz L, Rodríguez A, Fernández C, et al. Efecto de un tratamiento de 2 mesesconN-acetilcisteínasobrelafuncióndeneutrófilos en mujeres mayores de 50 años [abstract]. Rev Esp Geriatr Gerontol 2005; 40 (Suppl. 1): 116 24. Ventresca GP, Cicchetti V, Ferrari V. Acetylcysteine. In: Braga PC, Allegra L, editors. Drugs in Bronchial Mucology. New York: Raven Press, 1989: 77-102 25. Fluimucil: summary of product characteristics. 2002 26. Borgström L, Kågedal B. Dose dependent pharmacokinetics of N- acetylcysteine after oral dosing to man. Biopharm Drug Dispos 1990; 11 (2): 131-6 27. De Caro L, Ghizzi A, Costa R, et al. Pharmacokinetics and bioavailability of oral acetylcysteine in healthy volunteers. Arzneimittelforschung 1989; 39 (3): 382-6 28. Tegner H, Torelmalm NG. Interaction between N-acetylcysteine and cigarette smoke extract. Eur J Respir Dis 1985; 66 Suppl. 139: 130-1 29. Rogers DF, Godfrey RW, Majumdar S, et al. Oral N-acetylcysteine speeds reversal of cigarette smoke-induced mucous cell hyperplasia in the rat. Exp Lung Res 1988; 14 (1): 19-35 30. Rogers DF, Turner NC, Marriott C, et al. Oral N-acetylcysteine or S- carboxymethylcysteine inhibit cigarette smoke-induced hypersecretion of mucus in rat larynx and trachea in situ. Eur Respir J 1989; 2 (10): 955-60 31. Lightowler JE, Lightowler NM. 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