COPD: Treatment with twice daily N-acetylcysteine 600 mg Interview with:
Jinping Zheng MD FACCP
on behalf of Prof. Nanshan Zhong

Prof. Nanshan Zhong

Prof. Nanshan Zhong

–Jinping Zheng, MD, FCCP
Guangzhou Institute of Respiratory Disease
First Affiliated Hospital of Guangzhou Medical University
151 Yanjiang Rd. Guangzhou 510120, China What are the main findings of the study?

Answer: PANTHEON is the largest, evidence-based study of long-term treatment with N-acetylcysteine (NAC) in COPD patients conducted to date. The main finding of this study is that 1-year of treatment with high dose NAC (600mg twice daily) was effective at reducing exacerbations in patients with COPD, especially in the earlier stage [GOLD II (moderate) of disease. NAC was well tolerated. Were any of the findings unexpected?

Answer: We expected but failed to demonstrate the improvement of the SGRQ total scores in COPD patients treated with NAC, The low SGRQ was probably attributable to the low severity of COPD spirometric impairment. What should clinicians and patients take away from your report?

Answer: Oral administration of NAC, an anti-oxidant and mucolytic medicine, is recommended as a valuable treatment for prevention of progression in patients with COPD.  The treatment strategy of NAC includes higher dose, longer term and earlier (moderate severity) administraton. What recommendations do you have for future research as a result of this study?

Answer: Future studies are needed to explore efficacy in patients with mild COPD (GOLD I); We also recommend that the thio-compound mucolytics (NAC or Carbocisteine) should be put in the list of routine management of COPD in COPD guidelines such as GOLD (Global Initiative for Chronic Obstructive Lund Disease), owing to their similar efficacy comparing with ICS/LABA, the characters of cheaper, safe and easier to handle (oral administration).


Twice daily N-acetylcysteine 600 mg for exacerbations of chronic obstructive pulmonary disease (PANTHEON): a randomised, double-blind placebo-controlled trial
Prof Jin-Ping Zheng MD,Prof Fu-Qiang Wen MD,Prof Chun-Xue Bai MD,Prof Huan-Ying Wan MD,Prof Jian Kang MD,Prof Ping Chen MD,Prof Wan-Zhen Yao MD,Prof Li-Jun Ma MD,Xia Li MS,Luca Raiteri MD,Marco Sardina MD,Yi Gao MD,Bai-Song Wang PhD,Prof Nan-Shan Zhong MD,on behalf of the PANTHEON study group
The Lancet Respiratory Medicine – 30 January 2014
DOI: 10.1016/S2213-2600(13)70286-8