COPD: Benefits of high dose N-acetylcysteine

Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB Associate Consultant, Kwong Wah Hospital, Hong Kong Life member and Council member of Hong Kong Thoracic Interview with:
Dr. Hoi Nam Tse,  FCCP, MRCP, MBChB
Associate Consultant, Kwong Wah Hospital, Hong Kong
Life member and Council member of Hong Kong Thoracic Society

MedicalResearch: What are the main findings of the study?

Dr. Hoi Nam Tse: N-acetylcysteine (NAC) is an oral mucolytic containing anti-oxidative and anti-inflammatory property. Our study demonstrated that long term use of high-dose : N-acetylcysteine (600 mg twice daily for 1 year) was a well-tolerated treatment, and it reduced exacerbations and prolonged time to first exacerbation in ‘high-risk’ COPD patients–which was defined as patients who had 2 or more exacerbations per year, FEV1<50% or both. Such beneficial effect was not obvious in the ‘low-risk’ COPD patients.

MedicalResearch: Were any of the findings unexpected?

Dr. Hoi Nam Tse: Apart from supporting to the previous PANTHEON study (High-dose N-acetylcysteine in the prevention of COPD exacerbations study) and HIACE (High-dose N-acetylcysteine in stable COPD) trial on the use of high-dose NAC (1200mg daily) in reducing COPD exacerbations, our current study did shed light on the tailored-made NAC treatment to the ‘exacerbation-prone/frequent-exacerbator’ phenotype COPD patients. The exacerbation-prone COPD patients have a higher oxidative burden and therefore have a more significant beneficial effect by restoring oxidative imbalance by the NAC treatment.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Hoi Nam Tse: It was suggested that a NAC should be given at a higher dose (1200mg daily or above) to exert its anti-oxidative/ anti-inflammatory effects in COPD patients. This beneficial effect is most obvious in the exacerbation-prone (high exacerbation risk) COPD patients.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Hoi Nam Tse: Further large scale studies may be need to investigate 1) the effects of NAC in various COPD phenotype and severities; 2) any synergistic effects of NAC and other anti-inflammatory drugs; 3) safety and additional benefit using even higher dose of NAC.


Benefits of high dose N-acetylcysteine to exacerbation-prone COPD patients

Hoi Nam Tse, FCCP, MBChB; Luca Raiteri, MD; King Ying Wong, FCCP, MBBS; Lai Yun Ng, MRCP, MBChB; Kwok Sang Yee, FRCP, MBBS; Cee Zhung Steven Tseng, MB, BCh, BAO

Chest. 2014. doi:10.1378/chest.13-2784


Last Updated on May 19, 2014 by Marie Benz MD FAAD