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Q: medicine ( Answered,   0 Comments )
Subject: medicine
Category: Health
Asked by: bouncer4-ga
List Price: $100.00
Posted: 22 Jan 2005 06:33 PST
Expires: 21 Feb 2005 06:33 PST
Question ID: 461467
I want to find peer reviewed medical studies concluding that
acetylcysteine is an acceptable drug in treating copd (chronic
obstructive pulmonary disease).
Subject: Re: medicine
Answered By: nancylynn-ga on 22 Jan 2005 09:19 PST
Hello bouncer4-ga: 

At Healthnotes Newswire (dated October 2, 2003):
?Supplementing with N-Acetylcysteine (NAC) can reduce the need for
hospitalization among people suffering from chronic obstructive
pulmonary disease (COPD), according to a study in the European
Respiratory Journal (2003;21:795?8).? (And, of course, the ERJ is a
peer-reviewed publication.)

You can read that study, ?N-acetylcysteine reduces the risk of
re-hospitalisation among patients with chronic obstructive pulmonary
disease? (by C.M.J.M. Gerrits1, R.M.C. Herings, H.G.M. Leufkens, and
J-W.J. Lammers), at:

From the Abstract:

?Using the PHARmacoMOrbidity linkage (PHARMO) system the authors
included all patients aged  55 yrs who had been dispensed medication,
labelled for respiratory indications (anatomical therapeutic chemical
(ATC) classification system: R03), between 1986?1998 and who had also
been hospitalised for COPD (International Classification of Diseases
(ICD)-9: 491, 492, 496) in this time frame . . . . A total of 1,219
patients, who were hospitalised for COPD between 1986?1998, were
included in this study. After adjustment for disease severity, it was
observed that the use of N-acetylcysteine was significantly associated
with a reduced risk of readmission. The readmission risk was
significantly lower in patients with high average daily doses of
In conclusion it was observed that N-acetylcysteine reduces the risk
of re-hospitalisation for chronic obstructive pulmonary disease by 30%
. . . .?

To read the full text, go to the top of this page:
and at top right, click ?Full Text (PDF),? which will bring up this URL:

In the interest of balance, also see the study ?Randomised, controlled
trial of N-acetylcysteine for treatment of acute exacerbations of
chronic obstructive pulmonary disease,? by Peter N Black , Althea
Morgan-Day , Tracey E McMillan , Phillippa J Poole and Robert P Young,
Department of Medicine, University of Auckland . . . Auckland, New
(Published by BMC Pulmonary Journal, December 6, 2004 BMC is a
peer-reviewed journal:

This study conflicted with prior one. Under ?Discussion? (near bottom
of the page), the researchers note: ?N-acetylcysteine has been
consistently shown to reduce the number of exacerbations of COPD when
it is taken for 3 months or more. In contrast we failed to show any
benefit when N-acetylcysteine was administered as a treatment for
acute exacerbations of COPD. There are a number of possible
explanations for the failure to see any benefit.
?We cannot exclude the possibility that there was a Type II error and
that there is indeed a beneficial effect of N-acetylcysteine in the
treatment of acute exacerbations. A larger study would be needed to
rule out this possibility but there was less improvement in
breathlessness, lung function and oxygen saturation with
N-acetylcysteine than with placebo that argues against this

?Another possibility that needs to be considered is that we used too
low a dose of N-acetylcysteine and that the concentrations of
N-acetylcysteine in the lung were not high enough to exert adequate
antioxidant or anti-inflammatory effects.?

See the study: ?Reduction in days of illness after long-term treatment
with N-acetylcysteine controlled-release tablets in patients with
chronic bronchitis, JB Rasmussen and C Glennow? (European Respiratory
Journal 1988; 1: 351-355).
(If you?d like to order the full text, that information is available
at top right, see ?Order Full text via Infotrieve.?)

Of Possible Interest:

At the bottom of this page at Aurora Health?s site:

There is a long list of study references. You may be able to locate
some of these studies offline. Check this helpful FAQ at NIH?s
National Library of Medicine/Entrez PubMed site for suggestions on how
to find full texts of these references:

"Hansen NCG, Skriver A, Brorsen-Riis L, et al. Orally administered
N-acetylcysteine may improve general well-being in patients with mild
chronic bronchitis. Respir Med. 1994;88:531?535."
Here?s an abstract from the National Library of Medicine:

"Riise GC, Larsson S, Larsson P, et al. The intrabronchial microbial
flora in chronic bronchitis patients: a target for N-acetylcysteine
therapy? Eur Respir J. 1994;7:94?101."
You can see Abstract at

Some other relevant studies:

?N-acetylcysteine reduces the exacerbation rate in patients with
moderate to severe COPD.? (Published: Respiration. 1999
Nov-Dec;66(6):495-500.)  See Abstract:

You can find Respiration, Volume 6, 1999, at Karger Publishers:

The Abstract is here:

?Conclusions: These data confirm results of previous studies which
reported a reduction in the number of exacerbations in patients having
moderate to severe COPD treated with the antioxidant NAC. Further, the
once-daily formulation is well tolerated and is likely to improve
patient compliance with the prescribed regimen.?

At the bottom of that page see links for ordering the full text of the
article/study, which costs $25:

I couldn?t find any information regarding this reference at Aurora
Health: ?Grandjean EM, Berthet P, Ruffmann R, et al. Efficacy of oral
long-term N-acetylcysteine in chronic bronchopulmonary disease: a
meta-analysis of published double-blind, placebo-controlled clinical
trials. Clin Ther. 2000;22:209?221.? But perhaps you can find that
issue of Clinical Therapy at a library.

Search Strings:

N-acetylcysteine +COPD
N-Acetylcysteine AND COPD AND study

I hope my research is of help to you. If you require clarification, or
assistance navigating any of the above links, please post a ?Request
For Clarification? prior to rating my answer.

Best Regards,
Google Answers Researcher

Clarification of Answer by nancylynn-ga on 22 Jan 2005 14:12 PST
It bugged me that I couldn?t find more information about that 2000
study that I cited at the end of my answer:

?Grandjean EM, Berthet P, Ruffmann R, et al. Efficacy of oral
long-term N-acetylcysteine in chronic bronchopulmonary disease: a
meta-analysis of published double-blind, placebo-controlled clinical
trials. Clin Ther. 2000;22:209?221.? (That study determined that
long-term use of NAC reduces acute exacerbations of chronic

Turns out the name of that journal is Clinical Therapeutics, not
Clinical Therapy! (No wonder I couldn't find it earlier.) Here?s the
journal?s homepage:

You can order a reprint of that article at this page:
However, the minimum order is 100 copies?!? I?m guessing you don?t need 100 copies.

So I did some more hunting around, and I found an Abstract for that
study at Ingenta Connect:

It turns out you can purchase the study via Science Direct:
(You may need to copy & paste the following URL, as it?s so long):,_Issue_2,_Pages_153-264_(February_2000)%23tagged%23Volume%23first%3D22%23Issue%23first%3D2%23Pages%23first%3D153%23last%3D264%23date%23(February_2000)%23&_auth=y&view=c&_acct=C000050221&_version=1&_urlVersion=0&_userid=10&md5=3000c78d3a133b72143cd22e232c7893

At the above URL, scroll down to article 4, you?ll see the title,
?Efficacy of Oral Long-Term N-Acetylcysteine in Chronic
Bronchopulmonary Disease: A Meta-Analysis of Published Double-Blind,
Placebo-Controlled Clinical Trials.?

Click on ?PDF (572 K)?  That will bring up a page where you can
register to purchase the article for $30.

I also found the proper site for "Riise GC, Larsson S, Larsson P, et
al. The intrabronchial microbial flora in chronic bronchitis patients:
a target for N-acetylcysteine therapy? Eur Respir J. 1994;7:94?101."
Here?s the Abstract:
To read the full article, go to the top of this page and click ?Full
Text? or ?Full Text PDF.?

You may also be interested in this 2004 ERJ article, ?Antioxidant
properties of N-acetylcysteine: their relevance in relation to chronic
obstructive pulmonary disease,? by P.N.R. Dekhuijzen. See Abstract:
To view the article (there is a $12 charge to for the full article),
go to the top right of the page and click ?Full Text.? Just scroll
down to "Pay per Article."
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