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The efficacy of N-acetylcysteine in the management of chronic obstructive pulmonary disease: a systematic review and meta-analysis

drugs-and-devices
evidence-based-medicine

Abstract

Introduction: The purpose of this study is to evaluate the efficacy and safety of N-acetylcysteine (NAC) in the treatment of chronic obstructive pulmonary disease (COPD).

Methods: This study acquired a unique registration number on PROSPERO: CRD42024597263. In December 2024, the researcher systematically searched PubMed, Embase, Web of Science, and Cochrane Library for all published studies. The Cochrane Collaboration’s tool trials were used for study quality assessment; Review Manager software was used for statistical analysis and forest plot output.

Results: In total, 14 studies were included in the final analysis. Our findings suggest that the use of NAC is effective in reducing the incidence of acute exacerbations in patients with COPD [RR=0. 88 , 95%CI (0.8 0 , 0.9 7 ), P=0.0 1 ]. Further subgroup analyses were performed according to the dose of NAC, and the results of the meta-analysis showed that low-dose NAC [RR=0.86, 95%CI (0.75, 0.99), P=0.03] significantly reduced the incidence of acute exacerbations in COPD, whereas high-dose NAC [RR=0.88, 95%CI (0.73, 1.06), P=0.19] did not significantly reduce the incidence. In addition, NAC use was not statistically different from control in improving pulmonary ventilation (FEV1 and FVC), increasing adverse drug-related events, improving quality of life in patients with COPD (St. George's Respiratory Questionnaire Scores), and increasing body glutathione (GSH) levels.

Conclusions: In conclusion, our study suggests that the use of NAC significantly reduces the risk of acute exacerbations in patients with COPD. In contrast, NAC did not have prominent advantages in improving pulmonary ventilation, increasing drug-related adverse effects, improving patient quality of life, and increasing GSH levels in COPD patients. Higher quality, larger samples, and more rigorous RCTs are needed to validate our findings.

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