Currently, bronchodilators are the mainstay treatment of stable chronic obstructive pulmonary disease while systemic corticosteroids and antibiotics have a major role in COPD acute exacerbations. Inhaled N-acetylcysteine is a mucolytic that has a pharmacologic role in respiratory conditions associated with excessive thick mucus production. Additionally, N-acetylcysteine has been studied as an adjunct agent for the clinical management of COPD because of its antioxidant and inflammatory properties. This paper provides a narrative review of literature on the effect Nacetylcysteine has on clinical outcomes in stable COPD and in acute COPD exacerbations. Primary literature was sought utilizing databases using Medline (2004-present). The database was searched using the key MeSH terms N-acetylcysteine and COPD, COPD exacerbation.
Current literature indicates in conjunction with standard drug regimen according to the COPD treatment guidelines, regular and high dose N-acetylcysteine (NAC) decrease frequency of exacerbations in stable COPD patient. Additionally, high dose N-acetylcysteine may improve airway obstruction in stable COPD patients. There is insignificant data for the use of N-acetylcysteine for patients experiencing acute exacerbations of COPD. Further studies should be performed as the overall benefits are still not fully established.