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The evidence of the use of oral N-acetylcysteine in the reduction and the prevention of exacerbations in chronic obstructive pulmonary disease

International Journal of Family & Community Medicine
Inês Pereira,1 Ana Marta Pinto,2 Ana Catarina Silva,3 Ana Gabriela Oliveira,2 Catarina Lamego2


Introduction: Exacerbations are responsible for the majority of morbidity, mortality and costs  associated  with  chronic  obstructive  pulmonary  disease.  However,  the  evidence  that  oral mucolytics have an important clinical effect on this pathology is limited. The objective of this evidence-based review was to describe the current state of knowledge regarding the reduction and prevention of exacerbations in chronic obstructive pulmonary disease with the use of oral N-acetylcysteine.

Materials  and  methods: Research was performed on recommended scientific bases in English, Portuguese and Castilian, without restriction on the date of publication, with the MeSH  words  “Acetylcystein”  and  “Pulmonary  Disease,  Chronic  Obstructive”.  Inclusion  and exclusion criteria have been defined. The evaluation of the levels of evidence and the  assignment  of  the  recommendation  forces  were  made  through  the  scale  Strength  Of  Recommendation Taxonomy. 

Results: Seven articles were obtained through the methodology used: four systematic reviews  and  three  guidelines.  All  studies  concluded  that  the  use  of  oral  N-acetylcysteine  decreases  and  prevents  exacerbations  in  patients  with  chronic  obstructive  pulmonary  disease.

Discussion:  There  are  few  studies  that  allow  us  to  clearly  recommend  the  use  of  oral  N-acetylcysteine in patients with chronic obstructive pulmonary disease. Still, according to the existing studies and the usual clinical practice, there seems to be benefit with its use in the decrease and in the prevention of exacerbations in this group of patients.

Conclusions: Further studies are needed to evaluate the efficacy and the safety of oral N-acetylcysteine  in  the  reduction  and  prevention  of  exacerbations  in  chronic  obstructive  pulmonary disease.


chronic obstructive pulmonary disease, oral n-acetylcysteine, exacerbations, prevention, decrease