A Systematic Review and Meta-Analysis: The Long-Term Effects of Oral N-Acetylcysteine in Chronic Obstructive Pulmonary Disease

Nasikhatussoraya, Nova
Umam, Hamid Faqih
Rizkani, Ainingtyas Marda
Santoso, Hidayat

Nusantara Science and Technology Proceedings
The 4th International Conference on Community Medicine and Medical Sciences

Chronic obstructive pulmonary disease (COPD) is one of the world's most prevalent causes of morbidity and mortality. About 5.6% of Indonesians have COPD. Most COPD patients have mucus hypersecretion and inadequate mucus clearance, leading to airway obstruction. N-acetylcysteine (NAC) is a mucolytic drug with antioxidant and anti-inflammatory effects. Long-term oral NAC use in COPD remains controversial. We searched four databases to analyze the effects of oral NAC in COPD over a minimum six-month treatment. The data was analyzed through Review Manager 5.4. Eight randomized controlled trials, comprising 3.187 patients, were selected for inclusion in the study. NAC had a lower risk of exacerbations (RR 0.78, 95% CI 0.66-0.93; p=0.005), whether at high dose (1200mg/day) or low dose (600mg/day). The risk is higher at the high dose (RR 0.90, p=0.04) than at the low dose (RR 0.70, p=0.0002). NAC did not affect FEV1 (mean difference 4.71, 95% CI -3.20-12.61; p=0.24), and adverse events were the same as with placebo (RR 1.14, 95% CI 0.78-1.67; p=0.51). Long-term oral NAC reduces the risk of COPD exacerbations at any dose and was well tolerated.