Md. Amanullah Chowdhury 1, Shaila Zaman 2, Mohammad Ruhul Alam 3, Subhashish Dey 4, Hena Khatun 5, Mohammad Abdus Shakur Khan 6, Kazi Saifuddin Bennoor 6, SK Shahinur Hossain 7, Md. Ali Hossain8, Bashir Ahmed8, Md. Khairul Hassan Jessy8, Syed Rezaul Huq7

Abstract
Background: Current pharmacotherapy for Bronchiectasis has limited clinical efficacy as such patients
often remain symptomatic. Mucus plug play a major role in the pathogenesis of acute exacerbations of
Bronchiectasis. Oral N- acetylcysteine (NAC) has mucolytic, anti inflammatory and anti bacterial properties.
A study was undertaken to determine whether oral NAC would reduce the frequency of acute exacerbations
of bronchiectasis. Methods: It was a randomized, prospective and single blind study conducted at the
department of Respiratory Medicine in National Institute of Diseases of the Chest and Hospital (NIDCH),
Mohakhali, Dhaka. Seventy stable bronchiectatic patients were selected and randomized into N- acetylcysteine
(NAC) Group and placebo group, each having 35 patients. Patients were treated with tab. N-acetylcysteine,
600 mg twice daily in addition with their conventional therapy and other group of patients were treated with
placebo daily in association with conventional treatment. A spirometry and CAT score was performed in each
case at the beginning and at the end of third month. Difference of mean FEV1 and CAT score from baseline
between two groups and also mean exacerbation rate were measured from baseline. Results: A total number
of 70 patients were selected and among them 28 patients in NAC group and 30 patients of placebo group
came for final follow up.In NAC group the mean FEV1 increased from 0.925 liter to 1.103 liter after three
months. This difference was statistically highly significant (p<0.001).In both NAC and placebo groups the
mean CAT score decreased significantly but in NAC group the CAT scores reduced significantly more. After
three months the mean exacerbation number reduced to zero in NAC group and stood at 1.03 in placebo
group. These differences were highly significant (p<0.001). In NAC group, exacerbation occurred in four
patients and in placebo group, exacerbation occurred in eight patients giving rise to a RR value of 0.53 and
number of patients needed to treat (NNT) value of 8. Conclusion: NAC significantly reduced the exacerbation
frequency from baseline to 3 months follow-up. It had improved the quality of life of the patients evident by the
significant reduction in the CAT score and a clinical improvement of FEV1 value.
Keywords: N- acetylcysteine (NAC), Forced Expiratory Volume in One Second (FEV1), COPD Assessment
Test (CAT) score, Bronchiectasis

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