Clinical efficacy of N-acetylcysteine in adjuvant therapy for acute exacerbation of asthma-chronic obstructive pulmonary disease overlap / 中国医师进修杂志

ABSTRACT

Objective To investigate clinical efficacy of N-acetylcysteine (NAC) in the adjuvant treatment of patients with acute exacerbation of asthma-chronic obstructive pulmonary disease overlap (ACO). Methods One hundred and forty-six patients with acute exacerbation of ACO admitted to department of respiratory and critical care medicine of Henan provincial people′s hospital from March 2016 to August 2018 were divided into control group and observation group according to random number table, with 73 patients in each group. The control group was given clinical treatment such as bronchodilator, inhaled glucocorticoid and low- flow oxygen inhalation during hospitalization, and inhalation of budesonide/formoterol fumarate powder combined with tiotropium was continued after discharge. The treatment lasted for 4 weeks. The observation group was added with NAC 600 mg, twice daily, totally for 4 weeks on the basis of the control group. Baseline data and duration of hospital stay were collected. Before and after treatment, blood routine, c-reactive protein (CRP), forced expiratory volume in one second (FEV1)/forced vital capacity (FVC) and FEV1% pred were recorded. Clinical efficacy and adverse drug reaction were compared between the two groups. Results The white blood cell count, eosinophil count, neutrophil count, CRP, FEV1/FVC and FEV1% pred of two groups were significantly ameliorative after treatment compared with those before treatment, and the difference was statistically significant (P < 0.05). The white blood cell count, eosinophil count, neutrophil count and CRP after treatment in observation group were significantly lower than those in control group (7.40 ± 1.12)×109/L vs. (8.34 ± 1.56) ×109/L, (0.30 ± 0.15) ×109/L vs. (0.42 ± 0.18) ×109/L, (3.76 ± 1.49) ×109/L vs. (4.58 ± 1.72) × 109/L, (5.33 ± 1.65) mg/L vs. (5.95 ± 1.74) mg/L, and the differences were statistically significant (P<0.05). There were no statistical differences in FEV1/FVC and FEV1%pred after treatment between observation group and control group (P > 0.05). The total effective rate after treatment in observation group was significantly higher than that in control group 94.52% (69/73) vs. 82.19% (60/73), and the difference was statistically significant (P<0.05). During the treatment, duration of hospital stay in observation group was shorter than that in control group (5.82 ± 2.29) d vs. (7.25 ± 3.05) d, and the difference was statistically significant (P<0.05). The incidence of adverse reactions in observation group was compared with control group 10.96% (8/73) vs.5.48% (4/73), and the difference was not statistically significant (P > 0.05). Conclusions NAC has a significant effect in adjuvant treatment of acute exacerbation of ACO, which can significantly inhibit the level of inflammation and shorten the length of hospital stay.