Effect of high-dose N-acetylcysteine on airway geometry, inflammation, and oxidative stress in COPD patients

Abstract

Background

Previous studies have demonstrated the potential beneficial effect of N-acetylcysteine (NAC) in chronic obstructive pulmonary disease (COPD). However, the required dose and responder phenotype remain unclear. The current study investigated the effect of high-dose NAC on airway geometry, inflammation, and oxidative stress in COPD patients. Novel functional respiratory imaging methods combining multislice computed tomography images and computer-based flow simulations were used with high sensitivity for detecting changes induced by the therapy.

Methods

Twelve patients with Global Initiative for Chronic Obstructive Lung Disease stage II COPD were randomized to receive NAC 1800 mg or placebo daily for 3 months and were then crossed over to the alternative treatment for a further 3 months.

Results

Significant correlations were found between image-based resistance values and glutathione levels after treatment with NAC (P = 0.011) and glutathione peroxidase at baseline (P = 0.036). Image-based resistance values appeared to be a good predictor for glutathione peroxidase levels after NAC (P = 0.02), changes in glutathione peroxidase levels (P = 0.035), and reduction in lobar functional residual capacity levels (P = 0.00084). In the limited set of responders to NAC therapy, the changes in airway resistance were in the same order as changes induced by budesonide/formoterol.

Conclusion

A combination of glutathione, glutathione peroxidase, and imaging parameters could potentially be used to phenotype COPD patients who would benefit from addition of NAC to their current therapy. The findings of this small pilot study need to be confirmed in a larger pivotal trial.

Keywords:

• functional respiratory imaging
• computational fluid dynamics
• computed tomography
• chronic obstructive pulmonary disease
• N-acetylcysteine

Author contributions

JDB, WV, SV, CVH, RC, PMP and WDB were responsible for the conception and design of the study, along with its analysis and interpretation. JDB, WV, SV, CVH, RC, PMP, and WDB drafted and revised the manuscript for important intellectual content.

Disclosure

JDB is a founder/shareholder of FluidDA NV, Kontich, Belgium. WV, SV, and CVH are employed by FluidDA NV, and WDB is the director of FluidDA NV. PMP and RC have no conflicts of interest to report. The study was supported by Zambon SpA, Bresso, Italy.