Oxidation pathway and exacerbations in COPD: the role of NAC

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•• An important review to understand the existing and potential therapeutic uses for NAC and the fact that its strength is the targeted replenishment of GSH in deficient cells.

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•• A very important trial that has documented the effect of NAC in preventing acute exacerbation of COPD, at least in Chinese patients.

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•• meta-analysis of 13 studies that examined the effects of NAC in preventing COPD exacerbations.

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• A small but intriguing study documenting that high-dose (1800 mg daily) NAC for 3 months influences airway geometry, inflammation, and oxidative stress in COPD patients.

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• A point of view suggesting that step-up and step-down pharmacological treatment in COPD is a possibility