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N-Acetylcysteine Beneficial for Chronic Lung Disease
By Alan R. Gaby, MD
Supplementing with N-Acetylcysteine (NAC) can reduce the need for hospitalization among people suffering from chronic obstructive pulmonary disease (COPD), according to a study in the European Respiratory Journal (2003;21:795–8). The findings of this study provide new hope for individuals suffering from this incurable and often debilitating disease.

COPD is a common condition that consists of a combination of chronic bronchitis (inflammation of the airways) and emphysema (damage to, or destruction of, lung tissue). Symptoms include weakness, shortness of breath, weight loss, and recurrent lung infections. People with advanced disease frequently require supplemental oxygen and have great difficulty performing activities of daily living. Treatment consists of anti-inflammatory drugs, medications that dilate the bronchial passages, and antibiotics to treat infections.

NAC is a compound that is converted by the body into the naturally occurring amino acid cysteine. NAC has been shown to lower blood levels of homocysteine, an effect that is potentially beneficial for heart disease prevention. In addition, NAC given intravenously is the standard treatment for acute acetaminophen (Tylenol®) poisoning.

NAC also can break up trapped mucus and enhance its clearance from the bronchial passages, thereby improving the flow of air in and out of the lungs in people with COPD. In addition, NAC is the precursor of glutathione, one of the major antioxidants in lung tissue. Although the mucus-clearing effect of NAC occurs mainly when the compound is administered by inhalation, oral NAC has repeatedly been shown to prevent flare-ups in people with chronic bronchitis.

In the new study, 1,219 people who had been hospitalized for COPD were observed for an average of nine months after they were discharged from the hospital. Those who were prescribed NAC were approximately one-third less likely to be readmitted to the hospital, compared with those who were not given NAC. The risk of hospitalization decreased with increasing doses of NAC. Excluding those who were prescribed less than 400 mg per day, treatment with NAC was associated with an 85% reduction in the rate of readmission.

A large number of studies have used 600 mg per day of NAC for prevention of chronic bronchitis. Although nearly 20% of participants in some studies experienced side effects, including nausea, vomiting, abdominal pain, indigestion, dyspepsia, dry mouth, headache, dizziness, or abnormal taste, most people tolerated the treatment well. Long-term use of NAC has the potential to increase the requirement for zinc and copper. Some doctors, therefore, advise people who are taking NAC also to take a multivitamin-mineral preparation that provides approximately 15 mg of zinc and 2 mg of copper per day.

Because of the serious nature of COPD, people interested in taking NAC should consult their doctors.

Alan R. Gaby, MD, an expert in nutritional therapies, testified to the White House Commission on CAM upon request in December 2001. Dr. Gaby served as a member of the Ad-Hoc Advisory Panel of the National Institutes of Health Office of Alternative Medicine. He is the author of Preventing and Reversing Osteoporosis (Prima, 1994), and co-author of The Natural Pharmacy, 2nd Edition (Healthnotes, Prima, 1999), the A–Z Guide to Drug-Herb-Vitamin Interactions (Healthnotes, Prima, 1999), Clinical Essentials Volume 1 and 2 (Healthnotes, 2000), and The Patient’s Book of Natural Healing (Prima, 1999). A former professor at Bastyr University of Natural Health Sciences, in Kenmore, WA, where he served as the Endowed Professor of Nutrition, Dr. Gaby is the Chief Medical Editor for Healthnotes, Inc.