Management of COPD exacerbations: pharmacotherapeutics of medications

Efficacy of treatment with N-acetylcysteine inhalation for AECOPD: A propensity-score-matched cohort study

INTRODUCTION

N-acetylcysteine (NAC) prevents acute exacerbations of chronic obstructive pulmonary disease (AECOPD). However, the value of NAC inhalation in the treatment of patients with AECOPD is still poorly understood. The study was conducted to evaluate the efficacy of NAC inhalation in AECOPD patients requiring hospitalization.

METHODS

In this single institutional, retrospective cohort study, all patients with AECOPD requiring hospitalization between January 2021 and January 2022 were included. Patients were divided into NAC group and Non-NAC group according to whether being treated with NAC inhalation and were matched using the propensity score. The primary outcome was a composite of progression to ventilation requirement, in-hospital mortality and readmission for AECOPD within 30 days. The effect on the mean hospitalized days, blood gas indexes and the incidence rate of adverse drug events were compared between the two groups.

RESULTS

Ninety-six patients in the NAC group were matched with 96 patients in the Non-NAC group. The differences in the primary composite end point (NAC group vs Non-NAC group, 5.2% vs 16.7%; P = 0.011) were significant. The median time to discharge was shorter in the NAC group (8.3 vs. 9.1 days, P = 0.030). The NAC group presented a larger increase in partial pressure of arterial oxygen (Pa O2 ) and a higher ratio of self-reported symptomatic improvement from admission to day 5. There was no definite difference between the two groups in the frequency of adverse event.

CONCLUSION

NAC inhalation is associated with an improved clinical outcome. A further study should be conducted to confirm the clinical usefulness of NAC inhalation in AECOPD patients.

Assessment and Management of COPD

Chronic obstructive pulmonary disease (COPD) is characterized by progressive airflow obstruction, worsening exercise performance and deteriorating health. It is associated with significant morbidity, mortality, and costs to healthcare systems. Although no cure exists for COPD, there are treatments, medications, and lifestyle changes patients can adopt to feel better and prevent further damage to their lungs. This article discusses the assessment and treatment strategies, medication administration, oxygen management, and education for patients with COPD. Home care strategies may alleviate readmissions or the need for emergent care, thus reducing the impact of COPD on patients.