title: Priming of beta-2 agonist and antimuscarinic induced physiological responses induced by 1200mg/day NAC in moderate to severe COPD patients: A pilot study.
abstract: This study evaluated antioxidant modulations of lung physiological-responses to beta-2-agonist and antimuscarinic bronchodilators with 1200mg/day n-acetyl-cysteine (NAC) in a placebo-controlled, randomised, double-blind, parallel-group study, in moderate-very severe COPD patients.
  
  
  METHODS
  15 COPD patients received NAC treatment, while 9 COPD patients received placebo treatment, for 15 days. Pre-and-post salbutamol and ipratopium-bromide lung-physiology responses were measured using body-plethysmography, impulse-oscillometry (IOS) and spirometry before-and-after study treatments.
  
  
  RESULTS
  Compared to pre-treatment, the NAC-treatment significantly enhanced the potential of ipratopium-bromide to reduce functional-residual-capacity (FRC) by nearly 3-folds (mean% FRC-response: pre-NAC: -5.51%±10.42% versus post-NAC: -17.89%±12.94%, p=0.02; mean-absolute FRC-response: pre-NAC: -300ml±450ml versus post-NAC: -770ml±550ml, p=0.02), which was superior to placebo-treatment. The increase in total-lung-capacity response to ipratopium-bromide, although insignificant, was superior with post-NAC treatment versus post-placebo treatment (p=0.049). The salbutamol-response remained unaltered with either treatment.
  
  
  CONCLUSIONS
  The treatment with 1200mg/day NAC has potential to enhance the bronchodilator ability of antimuscarinic-agents but not beta-2-agonist. However, its clinical application has to be established in large sample-size studies for longer-duration.
authors.affiliation: Chest Research Foundation, Department of Pulmonary Research, Pune, Maharashtra, India.
authors.forename: Ravikumar
authors.initials: R
authors.lastname: Sinojia
authors.affiliation: Chest Research Foundation, Department of Pulmonary Research, Pune, Maharashtra, India.
authors.forename: Moin
authors.initials: M
authors.lastname: Shaikh
authors.affiliation: Chest Research Foundation, Department of Pulmonary Research, Pune, Maharashtra, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Kodgule
authors.affiliation: Chest Research Foundation, Department of Pulmonary Research, Pune, Maharashtra, India.
authors.forename: Satish
authors.initials: S
authors.lastname: Bhosale
authors.affiliation: Chest Research Foundation, Department of Pulmonary Research, Pune, Maharashtra, India.
authors.forename: Sapna
authors.initials: S
authors.lastname: Madas
authors.affiliation: Cipla Ltd., Mumbai, India.
authors.forename: Abhijit
authors.initials: A
authors.lastname: Vaidya
authors.affiliation: Chest Research Foundation, Department of Pulmonary Research, Pune, Maharashtra, India.
authors.forename: Sundeep
authors.initials: S
authors.lastname: Salvi
authors.affiliation: Chest Research Foundation, Department of Pulmonary Research, Pune, Maharashtra, India. Electronic address: bbrashier@crfindia.com.
authors.forename: Bill
authors.initials: B
authors.lastname: Brashier
mesh_terms: D000111:Acetylcysteine / Q000627:therapeutic use*; D000368:Aged; D000420:Albuterol / Q000627:therapeutic use; D000975:Antioxidants / Q000627:therapeutic use*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D006801:Humans; D009241:Ipratropium / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D018727:Muscarinic Antagonists / Q000627:therapeutic use*; D010865:Pilot Projects; D010991:Plethysmography; D029424:Pulmonary Disease, Chronic Obstructive / Q000188:drug therapy* / Q000503:physiopathology; D013147:Spirometry; D018709:Statistics, Nonparametric; D014109:Total Lung Capacity / Q000187:drug effects
chemical_list: D000975:Antioxidants; D001993:Bronchodilator Agents; D018727:Muscarinic Antagonists; D009241:Ipratropium; D000420:Albuterol; D000111:Acetylcysteine
keywords: Anti-oxidant; Ipratropium-bromide; Priming; Salbutamol; n-acetyl-cysteine