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[[wikipedia:Acetylcysteine|N-acetylcysteine]] (NAC; Mucomyst as nebuliser; Acetadote intravenous) is the prototype thiol mucolytic. Its acetylated sulfhydryl group reduces the disulfide bonds of mucus glycoproteins, lowering viscosity. The medicine has been used by nebuliser since the 1960s for retained secretions in COPD, post-operative atelectasis, and selected bronchiectasis; the clinical evidence for routine COPD mucolytic use is mixed and current guidelines recommend it only for patients with frequent exacerbations on optimal bronchodilator therapy. The oral preparation, much less effective for respiratory secretions because of substantial first-pass metabolism, has small evidence-base utility in idiopathic pulmonary fibrosis (the PANTHER-IPF and IFIGENIA trials) and remains in selected use as antioxidant therapy in IPF. The dominant clinical use of N-acetylcysteine is, in contrast to its mucolytic indication, the antidotal treatment of [[wikipedia:Paracetamol poisoning|paracetamol overdose]] (replenishment of hepatic glutathione consumed by the reactive paracetamol metabolite NAPQI), described under [[Acetaminophen|acetaminophen]]. | [[wikipedia:Acetylcysteine|N-acetylcysteine]] (NAC; Mucomyst as nebuliser; Acetadote intravenous) is the prototype thiol mucolytic. Its acetylated sulfhydryl group reduces the disulfide bonds of mucus glycoproteins, lowering viscosity. The medicine has been used by nebuliser since the 1960s for retained secretions in COPD, post-operative atelectasis, and selected bronchiectasis; the clinical evidence for routine COPD mucolytic use is mixed and current guidelines recommend it only for patients with frequent exacerbations on optimal bronchodilator therapy. The oral preparation, much less effective for respiratory secretions because of substantial first-pass metabolism, has small evidence-base utility in idiopathic pulmonary fibrosis (the PANTHER-IPF and IFIGENIA trials) and remains in selected use as antioxidant therapy in IPF. The dominant clinical use of N-acetylcysteine is, in contrast to its mucolytic indication, the antidotal treatment of [[wikipedia:Paracetamol poisoning|paracetamol overdose]] (replenishment of hepatic glutathione consumed by the reactive paracetamol metabolite NAPQI), described under [[Acetaminophen|acetaminophen]]. | ||
The carbocysteine, erdosteine, and bromhexine class are widely used in European and Asian practice but not approved in the United States. [[wikipedia:Carbocysteine|Carbocysteine]] (S-carboxymethyl-L-cysteine, Mucodyne in U.K.) is an oral thiol mucolytic with mixed evidence for COPD; erdosteine has antioxidant and mucolytic properties; ambroxol and its | The carbocysteine, erdosteine, and bromhexine class are widely used in European and Asian practice but not approved in the United States. [[wikipedia:Carbocysteine|Carbocysteine]] (S-carboxymethyl-L-cysteine, Mucodyne in U.K.) is an oral thiol mucolytic with mixed evidence for COPD; erdosteine has antioxidant and mucolytic properties; ambroxol and its precursor bromhexine enhance surfactant production and have been used widely in Europe and Asia for acute and chronic bronchitis. | ||
The '''expectorants''' (the largest of which is [[wikipedia:Guaifenesin|guaifenesin]], available over-the-counter in many cough-and-cold preparations) are conventionally considered alongside mucolytics, although they act by a slightly different mechanism: guaifenesin increases the volume and reduces the viscosity of respiratory secretions by enhancing vagal-mediated reflex bronchial secretion. The clinical evidence for expectorant efficacy in routine acute bronchitis is limited. | The '''expectorants''' (the largest of which is [[wikipedia:Guaifenesin|guaifenesin]], available over-the-counter in many cough-and-cold preparations) are conventionally considered alongside mucolytics, although they act by a slightly different mechanism: guaifenesin increases the volume and reduces the viscosity of respiratory secretions by enhancing vagal-mediated reflex bronchial secretion. The clinical evidence for expectorant efficacy in routine acute bronchitis is limited. | ||