Evidence supporting the use of: N-acetyl-cysteine (NAC)
For the health condition: Emphysema

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Synopsis

Source of validity: Scientific
Rating (out of 5): 2

N-acetyl-cysteine (NAC) is used in the management of emphysema primarily due to its mucolytic and antioxidant properties. NAC acts as a precursor to glutathione, a critical antioxidant in the lungs, and helps to reduce oxidative stress, which is elevated in chronic obstructive pulmonary diseases (COPD) such as emphysema. It also breaks disulfide bonds in mucus, making it less viscous and easier to expectorate. Several clinical trials and meta-analyses have evaluated the use of NAC in COPD, which includes emphysema as a component. Some studies have shown that long-term NAC administration can reduce exacerbation frequency and improve sputum clearance, but improvements in lung function (as measured by FEV1) are generally modest or inconsistent. Evidence specific to emphysema (as opposed to broader COPD populations) is limited, and clinical guidelines do not universally recommend NAC for all patients with emphysema. The overall quality of evidence is moderate, with some positive findings but also notable heterogeneity across studies. In summary, while there is a scientific rationale and some clinical support for NAC in the context of emphysema, the evidence is not robust enough to be considered standard of care, and its benefit is likely modest, leading to a rating of 2 out of 5.

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