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DOI: 10.1055/s-2002-36122
N-Acetylcystein in der Therapie der chronischen Bronchitis
N-Acetylcystein in the Therapy of Chronic BronchitisPublication History
Publication Date:
12 December 2002 (online)
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Zusammenfassung
Die chronische Bronchitis (CB) zeigt eine steigende Morbidität und Mortalität weltweit und bereitet hohe sozioökonomische Kosten. N-Acetylcystein (NAC), ursprünglich als Mukolytikum bei der CB verwendet, besitzt auch antioxidative Eigenschaften.
Außerdem kann es die intrabronchiale bakterielle Kolonisation bei der CB reduzieren. In einer randomisierten Pilotstudie bei 24 Patienten (16 Männer, 8 Frauen, mittleres Alter 66 ± 10 Jahre) mit akuter CB-Exazerbation und positivem Bakteriennachweis im Sputum konnte gezeigt werden, dass die zusätzliche Gabe von 2 × 600 mg NAC täglich zur Standardtherapie mit Antibiotika zu einer signifikant höheren bakteriellen Eradikation führte gegenüber einer Therapie mit Antibiotika alleine (70 % gegenüber 36 %, p < 0,03). Eine Reihe von Studien konnte zeigen, dass NAC zu einer Verringerung und Verkürzung von CB-Exazerbationen bei COPD führt und möglicherweise auch die Lungenfunktion günstig beeinflusst. Die Verbesserung von Symptomen und Lebensqualität hat Einfluss auf die sozioökonomischen Kosten, was den Einsatz von NAC bei der CB rechtfertigt. Eine größere, randomisierte plazebokontrollierte Studie, um den Stellenwert einer antioxidativen Therapie mit NAC bei CB und COPD besser definieren zu können, ist initiiert worden.
Abstract
Chronic bronchitis (CB) shows an increasing global morbidity and mortality with major impact on socioeconomics. N-Acetylcysteine (NAC), previously used as a mucolytic compound in CB, has also antioxidative effects. Furthermore it influences intrabronchial bacterial colonisation. In a randomised pilot study of 24 patients (16-male, 8 female, mean age 66 ± 10 years) with acute exacerbation of CB and positive bacterial culture in the sputum, the addition of twice daily 600 mg NAC to standard antibiotic therapy lead to a significantly higher bacterial eradication rate (70 % versus 36 %, p < 0.03). Clinical studies suggest that treatment with NAC has different effects in CB including a reduction of the number and duration of acute exacerbation episodes and possibly influences lung function. The improvement of symptoms and quality of life also has an impact on socio-economic costs. The use of NAC in CB as an antioxidative rather than a mucolytic compound should be considered. However, further placebo controlled studies are undergoing to definitively establish the role of NAC for the treatment of CB and COPD.
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Prof. Dr. med. M. Tamm
Pneumologie · Universitätskliniken Basel
Petersgraben 4
4031 Basel
Schweiz