6533b832fe1ef96bd129acf9
RESEARCH PRODUCT
Oxidative Stress and Respiratory System: Pharmacological and Clinical Reappraisal of N-Acetylcysteine
Angelo CorsicoPierachille SantusScichilone NicolaPaolo SolidoroFulvio BraidoFabiano Di Marcosubject
Pulmonary and Respiratory MedicineChronic ObstructiveAntioxidantantioxidantNeutrophilsmedicine.medical_treatmentAntioxidant; Copd exacerbation; Lung function; Small airways; Acetylcysteine; Antioxidants; Bronchitis Chronic; Disease Progression; Expectorants; Forced Expiratory Volume; Hospitalization; Humans; Macrophages; Neutrophils; Pulmonary Disease Chronic Obstructive; Reactive Oxygen Species; Respiratory Physiological Phenomena; Oxidative Stress; Pulmonary and Respiratory MedicineAntioxidant; Copd exacerbation; Lung function; Small airways; Acetylcysteine; Antioxidants; Bronchitis Chronic; Disease Progression; Expectorants; Forced Expiratory Volume; Hospitalization; Humans; Macrophages; Neutrophils; Pulmonary Disease Chronic Obstructive; Reactive Oxygen Species; Respiratory Physiological Phenomena; Oxidative StressOxidative phosphorylationReviewSettore MED/10 - Malattie Dell'Apparato Respiratoriomedicine.disease_causeAntioxidantsAcetylcysteinePulmonary Diseasechemistry.chemical_compoundPulmonary Disease Chronic ObstructiveCOPD exacerbationForced Expiratory VolumemedicineHumansRespiratory systemChronicBronchitisExpectorantschemistry.chemical_classificationCOPDReactive oxygen speciessmall airwaysbusiness.industryMacrophageslung functionGlutathionemedicine.diseaseAcetylcysteineBronchitis ChronicHospitalizationOxidative StresschemistryImmunologyDisease ProgressionRespiratory Physiological PhenomenabusinessReactive Oxygen SpeciesOxidative stressmedicine.drugdescription
Abstract The large surface area for gas exchange makes the respiratory system particularly susceptible to oxidative stress-mediated injury. Both endogenous and exogenous pro-oxidants (e.g. cigarette smoke) trigger activation of leukocytes and host defenses. These mechanisms interact in a ìmultilevel cycleî responsible for the control of the oxidant/antioxidant homeostasis. Several studies have demonstrated the presence of increased oxidative stress and decreased antioxidants (e.g. reduced glutathione [GSH]) in subjects with chronic obstructive pulmonary disease (COPD), but the contribution of oxidative stress to the pathophysiology of COPD is generally only minimally discussed. The aim of this review was to provide a comprehensive overview of the role of oxidative stress in the pathogenesis of respiratory diseases, particularly COPD, and to examine the available clinical and experimental evidence on the use of the antioxidant N-acetylcysteine (NAC), a precursor of GSH, as an adjunct to standard therapy for the treatment of COPD. The proposed concept of ìmultilevel cycleî helps understand the relationship between respiratory diseases and oxidative stress, thus clarifying the rationale for using NAC in COPD. Until recently, antioxidant drugs such as NAC have been regarded only as mucolytic agents. Nevertheless, several clinical trials indicate that NAC may reduce the rate of COPD exacerbations and improve small airways function. The most plausible explanation for the beneficial effects observed in patients with COPD treated with NAC lies in the mucolytic and antioxidant effects of this drug. Modulation of bronchial inflammation by NAC may further account for these favorable clinical results.
| year | journal | country | edition | language |
|---|---|---|---|---|
| 2014-01-01 |