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Oxidative stress and respiratory system: pharmacological and clinical reappraisal of N-acetylcysteine.

Content Provider	World Health Organization (WHO)-Global Index Medicus
Author	Santus, Pierachille Corsico, Angelo Solidoro, Paolo Braido, Fulvio Di Marco, Fabiano Scichilone, Nicola
Description	Country affiliation: Italy Author Affiliation: Santus P ( 1Università degli Studi di Milano, Dipartimento di Scienze della Salute . Pneumologia Riabilitativa Fondazione Salvatore Maugeri-Istituto Scientifico di Milano-IRCCS, Milano , Italy.)
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 'multilevel cycle' 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 'multilevel cycle' 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.
File Format	HTM / HTML
ISSN	15412555
e-ISSN	15412563
DOI	10.3109/15412555.2014.898040
Journal	COPD: Journal of Chronic Obstructive Pulmonary Disease
Issue Number	6
Volume Number	11
Language	English
Publisher	Taylor & Francis
Publisher Date	2014-12-01
Publisher Place	Great Britain (UK)
Access Restriction	Open
Subject Keyword	Discipline Pulmonary Medicine Acetylcysteine Therapeutic Use Antioxidants Expectorants Oxidative Stress Pulmonary Disease, Chronic Obstructive Drug Therapy Etiology Pharmacology Bronchitis, Chronic Disease Progression Forced Expiratory Volume Drug Effects Hospitalization Macrophages Neutrophils Physiopathology Reactive Oxygen Species Metabolism Respiratory Physiological Phenomena Research Support, Non-u.s. Gov't
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine

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