Title : Clinical applications of N-acetylcysteine: Evidence based consensus statements from the Indian working group
Abstract:
Introduction: N-acetylcysteine (NAC) has mucolytic and antioxidant properties, resulting in wide clinical use. Thus, the working group reviewed the literature to reach a consensus regarding the use of NAC across the spectrum of indications.
Materials and Methods: The working group comprised of 42 physicians from all over India. We developed, debated, ranked, and noted the recommendations for ten statements based on the available literature. The group members were asked to score the statements on a 5-point Likert scale, where 1 represented "strongly disagree" and 5 represented "strongly agree." After calculating the percentage of members who scored a given statement, the consensus was categorized as strong, moderate, or weak depending on whether it was ≥80%, 50-79%, or ≤49%, respectively.
Results: Of 10 statements, strong consensus was reached for seven statements. NAC is unquestionably the antidote for paracetamol poisoning. As an adjunctive therapy, it is recommended for early-stage idiopathic pulmonary fibrosis, cystic fibrosis, and pneumonia management. For procedural and critical care, strong consensus recommended NAC for treating refractory mucus plugs causing atelectasis, facilitating tracheostomy care, and prophylaxis of contrast-induced nephropathy in high-risk, underhydrated patients. Indications with moderate consensus include regular use of NAC during diagnostic bronchoscopy and to decrease risk of exacerbation in COPD patients not on inhaled corticosteroids. A moderate consensus also recommended its potential role as an adjunct in cardiovascular disease, including heart failure and myocardial infarction.
Conclusion: These evidence-based consensus statements are a guide for rational and effective use of NAC across pulmonary, toxicological, and metabolic indications.
