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Effect of Nebulised Acetylcysteine on Sputum Quality and Diagnostic Yield
Author(s) -
Taylor David McD,
Taylor Simone,
Ho Jiong,
Cabalag Miguel,
Hijazi Ramzi,
Howden Benjamin P,
Charles Patrick GP
Publication year - 2009
Publication title -
journal of pharmacy practice and research
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.222
H-Index - 22
eISSN - 2055-2335
pISSN - 1445-937X
DOI - 10.1002/j.2055-2335.2009.tb00699.x
Subject(s) - sputum , medicine , acetylcysteine , placebo , gastroenterology , pathology , tuberculosis , chemistry , biochemistry , alternative medicine , antioxidant
Background Acetylcysteine acts as a mucolytic by cleaving disulfide bonds in mucoprotein and decreasing sputum viscosity. Mucolysis should lead to easier expectoration and improved sputum sample quality for microbiological analysis. Aim To compare an effect size for the efficacy of nebulised acetylcysteine and sodium chloride 0.9% in the procurement of good quality sputum samples. Method A double‐blind, randomised, placebo‐controlled pilot study in the emergency department. Adults with probable lower respiratory tract infection requiring sputum sampling were enrolled. Patients were randomised to receive acetylcysteine 1 g or sodium chloride 0.9% (placebo) via nebuliser. Patients, emergency department and microbiology staff were blinded to the treatment allocation. The study endpoints were good quality sputum samples (< 10 squamous cells per high‐powered field and < 10 squamous cells plus > 25 polymorphs per high‐powered field), sputum samples where a predominant pathogen was isolated and adverse effects of acetylcysteine and sodium chloride 0.9%. Results 28 patients were randomised to the acetylcysteine (n = 14) and sodium chloride 0.9% (n = 14) groups. Four (29%) patients in each group produced good quality sputum samples based on squamous cells alone. 2 (14%) and 3 (21%) patients in the acetylcysteine and sodium chloride 0.9% groups, respectively, produced good quality samples based on squamous cells and polymorph counts. Predominant pathogens were isolated in 2 (14%) patients in each group. 2 (14%) and 5 (36%) patients in the acetylcysteine and sodium chloride 0.9% groups, respectively, reported bronchospasm and/or coughing. Conclusion There was no detectable trend towards acetylcysteine improving sputum sample quality. A large scale trial is not warranted.