Tesis

Peran N-acetylcysteine dosis tinggi jangka pendek pada perubahan klinis dan kadar protein c-reaktif penderita penyakit paru obstruksi kronik eksaserbasi akut di RSUD dr moewardi surakarta

Chronic obstructive pulmonary disease (COPD) is an obstructive airway disorder characterised by slowly progressive and irreversible or only partially reversible. Oxidative stress is increased in patients with COPD, particulary during exacerbations and reactive oxygen species contribute to its pathophysiology. This suggest that antioxidants may be use in the treatment of COPD. Other studies have shown that nacetylcysteine (NAC) has antioxidant and antiinflamatory properties. In vitro, NAC inhibit neutrophil chemotaxis, interleukin (IL)-8 secretion and other pro-inflammmatory mediators such as the transcription nuclear factor (NF)-KB, which is directly correlated with the production of the systemic inflamatory marker C-reactive protein (CRP). The aim of this study was to evaluate the role of high dose-short course n-acetylcysteine in clinical improvement and c-reactive protein’s patients with exacerbations of chronic obstructive pulmonary disease. Forty two patients exacerbations of COPD participatied in this study. The subjects were randomly assigned, divided by three treatment groups: placebo (n = 14), NAC 600 mg/day (n = 14) and NAC 1200 mg/day (n = 14). Concomintant use of inhaled p2-agonist and anticholinergics, aminophylline drip, cefotaxim 1g/12h, methylprednisolon 62,5mg/8h were permitted during the study, while the use of antitussive and mucolitic were prohibited. Clinical symptoms were scored on 2-point scales, difficulty of expectoration and auscultation breath sound. CRP level are determined by high sensitivity C-reactive protein (HS-CRP). All measurements would be taken in baseline and were repeated after 5 days. The results of this study showed that clinical outcomes were improved significantly in patients treated with TJAC compared to placebo and clinical outcome of patients treated with NAC 1200 mg/day were more frequently significant than treated with NAC 600 mg/day. There was no significantly reduction in CRP level. The conclusion was treatment with high dose short course NAC improving clinical outcomes in patients exacerbations of COPD.
Key word: COPD, exacerbation, NAC, clinical improvement, CRP