medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-485medsovet-9661Research ArticleРАЦИОНАЛЬНАЯ ФАРМАКОТЕРАПИЯRATIONAL PHARMACOTHERAPYВозможности N-ацетилцистеина в комплексной терапии хронической обструктивной болезни легкихThe possibilities of N-acetylcysteine in the complex therapy of chronic obstructive pulmonary diseasehttps://orcid.org/0000-0001-6257-354XБолотоваЕ. В.BolotovaE. V.

Болотова Елена Валентиновна, д.м.н., профессор кафедры терапии №1

Author ID: 277732

350063, Краснодар, ул. Седина, д. 4

Elena V. Bolotova, Dr. Sci. (Med.), Professor of the Department of Therapy No. 1

4, Mitrofan Sedin St., Krasnodar, 350

bolotowa_e@mail.ruhttps://orcid.org/0009-0005-7711-3817ФроловаТ. Ю.FrolovaT. I.

Фролова Татьяна Ивановна, к.м.н., доцент кафедры факультетской терапии

Author ID: 1221261

350063, Краснодар, ул. Седина, д. 4

Tatyana I. Frolova, Cand. Sci. (Med.), Associate Professor of the Faculty Therapy Department

4, Mitrofan Sedin St., Krasnodar, 350

doktor2052@yandex.ruКубанский государственный медицинский университетРоссияKuban State Medical UniversityRussian Federation202512122025020174178Copyright © Болотова Е.В., Фролова Т.Ю., 20252025Болотова Е.В., Фролова Т.Ю.Bolotova E.V., Frolova T.I.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/9661

Хроническая гиперсекреция слизи играет важную роль в патогенезе и прогрессировании хронической обструктивной болезни легких (ХОБЛ). Основываясь на имеющихся в настоящее время данных, в современные клинические рекомендации включены муколитические препараты. N-ацетилцистеин (NAC) – эффективный муколитический препарат, снижающий вязкость и эластичность мокроты, улучшающий мукоцилиарный клиренс, обладающий антиоксидантной, противовоспалительной активностью, в т. ч. у пациентов с ХОБЛ. NAC улучшает симптомы и качество жизни пациентов с ХОБЛ, риск и длительность обострений, риск смертности в определенных группах пациентов с ХОБЛ. Прием NAC связан с благоприятным профилем безопасности как при высоких, так и при стандартных дозах. Целью данного клинического наблюдения является оценка эффективности NAC в комплексном лечении пациента с крайне тяжелой ХОБЛ. На основании динамики клинических, инструментальных и лабораторных показателей пациента обосновано назначение муколитика (NAC) в дозе 600 мг/сут. Представленный клинический случай продемонстрировал высокую эффективность N-ацетилцистеина в дозе 600 мг/сут, назначенного в дополнение к базисной терапии пациенту с крайне тяжелой ХОБЛ с наличием продуктивного кашля с трудно отделяемой мокротой. При добавлении NAC в дозе 600 мг/сут к фиксированной тройной комбинации ДДАБ/ДДАХ/ИГКС пациенту с крайне тяжелой ХОБЛ отмечено уменьшение кашля, улучшение отхождения мокроты, снижение баллов по тесту CAT; нежелательные реакции на фоне приема NAC в дозе 600 мг/сут не зарегистрированы.

Chronic mucus hypersecretion plays an important role in the pathogenesis and progression of chronic obstructive pulmonary disease (COPD). Based on the currently available data, mucolytic drugs are included in current clinical guidelines. N-acetylcysteine (NAC) is an effective mucolytic drug that reduces the viscosity and elasticity of sputum, improves mucociliary clearance, and has antioxidant and anti-inflammatory activity, including in patients with COPD. NAC improves the symptoms and quality of life of patients with COPD, the risk and duration of COPD exacerbations, and the risk of mortality in certain groups of patients with COPD. Taking NAC is associated with a favorable safety profile at both high and standard doses. The purpose of this clinical observation is to evaluate the effectiveness of NAC in the complex treatment of a patient with extremely severe COPD. Based on the dynamics of the patient’s clinical, instrumental and laboratory parameters, the appointment of mucolytic (NAC) at a dose of 600 mg/day is justified. The presented clinical case demonstrated the high efficacy of N-acetylcysteine at a dose of 600 mg/day, prescribed in addition to basic therapy to a patient with extremely severe COPD who has a productive cough with difficult-to-separate sputum. Conclusions: when adding a dose of NAC 600 mg/day to a fixed triple combination LABA/LAMA/ICS in a patient with extremely severe COPD showed a decrease in cough, an improvement in sputum discharge, and a decrease in CAT scores; no adverse reactions were reported while taking NAC at a dose of 600 mg/day.

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The authors declare that there are no conflicts of interest present.