Irwin Ziment

Acetylcysteine: A Drug with an Interesting Past and a Fascinating Future

N-acetylcysteine (NAC) possesses a free sulfhydryl group that can rupture disulfide bridges. Although it is considered to be a mucolytic, its mucokinetic actions include expectorant, bronchorrheic and mucoregulatory contributions. New uses include the management of acetaminophen poisoning and the scavenging of free radicals liberated by cancer chemotherapy drugs. The antioxidant effects may be of prophylactic value in lungs at risk from smoking, pollution and infection. Other uses proposed for NAC include the therapy of connective tissue diseases and its use as a component in life extension diets.

History of the Treatment of Chronic Bronchitis

Although chronic bronchitis was first named and described in 1808, the disease has been known since earliest time, and numerous drugs have been utilized in its therapy. The basic historic theories of human function have readily been applied to bronchitis; thus in Greek medicine, the disease was appreciated as one of excess phlegm. Early remedies included garlic, pepper, cinnamon, and turpentine, whereas later therapies of choice emphasized coffee, ipecac, and potassium nitrate. Most of the favored bronchodilator drugs of today are derived from the traditional folk remedies, ephedrine, atropine, and theophylline. The most interesting historical drugs, however, are those that have given rise to modern mucokinetic agents such as bromhexine and iodides.

Unconventional therapy in asthma

ConclusionEvery city must have a population of individuals who support or practice alternative medical care (1). The numerous techniques vary from crystal therapy to pyramid power at the one extreme to harmless dietary fads and physical maneuvers, such as enemas (perhaps supplemented with oxygen) at the other extreme. In between, even in sophisticated Western societies, fortune tellers, astronomers, tarot card readers, exercisers and exorcisers, nutritionists, and stress reducers all ply their trades. Many patients with mild asthma or imagined asthma undoubtedly find solace if not cure at the hands of these practitioners of alternative and complementary health care. It is perhaps not so relevant to ask if such techniques can help as it is to ask why patients seek out such care when orthodox therapy is so successful. We may share the same concern expressed in a recent article inThorax that examined these alternative practices, in which it was asked: “Should we as a profession protest about treatments that have not been tested in any scientific way being offered (at a cost) to patients?” (7). However, it is important to recollect that orthodox medicine has its own doubts about the safety of β-adrenergics, the value of theophylline, the effectiveness of cromolyn, the role of steroids and the acceptability of immunotherapy. Thus, scientific therapy alone will not satisfy all asthmatics, and it is inevitable that individual patients will make their choices regarding whether to accept the therapy of a pulmonologist, an allergist, or one of a host of other health purveyors who can claim that they help patients with asthma. Perhaps we need to give more attention to the passions that inflame the minds of asthmatics, rather than striving to correct the cytoneurochemical events that cause inflammation in the lungs. It is clear that asthma, as much as or more than most other chronic diseases, may respond to Osler’s prescription of “time, in divided doses”. (38). Thus, it is not surprising that unorthodox remedies have such a large following among patients with true asthma and pseudoasthma, and that prolonged courses of scientifically inappropriate therapies can lead to excellent outcomes.