METHODS: The meta-analyses were conducted according to PRISMA guidelines. Exacerbations were assessed using total number of exacerbations. Improvement in patients\' respiratory symptoms and/or patients quality of life (QoL) were measured by validated tools or assessed at the end of the study.
RESULTS: Twenty studies were included, of which seven evaluated NAC in patients with symptoms of CB/pre-COPD as entry criterion. NAC treated patients showed a significant reduction of the incidence of exacerbations as compared to placebo both in COPD (IRR=0.76; 95% confidence interval (CI) 0.59-0.99) and CB/pre-COPD (IRR=0.81; 95% CI 0.69-0.95). Sensitivity analyses in studies with duration higher than 5 months, confirmed the overall results. CB/pre-COPD patients treated with NAC were significantly more likely to experience an improvement in symptoms and/or QoL compared to placebo (odds ratio (OR)=3.47; 95% CI 1.92-6.26). A similar trend was observed in the few COPD studies evaluable. Sensitivity analyses showed a significant association of NAC with improvement in symptoms and/or QoL both in CB/pre-COPD and COPD patients.
CONCLUSIONS: These findings provide novel data of NAC on the improvement in symptoms and QoL in addition to prevention of exacerbations in COPD and CB/pre-COPD. PROSPERO registry no. CRD42023468154.
方法:根据PRISMA指南进行meta分析。使用加重总数评估加重。患者呼吸道症状和/或患者生活质量(QoL)的改善通过验证工具进行测量或在研究结束时进行评估。
结果:纳入了20项研究,其中7人评估了以CB/COPD前症状为进入标准的患者的NAC。与安慰剂相比,NAC治疗的患者在COPD(IRR=0.76;95%置信区间(CI)0.59-0.99)和CB/COPD前(IRR=0.81;95%CI0.69-0.95)中的加重发生率均显着降低。持续时间超过5个月的研究的敏感性分析,确认了总体结果。与安慰剂相比,接受NAC治疗的CB/COPD前期患者的症状和/或QoL明显改善(比值比(OR)=3.47;95%CI1.92-6.26)。在少数可评估的COPD研究中观察到类似的趋势。敏感性分析显示,在CB/COPD前期和COPD患者中,NAC与症状和/或QoL的改善显著相关。
结论:这些研究结果为NAC提供了新的数据,可以改善COPD和CB/pre-COPD的症状和生活质量。PROSPERO注册表编号CRD42023468154。