BACKGROUND

Tobacco smoking remains a primary health concern, more significantly in developing countries and continuously exerts a huge impact on global health. Available treatments for smoking cessation are often associated with adverse side effects, thus there is a great need for new therapies for smoking cessation. N-Acetylcysteine (NAC) is a widely available and well tolerated drug that would increase the intracellular levels of glutathione which modulates oxidative, immune-inflammatory, glutamatergic and neurotrophic pathways. There is suggestive evidence for the use of NAC in smoking cessation. Despite promising preclinical and preliminary clinical findings, randomised controlled trials which aim to evaluate NAC’s efficacy for smoking cessation and substance use disorders have shown mixed outcomes. With this gap in literature this study aims to determine the effect of NAC as an adjunctive treatment for smoking cessation.

OBJECTIVE

The main objective of this study was to investigate the effect of NAC as an adjunctive treatment for smoking cessation

METHOD

The study covered randomised clinical trials published in peer-reviewed journals registered in the Cochrane Central Register of Controlled Trials and PubMed. Study population in the selected studies had patients 18-65 of age years and with tobacco-use disorder or patients who smoke an average of 5 sticks per day. The primary outcome would be the effect of NAC on smoking cessation. The researcher utilised Review Manager 5.4.1 for the analysis of this study.

RESULTS

Initial Search in PubMed and Cochrane Library identified 23 clinical trials (6 PubMed, 17 Cochrane Library). 3 articles were included in the analysis. A total of 238 participants were enrolled in the studies, with 121 enrolled in the treatment group (NAC) and 106 were in the placebo group. The mean age of participants is 36.59 years and treatment duration vary up with the shortest duration of 1 month and longest duration of 3 months. Pooled odds ratio (2.41) shows that the true population odds of smoking cessation were between 1.32 and 4.41 in favor to the participants in the NAC group with 95% confidence interval. Measurement of secondary outcomes showed a significant reduction on carbon monoxide exhaled in the NAC group compared to the placebo group (P-0.0001, MD (95CI) -2.04 (3.09,-0.99). Pooled odds ratio (3.4) shows that there is a higher odds of adverse events between 1.72 and 6.90 higher in the NAC group with 95% confidence interval.

CONCLUSION

The results of this study showed a favourable effect of NAC as an adjunctive treatment for smoking cessation. NAC has shown a great potential to address the limited access to therapy due to its good safety profile and its wide availability.

Human ; N-acetylcysteine ; Acetylcysteine ; Smoking Cessation

Background: The circumstances surrounding the current COVID-19 pandemic has necessitated the employment of telemedicine for administering care to patients and families. There is difficulty of seeking medical help among those with chronic and recurrent illness like asthma. The authors conducted a metanalysis to determine whether telemedicine for asthma management is effective Objective: This study aimed to systematically review the effectiveness of telemedicine consultation among asthmatic adults and children in terms of: a) asthma control, b) quality of life, c) cost effectiveness, d) lung function and e) exacerbations. Methods: A comprehensive search of randomized controlled trials was performed using the MEDLINE (PubMed), EMBASE, The Cochrane Library, Google Scholar, clinical trial registries (e.g., clinicaltrials.gov, clinicaltrialregister.eu) and relevant websites. The authors were interested in studies that measured these outcomes: asthma control, quality of life, cost effectiveness, lung function and exacerbations. Three reviewers identified studies for inclusion in this meta-analysis. They extracted data then used fixed effect and random effect modelling. Results: The authors identified 15 RCTs with total of 3,015 enrolled patients. A variety of telemedicine interventions were incorporated: telephone and Internet-based models of care. Most control used was the conventional face-to-face. Meta-analysis did not show a clinically important improvement in patients’ asthma control and lung function, there was no significant reduction in the number of hospital admission and visits to the emergency department over 12 months and not significantly cost effective. However, there was a significant improvement in the quality of life (95% CI [0.05, 0.29], p = 0.006). Conclusion Although nothing beats the advantage of physically seeing patients face-to-face, this study just supports the knowledge that telemedicine offers promising alternative to promote good communication between patients and caregivers, resulting in adherence to asthma management, which leads to better asthma control, improvement of patients’ quality of life, lung function, better cost-effectiveness and decrease in ER visits and exacerbation.
Telemedicine ; Asthma