Nebulized N-Acetyl Cysteine for Bronchiolitis in Inpatient Hospital Use
Status:
Unknown status
Trial end date:
2020-05-31
Target enrollment:
Participant gender:
Summary
Bronchiolitis is the major cause of hospital admission in infants < 6 months of age and
usually viruses like Respiratory syncytial virus (RSV), human metapneumo virus, Adeno virus,
para-influenza virus, Rhino virus and influenza virus are the main culprit. In the US, acute
bronchiolitis in infancy is responsible for approximately 150,000 hospitalizations yearly at
an estimated cost of $500 million. Globally in 2005 it was estimated that at least 33.8
million were affected with RSV and in the same year, RSV associated severe acute lower
respiratory infection (ALRI) were responsible for ~3.4 million hospitalizations and
66,000-199,000 deaths worldwide, with 99% of these deaths in developing countries.
In acute bronchiolitis there is cellular swelling and excessive mucus production. There is
also proliferation of goblet cells, which leads to increased mucus production. The excess
mucus produced is poorly cleared by non-ciliated (regenerating) epithelial cells leading to
areas of narrowing and blocking of the bronchioles, causing the airway obstruction,
hyperinflation, increased airway resistance, atelectasis and increased ventilation-perfusion
mismatch that characterize acute bronchiolitis.
Currently there is no medicine that has proven effective in treating acute bronchiolitis and
per American Academy of Pediatrics guidelines the management of acute bronchiolitis remains
supportive care for the acute respiratory failure associated with acute bronchiolitis.
N-Acetyl Cysteine (NAC) is an antioxidant, anti-mucus compound that increases intracellular
glutathione at the cellular level. It cleaves disulfide bonds by converting them to two
sulfhydryl groups. This action results in the breakup of mucoproteins in lung mucus, reducing
their chain lengths and thinning the mucus. Nebulized NAC is not studied well in acute
bronchiolitis and is uncommonly used for the same. NAC has been studied in the treatment of
various disease states, including those pulmonary in nature such as cystic fibrosis, chronic
bronchitis, non-cystic fibrosis bronchiectasis and found to be beneficial.
With this background knowledge, the purpose of this study is to evaluate the effectiveness of
nebulized mucolytic therapy in treatment of children with viral bronchiolitis.