COVID-19 News: Randomized Clinical Trial Shows That N-Acetylcysteine And Bromhexine Prevents COVID-19 Disease Severity

COVID-19 News: The global challenge posed by the coronavirus disease (COVID-19) since its emergence in December 2019 has prompted a relentless pursuit of effective treatments to alleviate its impact. With the virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), spreading rapidly across the globe, researchers at Hamedan University of Medical Science in Iran embarked on a groundbreaking double-blind randomized controlled trial. This study aimed to explore preventative measures that could impede the progression and deterioration of physical conditions in COVID-19 patients during the early stages of referral. The overarching goal was to curtail hospitalizations, reduce mortality rates, and enhance overall patient outcomes.


N-Acetycysteine Can Help In The Treatment Of COVID-19 In A Variety Of Ways
 
The Gravity of COVID-19
COVID-19, caused by SARS-CoV-2, presents a spectrum of symptoms ranging from mild, such as fever, cough, and loss of smell or taste, to severe cases marked by extensive lung involvement, acute respiratory distress syndrome, hospitalization, intubation, and, in some instances, death. The progression to severe cases often involves a decline in oxygen content in the blood, triggering a cascade of immune responses, including the production of cytokines and chemokines. In severe cases, the increase in neutrophils is associated with disease severity, leading to a phenomenon known as "cytokine storm." By the time patients are admitted to the hospital, the disease has likely advanced, with respiratory problems and multiple organ failure. Therefore, early intervention becomes crucial to address the cytokine and free radical storms as pathogenic agents.
 
N-Acetylcysteine (NAC) - A Multifaceted Compound
N-acetylcysteine, a familiar antidote for paracetamol poisoning, has found applications as a mucolytic in chronic lung diseases. Beyond its role in respiratory health, NAC boasts antioxidant properties that combat oxidative stress. As a prodrug, NAC transforms into L-cysteine, a precursor to glutathione - the body's biological antioxidant. By replenishing glutathione, NAC mitigates oxidative damage. Moreover, NAC exhibits anti-inflammatory effects by inhibiting nuclear factor-kappa B (NF-κB), a pivotal player in cytokine synthesis. Suppression of NF-κB has been associated with reduced replication rates in human coronaviruses, making NAC a potential candidate for inhibiting viral replication. In the context of COVID-19, NAC has shown promise in protecting against associated conditions, including cardiovascular diseases.
 
Previous COVID-19 News coverages by Thailand Medical News showed that NAC could treat SARS-CoV-2 infections in a variety of ways and even had antiviral properties.
 
https://www.thailandmedical.news/news/breaking-covid-19-drugs-study-shows-that-n-acetylcystein e-or-nac-is-an-effective-antiviral-and-immunomodulatory-drug-against-all-sars-cov-2-variants
 
https://www.thailandmedical.news/news/breaking-news-n-acetyl-cysteine-can-cause-conformational-perturbation-of-sars-cov-2-spike-protein,-indirectly-inhibiting-the-virus
 
https://www.thailandmedical.news/news/medical-news-polish-study-finds-n-acetylcysteine-and-sulodexide-exhibits-protective-properties-on-endothelial-cells-exposed-to-sars-cov-2
 
https://www.thailandmedical.news/news/covid-19-drugs-study-findsthat-n-acetylcysteine-reduces-post-covid-myocardial-injury-and-sulodexide-aids-in-endothelial-cells-recovery
 
https://www.thailandmedical.news/news/breaking-covid-19-research-russian-study-indicates-that-glutathione-deficiency-affects-covid-19-susceptibility,-nac-supplements-helps
 
https://www.thailandmedical.news/news/breaking-study-shows-that-sars-cov-2-infections-lead-to-increased-levels-of-oxidative-stress,-oxidant-damage-and-glutathione-deficiency
 
Cardiovascular Complications and NAC
COVID-19 often manifests with cardiovascular complications, both acutely and in post-acute sequelae. These complications encompass myocardial injury, acute coronary syndromes, myocarditis, cardiomyopathy, arrhythmias, heart failure, and deep venous thrombosis. NAC's vasodilator, anti-inflammatory, and antiaggregatory effects, akin to nitroglycerin, position it as a potential therapeutic agent. Intravenous NAC has shown benefits in improving outcomes such as acute myocardial infarction, unstable angina, and acute pulmonary edema. Additionally, NAC has been recommended as a protective agent for reperfusion, potentially preventing endothelial tissue damage. As cardiovascular complications pose significant threats in COVID-19, NAC's multifaceted properties make it a valuable contender for early intervention.
 
Bromhexine - Breaking Down Barriers
Bromhexine, a medication with a rich history in effectively breaking down and thinning mucous secretions in the respiratory tract, emerges as a valuable tool in managing COVID-19 symptoms. Its primary mechanism involves making respiratory mucous secretions more fluid, facilitating their expulsion from the body. This property helps relieve symptoms such as cough, congestion, and difficulty breathing. Beyond its expectorant and mucolytic effects, Bromhexine exhibits anti-inflammatory properties, contributing to the reduction of swelling and irritation in the respiratory tract. The drug's long history of use in respiratory tract disorders, coupled with its well-tolerated nature and few reported side effects, positions it as an important player in the management of respiratory symptoms associated with COVID-19.
 
Study Design and Setting
The double-blind randomized controlled trial conducted at Dibaj Therapeutic Center in Hamadan City, Iran, enrolled 225 COVID-19 outpatients between April and September 2022. Ethical approval was obtained from Hamadan University of Medical Sciences, with the study protocol registered in the Iranian Registry of Clinical Trials. Patients with a positive COVID-19 PCR test and symptomatic presentation were included, while pregnant individuals and those who had received a COVID-19 vaccine were excluded. Participants with oxygen saturation above 92% were allocated to three groups: Group A received N-acetylcysteine, Group B received Bromhexine, and Group C received standard care. Follow-ups on oxygen levels, symptoms, and hospitalization needs were conducted on days 7 and 14, with hospitalized patients monitored for one-month post-hospitalization.
 
Results and Discussion
The study, involving 225 patients randomly assigned to three groups, yielded significant insights into the efficacy of N-acetylcysteine and Bromhexine in treating COVID-19-positive patients. Both intervention groups demonstrated lower hospitalization rates compared to the control group, along with a reduced rate of admission to intensive care units. Although statistical significance was not reached, the trends observed suggest potential benefits of early intervention with these medications. The mortality rate in the control group was 9.33%, while both medication groups recorded zero mortality, emphasizing the potential life-saving impact of NAC and Bromhexine.
 
Conclusion
In conclusion, the results of this randomized clinical trial suggest that N-acetylcysteine and Bromhexine may play a crucial role in the early treatment of COVID-19-positive patients, offering a potential avenue for reducing hospitalizations, shortening hospital stays, and decreasing mortality rates. As the world continues to grapple with the ongoing COVID-19 pandemic, these findings present a ray of hope in the quest for effective treatments. Further research and exploration of NAC and Bromhexine as early interventions against COVID-19 are warranted, with the potential to reshape the landscape of managing this global health crisis. The multifaceted properties of N-acetylcysteine and Bromhexine make them promising candidates for further investigation and potential inclusion in the arsenal against COVID-19.
 
The study findings were published in the peer reviewed journal: Revista Clínica Española.
https://www.sciencedirect.com/science/article/abs/pii/S225488742400002X
 
For the latest COVID-19 News, keep on logging to Thailand Medical News.

Read Also:
https://www.thailandmedical.news/news/post-omicron-coughs-are-real-and-getting-to-be-common-with-the-throat-and-airways-being-in-a-state-of-low-but-persistent-inflammation-do-not-ignore