Welcome to the Twelve Trials of Christmas series on EMinFocus! This is the seventh of twelve posts in a series where I ramble on various topics for which I would love to see an EM study done. I’ve taken morsels of prior studies (case series, small trials, etc) and highlight reasons on why I believe this study would benefit EM. Some may pan out, some may not. All of them I would be highly interested in assisting with in any way possible to continue to advance our fine specialty.
The next ED study I would like to see is Nacetylcysteine (NAC) for COPD. Initially, the BRONCHUS trial in 2005 looked at 523 patients using once daily 600mg NAC for prevention of flares and mproving FEV1. They found no benefit. Two studies in the last two years have looked at twice daily dosing of NAC, finding decreased exacerbations, and a third showing NAC potentiated the bronchodilatory effect of ipratropium.
Given the above, a trial of NAC in the ED may provide some benefit in helping patients get over the initial hump, and perhaps, lead to an early discharge. (Perhaps akin to early systemic steroids in addition to the patients inhaled steroid regimen during exacerbations). At the least, it may cause pulmonology to reconsider giving NAC to their patients on the outside world and help it come standard of care.