{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,4]],"date-time":"2026-05-04T14:29:36Z","timestamp":1777904976236,"version":"3.51.4"},"reference-count":53,"publisher":"PAGEPress Publications","issue":"1","license":[{"start":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T00:00:00Z","timestamp":1736812800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Monaldi Arch Chest Dis"],"abstract":"<jats:p>Mucus hypersecretion is a trait of chronic obstructive pulmonary disease (COPD) associated with poorer outcomes. As it may be present before airway obstruction, its early treatment may have a preventive role. This narrative review of the literature presents the role of mucus dysfunction in COPD, its pathophysiology, and the rationale for the use of N-acetylcysteine (NAC). NAC can modify mucus rheology, improving clearance and reducing damage-induced MUC5AC expression. It exerts a direct and indirect (glutathione replenishment) antioxidant mechanism; it interferes with inflammatory molecular pathways, including inhibition of nuclear factor-kB activation in epithelial airway cells and reduction in the expression of cytokine tumor necrosis factor \u03b1, interleukin (IL)-6, and IL-10. Some clinical experiences suggest that the adjunctive use of NAC may reduce symptoms and improve outcomes for patients with COPD. In conclusion, NAC may be a candidate drug for the early treatment of subjects at risk of COPD development.<\/jats:p>","DOI":"10.4081\/monaldi.2025.3159","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T03:36:16Z","timestamp":1736825776000},"source":"Crossref","is-referenced-by-count":1,"title":["Mucus production and chronic obstructive pulmonary disease, a possible treatment target: zooming in on N-acetylcysteine"],"prefix":"10.4081","volume":"96","author":[{"ORCID":"https:\/\/orcid.org\/0009-0007-5649-8409","authenticated-orcid":false,"given":"Federico","family":"Baraldi","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1970-9653","authenticated-orcid":false,"given":"Tommaso","family":"Bigoni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria Pia","family":"Foschino Barbaro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1138-3882","authenticated-orcid":false,"given":"Claudio","family":"Micheletto","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2667-077X","authenticated-orcid":false,"given":"Giulia","family":"Scioscia","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8265-3037","authenticated-orcid":false,"given":"Alessandro","family":"Vatrella","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6924-4500","authenticated-orcid":false,"given":"Alberto","family":"Papi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2549","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"49876","doi-asserted-by":"publisher","DOI":"10.1186\/s12875-021-01583-w"},{"key":"49877","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(23)00461-7"},{"key":"49878","doi-asserted-by":"publisher","DOI":"10.1080\/17476348.2020.1804364"},{"key":"49879","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2022.106921"},{"key":"49880","doi-asserted-by":"publisher","DOI":"10.1164\/ajrccm.163.5.2101039"},{"key":"49881","doi-asserted-by":"publisher","DOI":"10.3390\/ph14100979"},{"key":"49882","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. Global strategy for prevention, diagnosis and management of COPD: 2024 report. Available from: https:\/\/goldcopd.org\/2024-gold-report."},{"key":"49883","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2024.03.010"},{"key":"49884","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.90388.2008"},{"key":"49885","doi-asserted-by":"publisher","DOI":"10.1038\/ni.3045"},{"key":"49886","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2006-0035SF"},{"key":"49887","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2006-0291TR"},{"key":"49888","doi-asserted-by":"publisher","DOI":"10.1155\/2023\/8840594"},{"key":"49889","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(21)00079-5"},{"key":"49890","doi-asserted-by":"publisher","DOI":"10.1172\/JCI120901"},{"key":"49891","doi-asserted-by":"publisher","DOI":"10.1172\/JCI29176"},{"key":"49892","doi-asserted-by":"publisher","DOI":"10.1242\/dev.00966"},{"key":"49893","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2023.2065"},{"key":"49894","doi-asserted-by":"publisher","DOI":"10.1165\/rcmb.2009-0151TR"},{"key":"49895","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra1813799"},{"key":"49896","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra0910061"},{"key":"49897","doi-asserted-by":"publisher","DOI":"10.1126\/scitranslmed.3010525"},{"key":"49898","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202006-2248OC"},{"key":"49899","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2019.12.046"},{"key":"49900","doi-asserted-by":"publisher","DOI":"10.1186\/s12931-021-01712-0"},{"key":"49901","doi-asserted-by":"publisher","DOI":"10.1016\/j.chest.2023.11.033"},{"key":"49902","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200612-1772OC"},{"key":"49903","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.202401-0121LE"},{"key":"49904","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2016.05.011"},{"key":"49905","doi-asserted-by":"publisher","DOI":"10.1073\/pnas.94.3.967"},{"key":"49906","doi-asserted-by":"publisher","DOI":"10.1016\/j.intimp.2020.107149"},{"key":"49907","doi-asserted-by":"publisher","DOI":"10.1016\/j.etp.2015.04.004"},{"key":"49908","doi-asserted-by":"publisher","DOI":"10.1152\/ajplung.00163.2014"},{"key":"49909","doi-asserted-by":"publisher","DOI":"10.1155\/2018\/9391261"},{"key":"49910","doi-asserted-by":"publisher","DOI":"10.1016\/S0891-5849(00)00215-X"},{"key":"49911","doi-asserted-by":"publisher","DOI":"10.1016\/j.tips.2019.04.015"},{"key":"49912","doi-asserted-by":"publisher","DOI":"10.1136\/thx.2004.027946"},{"key":"49913","doi-asserted-by":"publisher","DOI":"10.3109\/15412555.2014.898040"},{"key":"49914","doi-asserted-by":"publisher","DOI":"10.1016\/j.arbres.2023.02.009"},{"key":"49915","doi-asserted-by":"publisher","DOI":"10.1080\/08958378.2024.2319315"},{"key":"49916","unstructured":"Di Marco F, Foti G, Corsico AG. Where are we with the use of N-acetylcysteine as a preventive and adjuvant treatment for COVID-19? Eur Rev Med Pharmacol Sci 2022;26:715-21."},{"key":"49917","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.03.00018003"},{"key":"49918","doi-asserted-by":"publisher","DOI":"10.1080\/17476348.2018.1495562"},{"key":"49919","doi-asserted-by":"publisher","DOI":"10.1186\/s10020-021-00342-y"},{"key":"49920","doi-asserted-by":"publisher","DOI":"10.1080\/10715760500250257"},{"key":"49921","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)66456-2"},{"key":"49922","doi-asserted-by":"publisher","DOI":"10.1378\/chest.12-2357"},{"key":"49923","doi-asserted-by":"publisher","DOI":"10.1378\/chest.13-2784"},{"key":"49924","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.00002215"},{"key":"49925","doi-asserted-by":"publisher","DOI":"10.1016\/S2213-2600(13)70286-8"},{"key":"49926","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2018.12.014"},{"key":"49927","unstructured":"Global Initiative for Chronic Obstructive Lung Disease. Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease (2017). Available from: https:\/\/goldcopd.org\/archived-reports\/."},{"key":"49928","unstructured":"Micheletto C, Izquierdo JL, Avdeev SN, et al. N-acetylcysteine as a therapeutic approach to post-COVID-19 pulmonary fibrosis adjunctive treatment. Eur Rev Med Pharmacol Sci 2022;26:4872-80."}],"container-title":["Monaldi Archives for Chest Disease"],"original-title":[],"link":[{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/3159\/1999","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/download\/3159\/1999","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T09:43:00Z","timestamp":1775036580000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.monaldi-archives.org\/macd\/article\/view\/3159"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,14]]},"references-count":53,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,3,2]]}},"URL":"https:\/\/doi.org\/10.4081\/monaldi.2025.3159","relation":{},"ISSN":["2532-5264","1122-0643"],"issn-type":[{"value":"2532-5264","type":"electronic"},{"value":"1122-0643","type":"print"}],"subject":[],"published":{"date-parts":[[2025,1,14]]}}}