F. Antioxidants to prevent pneumothorax (PSP)
According to the study by the Trakya University, patients with Pneumothorax are associated with oxidate stress as erythrocyte superoxide dismutase activity was found to be significantly lower and the plasma malondialdehyde levels were significantly high in patients with primary spontaneous pneumothorax (PSP)(47).
Other study indicated that the clinical manifestations in all forms of this pathology had poor symptoms. Complex therapy proved to be highly effective. It included use of corticosteroids, antioxidants and immunomodulators; massive exudative pleurisy was managed by pleural puncture and removal of exudate, .in the study of a total of 2775 respiratory sarcoidosis patients who were examined over the last ten years 278 (10%) had pleural affections: thickening of interlobular pleura and pleural deposits (98.2%), exudative pleurisy (1.1%) and spontaneous pneumothorax (0.7%)(48).
2. N-acetyl-L-cysteine (NAC)
Reactive free oxygen radicals are known to play an important role in the pathogenesis of various lung diseases. According to the study by the University Hospital Bergmannsheil, Ruhr-University, in the study to investigate of N-acetyl-L-cysteine (NAC) and ambroxol, its SH group, NAC scavenges H2O2 (hydrogen peroxide), .OH (hydroxol radical), and HOCl (hypochlorous acid). Furthermore, NAC can easily be deacetylated to cysteine, an important precursor of cellular glutathione synthesis, and thus stimulate the cellular glutathione system. This is most evident in pulmonary diseases characterized by low glutathione levels and high oxidant production by inflammatory cells (e.g. in IPF and ARDS). NAC is an effective drug in the treatment of paracetamol intoxication and may even be protective against side-effects of mutagenic agents. In addition NAC reduces cellular production of pro-inflammatory mediators (e.g. TNF-alpha, IL-1). Also, ambroxol [trans-4-(2-amino-3,5-dibromobenzylamino)-cyclohexane hydrochloride] scavenges oxidants (e.g. .OH, HOCl)(49)
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