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Women's Health Update.

Effect of N-Acetylcysteine on Bronchietasis

I recently diagnosed bronchiectasis in a patient, with the help of a pulmonologist, so I was especially interested in this condition and this study. Bronchiectasis is a chronic lung disease that is described as permanent dilation of the bronchi and bronchioles and enlargement of mucus-secreting glands. Patients experience chronic excessive mucus secretions into the airway that results in a chronic cough and constant desire to expel the mucus. Inflammation, injury and changes to the shape of the bronchi, mucus collection, and respiratory infections are the four major aspects that underlie bronchiectasis.

The treatment of bronchiectasis is focused on managing the symptoms and reducing the number of respiratory infections. Mucoactive agents such as hypertonic saline, mannitol, and erdosteine can bring about some improvements in some patients. Studies on inhaling dry powder of mannitol for 12 weeks reduced sputum in these patients, and short-term use of erdosteine plus chest physical therapy reduced mucus secretion; but sample size has been small, and duration is too short to conclude anything definitive. Long-term antibiotic regimens are also used to reduce the frequency of exacerbations, although this approach can increase the risk of bacterial resistance and adverse events.

N-Acetylcysteine (NAC) is a dietary supplement used to thin the mucus, amongst many other uses, and reduces the viscosity and elasticity of sputum as well as having anti-inflammatory and antioxidant activity. This action of thinning the mucus and reducing inflammation, plus a clinical trial using NAC 1200 mg/day that reduced the rate of exacerbations and improved quality of life in chronic obstructive pulmonary disease patients, suggests that it could be helpful for those with bronchiectasis as well.

The purpose of the current study was to assess whether NAC 600 mg twice daily might reduce the number of exacerbations and improve quality of life. An exacerbation is defined as the increase in three or more key symptoms: cough, sputum volume and/or consistency, sputum purulence, breathlessness and/or exercise intolerance, fatigue, and coughing up blood for at least 48 hours.

A total of 161 patients were randomized with 81 receiving oral NAC 600 mg twice daily and 80 in the control group. Due to dropouts and deaths in both the treatment and control groups, there were in the end, 69 patients taking NAC and 70 in the control group. To emphasize the potential seriousness of bronchiectasis, one patient died of an acute exacerbation of bronchiectasis in the NAC group, and two died of the same cause in the control group.

The incidence of exacerbations in the NAC group was significantly lower than in the control group (1.31 vs 1.98 exacerbations per patient-year). The average number of exacerbations in the NAC group was one, compared with two in the control group. A total of 24.7% in the NAC group and 11.3% in the control group remained free of any exacerbation during the 12-month period. In addition, while the time to the first exacerbation did not differ between the NAC group and the control group, the time to the second exacerbation was longer in the NAC group.

Commentary: This study is very encouraging in light of a disease with no known cure. Not only did it reduce the number of exacerbations, it also reduced the volume of sputum and improved quality of life. NAC was also very well tolerated with a low incidence of adverse reactions, and long-term use of a year was found to be safe. It should be noted that there are subtypes of bronchiectasis, one being a dry bronchiectasis, and it is not clear if these individuals would benefit from NAC. While this study used NAC in oral encapsulated delivery, nebulized NAC might be a more effective way to deliver the medicine. I will be curious to learn if anyone has experience with that.

Qi Q, et al. Effect of N-acetylcysteine on exacerbations of bronchiectasis: a randomized controlled trial. Respiratory Research. 2019:20:73

Greater Cardiovascular Fitness in Midlife Women Leads to Lower Dementia Risk Later

This study was done looking at 200 Swedish women aged 38-60 who underwent cycling testing that measured cardiovascular fitness. They were followed for an average of 29 years. Using objective assessments and repeat neuropsychiatric evaluations, 23% were diagnosed with dementia at a mean age of 80. Researchers compared women who had medium cardiovascular fitness at baseline to those who had high fitness levels and found that those with a higher fitness level had an 88% lower risk for dementia over the course of the follow-up years. Of those that were in the high fitness category who were diagnosed with dementia, it developed about 11 years later compared to those with medium fitness.

Commentary: While fitness level cannot be asserted to be a causal effect, it is worth emphasizing the possibility that improved cardiovascular fitness in midlife could modify a woman's risk and delay or prevent dementia. There are several herbs and nutrients that have shown some suggestive influence in providing neurocognitive protection, but all research should be multifactorial in this area, given the growing numbers of individuals affected. Causation, prevention, and treatments all deserve assertive research and across the spectrum of issues related to causation: environmental exposures, stressors, diet, brief and long-term medication exposures, and genetics. Prevention: stress, nutrition, optimal sleep habits, herbal/nutrient supplements, and medications. Treatments: natural and pharmaceutical interventions.

Horder H, et al. Midlife cardiovascular fitness and dementia: A 44 y.r. longitudinal population study in women. Neurology. 2018; March 14; e-pub

Fenugreek/Ginger/Turmeric Combination Increases Breast Milk Supply

Health care providers, governments, and private organizations are supportive of the benefits of exclusive breastfeeding to promote health and optimal development of newborns. The World Health Organization recommends that infants should be exclusively breastfed for the first six months of life. Not all women around the world are able to accomplish this due to education, confidence, nutrition, nipple problems, pain, milk storage issues, and adequate milk volume. Many breastfeeding mothers do try to increase their milk volume and use traditional foods and medicines and herbal preparations. In Thailand, where the current study was conducted, fenugreek, ginger, and turmeric are traditional galactagogues.

The study was a randomized double-blind placebo-controlled trial, conducted at the Mahidol University in Thailand. Fifty breastfeeding women, ages 20-40, who were one month postpartum and exclusively breastfeeding were enrolled in this study. Women were randomly assigned to the herbal supplement or placebo, with 25 in each group. The herbal formula contained 200 mg fenugreek seed, 120 mg ginger, and 100 mg turmeric per capsule. Three capsules three times per day of herbal combination or placebo were given for four weeks.

Breastfeeding mothers receiving the herbal supplement had a 49% increase in milk volume at week 2 and a 103% increase at week 4. The increases in the placebo group were 11% at week 2 and 24% at week 4. The energy and nutrient composition of the human milk before and after the intervention was similar between the treatment and placebo groups, although the percent change in vitamin A tended to increase in the herbal group.

Commentary: Fenugreek is used in many parts of the world, including the US as a galactagogue and has been proven to be safe and effective. The major compounds in fenugreek are flavonoids, terpenoids and saponin (diosgenin). These compounds stimulate the anterior pituitary gland to increase prolactin. The increase in milk production often seen with fenugreek occurs within 24-72 hours. Ginger also can increase milk flow, possibly by improving blood circulation. Turmeric is used as a galactagogue in India but may also be able to decrease pain, tension, and inflammation in the breast. Ginger and turmeric may also stimulate the anterior pituitary to produce more prolactin resulting in increased quantity of milk.

Bumrungpert A, et al. Effects of fenugreek, ginger and turmeric supplementation on human milk volume and nutrient content in breastfeeding mothers: A randomized double-blind controlled trial. Breastfeeding Medicine. 2018;13(10).

by Tori Hudson, ND
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Author:Hudson, Tori
Publication:Townsend Letter
Date:Jul 1, 2019
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