N-acetylcysteine as a therapeutic approach to post-COVID-19 pulmonary fibrosis adjunctive treatment

Eur Rev Med Pharmacol Sci. 2022 Jul;26(13):4872-4880. doi: 10.26355/eurrev_202207_29212.


Objective: Growing interest is directed to the outcomes of COVID-19 in survivors, both in the convalescent period and in the long-term, which are responsible for morbidity and quality of life deterioration. This article aims to describe the mechanisms supporting the possible use of NAC as an adjuvant treatment for post-COVID-19 pulmonary fibrosis.

Materials and methods: A search was performed in PubMed/MEDLINE.

Results: Interstitial changes have been observed in the CT scan of COVID-19 pneumonia. In patients with respiratory outcomes in the post-COVID-19 stage, glutathione (GSH) deficiency was found and interpreted as a reaction to the inflammatory cascade caused by the viral infection, while the pathophysiological process of pulmonary fibrosis involves numerous cytokines, such as TGF-β, TNF-α, IL-1, PDGF and VEGF. NAC has a good tolerability profile, is easily administered orally and inexpensively, and has antioxidant and anti-inflammatory effects that may target the pathophysiologic mechanisms involved in pulmonary fibrosis. It may revert GSH deficiency, exerts direct and indirect antioxidant activity, anti-inflammatory activity and improves immune T-cell response.

Conclusions: The mechanism of action of NAC suggests a role in the treatment of pulmonary fibrosis induced by COVID-19.

MeSH terms

  • Acetylcysteine / pharmacology
  • Acetylcysteine / therapeutic use
  • Anti-Inflammatory Agents
  • Antioxidants / pharmacology
  • COVID-19 Drug Treatment*
  • Glutathione
  • Humans
  • Pulmonary Fibrosis* / chemically induced
  • Pulmonary Fibrosis* / drug therapy
  • Quality of Life


  • Anti-Inflammatory Agents
  • Antioxidants
  • Glutathione
  • Acetylcysteine