Papi A, et al. - In chronic obstructive pulmonary disease (COPD), researchers investigated if smoking status or use of concomitant medications have an impact on the ability of N-acetylcysteine (NAC) to reduce exacerbations, defined according to healthcare resource utilization (HCU), via post-hoc analyses of the PANTHEON dataset (PANTHEON was one of the largest studies to evaluate NAC in COPD). Participants were current, ex- and never-smokers, concomitantly treated with other medications. By 20%, the rate of HCU events were seen to be reduced with NAC (N=482) vs placebo (N=482), with a greater effect in current/ex-smokers (23%). A 60% reduction in the rate of exacerbations was also seen in patients receiving NAC and long-acting inhaled bronchodilator(s) but no inhaled corticosteroid (ICS) vs those receiving placebo, long-acting bronchodilator(s) and ICS. Overall, a beneficial impact of NAC in terms of reducing exacerbations in COPD was confirmed in post-hoc hypothesis-generating analyses. This benefit was specifically observed in patients with COPD who had a significant smoking history, and in those not treated with ICS. In these patient subgroups, NAC may afford an alternative to ICS-containing combinations.