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A Cochrane systematic review of NAC for COPD exacerbations (39 RCTs, n=7,436) found that NAC and other mucolytics significantly reduced the frequency of acute exacerbations (OR 0.75, 95% CI 0.62-0.92) (Poole et al., Cochrane Database Syst Rev, 2019) [43]
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It is naturally occurring and active at tiny concentrations
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