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The PANTHEON trial, a large double-blind RCT in GOLD defined COPD patients with severe airflow obstruction and a history of 2 COPD exacerbations in the previous year, found that NAC 600 mg BID reduced exacerbation rates in NAC group (497 acute exacerbations in 482 patients, 1.16 AcEx/pt/yr) versus placebo (641 acute exacerbations in 482 patients, 1.49 AcEx/Pt/yr), p 1 log 10 ) compared to untreated controls (67)

This article covers why 12 weeks is the minimum effective exposure, what happens during weeks 14 vs weeks 812, how to structure breaks between cycles, and what realistic outcomes look like at 90 days vs 180 days