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The landmark PANTHEON trial, a 1-year multicenter RCT in 1,006 Chinese COPD patients, found that high-dose NAC (600 mg twice daily) reduced the rate of acute exacerbations by 22% compared to placebo (1.16 vs 1.49 exacerbations per year, p=0.0011) (Zheng et al., Lancet Respir Med, 2014) [44]

Dysbiosis leads to a reduction in these primary bile acids and an increase in secondary bile acids, such as deoxycholic acid, produced by bacterial biotransformation of primary BAs