N-Acetylcysteine for Patients With COPD and Chronic Bronchitis

Inclusion Criteria: * Capability to provide written informed consent * Age ≥ 40 years and ≤ 85 years * FEV1/FVC ratio (post bronchodilator) \< 70% * FEV1 (post bronchodilator) \< 65% * Presence of chronic cough and sputum production defined as the following: * Presence of chronic cough and sputum will be defined by responses to the first two questions on the SGRQ. Subjects who respond positively to both question 1 (cough) and question 2 (sputum) on the SGRQ as either "several days per week" or "almost every day" will be eligible * Current or former smoker with lifetime cigarette consumption of at least 10 pack-years * Negative serum pregnancy test at the baseline visit if patient is a pre-menopausal female (menopause defined as absence of a menstrual cycle in the last 12 months) * Must be fluent in speaking the English language Exclusion Criteria: * Not fully recovered for at least 30 days from a COPD exacerbation characterized by typical symptoms and treated with antibiotics or prednisone * Known allergy or sensitivity to NAC or albuterol * Any patient with unstable cardiac disease * Any patient with a documented history of uncompensated congestive heart failure in the last 2 years * Clinical diagnosis of asthma, bronchiectasis, cystic fibrosis, or severe alpha-1 antitrypsin deficiency * Active lung cancer or history of lung cancer if it has been less than 2 years since lung resection or other treatment. If history of lung cancer, must have no evidence of recurrence in the 2 years preceding the baseline visit. * Undergoing active treatment for malignancy except for hormonal therapy (i.e. prostate cancer, breast cancer) or non-metastatic skin cancer and are not symptomatic * Chronic kidney disease with an estimated GFR of \< 30 ml/min. GFR will be estimated using the Modification of Diet in Renal Disease (MDRD) formula * History of cirrhosis with evidence of portal hypertension (ascites, chronic edema) * Participation in a pulmonary rehabilitation program or completion within past 6 weeks * Prisoners or institutionalized patients * Participation in another study involving an investigational product within 30 days of the baseline visit * Pregnant or breast-feeding patients. * Use of guaifenesin in the last 30 days * Currently on long acting nitrates for angina or heart failure * Abnormalities in screening blood work defined as: * WBC \< 3.0 or \> 15.0 K/cmm * Hemoglobin \< 9.0 or \> 17.0 gm/dl * Platelets \< 75 or \> 400 K/cmm * ALT \> 3 times the upper limit of normal * INR \> 1.5 unless on warfarin therapy * Any concomitant condition that might endanger the patient through participation in the study or interfere with study procedures, as assessed by the investigator