Expectorants for children. Which cough expectorants are better and more effective? Antitussive and expectorant action

18.1. EXPECTORANTS

The most effective antitussive drugs with efferent peripheral action are mucolytics. They dilute bronchial secretions well by changing the structure of mucus. These include proteolytic enzymes (deoxyribonuclease), acetylcysteine ​​(ACC, carbocysteine, N-acetylcysteine ​​(fluimucil), bromhexine (bisolvan), ambroxol (ambrohexal, lasolvan), dornase (pulmozyme), etc.

Classification:

Acetylcysteine

M-derivative of the natural amino acid cysteine. The effect of the drug is associated with the presence of a free sulfhydryl group in the structure of the molecule, which cleaves the disulfide bonds of macromolecules, mucus glycoprotein through a sulfhydryl-disulfide intersubstitution reaction; as a result, M-acetylcysteine ​​disulfides are formed, which have a significantly lower molecular weight, and the viscosity of sputum decreases.

Acetylcysteine:

It has a stimulating effect on mucosal cells, the secretion of which has the ability to lyse fibrin and blood clots,

Capable of increasing the synthesis of glutathione, which is important for detoxification, in particular, in case of poisoning with paracetamol and toadstool,

Protective properties were identified against factors such as free radicals and reactive oxygen metabolites responsible for the development of acute and chronic inflammation in lung tissue.

Long-term use of acetylcysteine ​​is not advisable, since it suppresses mucociliary transport and the production of secretory IgA. In some cases, the mucolytic effect of acetylcysteine ​​is undesirable, because the state of mucociliary transport is negatively affected by both an increase and an excessive decrease in secretion viscosity. Acetylcysteine ​​can sometimes have an excessive thinning effect, which can cause the so-called “flooding” syndrome of the lungs and require the use of suction to remove accumulated secretions, especially in young children. Therefore, conditions must be provided for adequate removal of sputum: postural drainage, vibration massage, bronchoscopy.

When taken orally, the drug is quickly and well absorbed and is metabolized (hydrolyzed) in the liver into the active metabolite - cysteine. Due to the “first pass” effect, the bioavailability of the drug is low (about 10%). The maximum concentration in the blood plasma is achieved after 1-3 hours. T 1/2 is 1 hour, the elimination route is predominantly hepatic.

Indications and contraindications

Acetylcysteine ​​is indicated as an adjuvant for various bronchopulmonary diseases with the presence of thick, viscous, difficult to separate sputum of a mucous or mucopurulent nature: chronic obstructive bronchitis, bronchiolitis, bronchopneumonia, bronchiectasis, bronchial asthma, cystic fibrosis. The drug should be prescribed with caution to patients with broncho-obstructive syndrome, since in 1/3 of cases an increase in bronchospasm is noted. The drug is not prescribed for an attack of bronchial asthma or for bronchial asthma with normal sputum discharge. In otolaryngology, the mucolytic effect of the drug is also widely used for purulent sinusitis and inflammation of the middle ear. Caution is required when using this mucolytic in acute bronchitis, since the drug can reduce the production of lysozyme and IgA and increase bronchial hyperreactivity. Acetylcysteine ​​is well tolerated, sometimes nausea, vomiting, and heartburn may occur when taking the drug; liquefaction of mucus eliminates its protective effect, which can lead, for example, to an exacerbation of peptic ulcer disease. In such cases, these drugs are recommended to be used in smaller doses and mainly in the form of inhalations.

Dosage regimens

Acetylcysteine ​​in adults is used 200 mg 3 times a day or 600 mg 1 time a day for acute conditions for 5-10 days or

2 times a day for up to 6 months - for chronic diseases. In newborns, acetylcysteine ​​is used only for health reasons at a dose of 10 mg/kg body weight, on average 50-100 mg 2 times a day. For cystic fibrosis, the drug is used in the same single doses 3 times a day. In surgical and endoscopic practice, acetylcysteine ​​is also used endotracheally, by slow instillations and, if necessary, parenterally - intramuscularly or intravenously. The effect of the drug begins after 30-60 minutes and lasts for 4 hours. The endobronchial route of administration makes it possible to avoid undesirable effects. Combined administration of drugs is also possible - inhalation + oral. Broncho-obstructive syndrome can be avoided by first using a bronchodilator.

Mesna

It has an effect similar to acetylcysteine, but is more effective. Mesna as a mucolytic is usually used inhalation and intratracheally. It is also used for the prevention of hemorrhagic cystitis during treatment with cyclophosphamide (iv and orally). Not used in children.

Pharmacokinetics and pharmacodynamics

The drug is easily absorbed and quickly eliminated from the body unchanged. Used for inhalation in conditions after neurosurgical and thoracic operations, after resuscitation and for chest injuries to improve sputum discharge; with cystic fibrosis, bronchial asthma with difficult sputum discharge, with chronic bronchitis, emphysema and bronchiectasis, atelectasis due to blockage of the bronchi with mucus. Drip infusions are indicated when it is necessary to prevent the formation of a mucus plug and facilitate the suction of secretions from the bronchi during anesthesia or in conditions of intensive treatment, as well as for drainage in case of sinusitis or otitis media.

Dosage regimens

Inhalation is carried out 2-4 times a day for 2-24 days. To do this, use the contents of 1-2 ampoules without dilution or in a 1:1 dilution with distilled water. Drip infusion is carried out through an intratracheal tube, 1-2 ml of the drug diluted with the same volume of water; instill every hour until the secretion is liquefied and removed. For asthmatic conditions, the drug is used only in a hospital. When using mesna inhaled, cough and bronchospasm are possible (especially in patients with bronchial asthma who do not tolerate aerosols well), with

When using a 20% solution, burning chest pain may occur (in these cases, the drug is diluted with distilled water in a ratio of 1:2). Mesna is combined with almost all antibiotics, except aminoglycosides.

Fluimucil

The mechanism of action is similar to acetylcysteine, but more active. It also has the least pronounced side effects: it practically does not irritate the gastrointestinal tract. The advantages of fluimucil are the ability to use its solution during nebulizer therapy in patients with COPD, as well as its antioxidant and anti-inflammatory activity.

Rinofluimucil

Used for acute and chronic rhinosinusitis, exudative and recurrent otitis. In otolaryngology, acetylcysteines, used in short courses, locally intranasally (rinofluimucil) in combination with the introduction of an antibiotic into the sinuses (in particular, chloramphenicol), gave preliminary good results in patients with exacerbations of chronic rhinosinusitis with increased secretion viscosity, with prolonged subacute rhinosinusitis. A rapid mucolytic effect was noted, but not only the liquefaction of the purulent exudate occurred, but also an increase in its volume. Therefore, the introduction of acetylcysteine ​​into the sinuses requires active drainage and aspiration of intrasinus secretion in the next 5-6 hours after administration of the drug; 2-3 appointments are enough for a course of treatment. However, with inadequate use of acetylcysteines and in the absence of proper active aspiration of secretions in conditions of impaired mucociliary activity observed in subacute and chronic rhinosinusitis, a worsening of the rhinoscopic picture may be observed.

Interactions

Antibacterial therapy significantly increases the viscosity of sputum due to the release of DNA during the lysis of microbial bodies and leukocytes. In this regard, it is necessary to take measures to improve the rheological properties of sputum and facilitate its discharge. This measure is the prescription of mucolytics in combination with antibiotics. When prescribing them simultaneously, their compatibility must be taken into account: acetylcysteine ​​reduces the absorption of penicillins, cephalosporins, tetracycline, erythromycin (the interval between doses is 2 hours). Mesna should not be used together with aminoglycoside ladies. Acetylcysteine ​​preparations for inhalation or installation should not be mixed with antibiotics, as this may cause

their mutual inactivation. The exception is fluimucil, for which a special form has even been created: fluimucil + antibiotic IT (thiamphenicol glycinate acetylcysteinate). It is available for inhalation, parenteral, endobronchial and topical use. Thiamphenicol has a wide spectrum of antibacterial action. Once in the respiratory tract, it is hydrolyzed into N-acetylcysteine ​​and thiamphenicol. It is effective against bacteria that most commonly cause respiratory tract infections. Fluimucil effectively thins sputum and facilitates the penetration of thiamphenicol into the area of ​​inflammation, inhibits the adhesion of bacteria to the epithelium of the respiratory tract.

Acetylcysteine ​​enhances the effect of nitroglycerin, and therefore an interval is required between doses of the drug. You cannot combine acetylcysteine ​​with antitussives (stagnation is possible due to suppression of the cough reflex). In patients with broncho-obstructive syndrome, acetylcysteines can be combined with bronchodilators β 2 -agonists, theophyllines), a combination with m-anticholinergic blockers is undesirable, since they thicken sputum.

Combined cough medications.

This group of medications, usually available over the counter or prescribed by doctors, contains two or more ingredients. A number of combination drugs include a centrally acting antitussive drug, an antihistamine, an expectorant and a decongestant (broncholitin, stoptussin, sinekod, hexapneumin, Lorraine). Often they also contain a bronchodilator (solutan, trisolvin) and/or an antipyretic component, antibacterial agents (hexapneumin, Lorraine). They relieve cough during bronchospasm, acute respiratory viral infection or bacterial infection, but they should be prescribed according to appropriate indications. Often such drugs are not indicated or even contraindicated for young children, especially the first months of life. In addition, combination drugs, in particular those prescribed by doctors, may combine medications that are opposite in their effects or contain suboptimal or low concentrations of drugs, which reduces their effectiveness.

II. Drugs of the carbocysteine ​​group

(fluditek, fluifort, broncatar, mucopront, mucodin)

The mechanism of action of carbocisteine ​​is associated with the activation of sialic transferase, an enzyme of goblet cells of the bronchial mucosa, under the influence of which the production of acidic mucins slows down. This normalizes the ratio of neutral or acidic

mucus mucins, as a result of which the elasticity and regeneration of the mucous membrane are normalized, its structure is restored, the number of goblet cells decreases (this effect is observed throughout all mucous membranes of the body) and, as a result, the amount of mucus produced decreases. In addition to the above, the secretion of immunologically active IgA (specific protection) and the number of sulfhydryl groups (nonspecific protection) are restored, mucociliary clearance is improved (the activity of ciliated cells is potentiated). Thus, carbocysteine, unlike acetylcysteine, bromhexine and ambroxol, also has a mucoregulatory effect. In this case, the effect of carbocisteine ​​extends to the upper and lower respiratory tract, as well as the paranasal sinuses, middle and inner ear. Carbocisteine ​​is active only when taken orally. Using Fluditec as an example, it was shown that as a result of optimizing the ratio of acidic and neutral sialomucins between the layer of pathological mucus and the mucous membrane of the respiratory tract, a new layer of mucus with normal rheological properties is formed. It is she who contacts the cilia of the ciliated epithelium, pushing the old mucus upward.

Indications and contraindications

The drug is indicated primarily in the initial stage of an acute inflammatory process in the respiratory system, when there is a significant increase in the secretion of liquid mucus and is characterized by increased formation of goblet cells, as well as chronic inflammation, accompanied by increased production of mucus with altered physicochemical characteristics, but not purulent . Since the effect of the drug is manifested at all levels of the respiratory tract: both at the level of the mucous membrane of the bronchial tree and at the level of the mucous membranes of the nasopharynx, paranasal sinuses and mucous membranes of the middle ear, carbocisteine ​​is widely used not only in pulmonology, but also in otorhinolaryngology. Positive results with the inclusion of mucolytics with a mucoregulatory effect (Fluiford, carbocysteine ​​lysine salt) were also obtained in the group of patients with acute and chronic exudative otitis media, as well as with recurrent otitis media. Special indications for the use of carbocysteine ​​in children of the first year of life may be the following: “wet” bronchitis, occurring with an abundance of liquid sputum of low viscosity and the danger of “swamping of the bronchi”; bronchopulmonary diseases with impaired cough reflex (against the background of organic and functional lesions)

tion of the central nervous system, traumatic brain injuries, after surgical interventions on the central nervous system, etc.); congestive bronchitis due to congenital heart defects; bronchitis due to the syndrome of “fixed cilia”, Sievert-Kartagener syndrome, after intubation, in the postoperative period; prevention of chronic bronchitis in bronchopulmonary dysplasia in order to prevent glandular degeneration of the mucous membrane. Side effects develop rarely, mainly in the form of dyspeptic symptoms and allergic reactions. The drug is not used for exacerbation of gastric and duodenal ulcers, as well as conditions in which pulmonary bleeding is noted. The simultaneous use of antitussive and mucolytic drugs is completely unacceptable. It is not recommended to use carbocisteine ​​for pregnant and nursing mothers.

Pharmacokinetics and pharmacodynamics

The maximum concentration in the blood serum and mucous membrane of the respiratory tract is achieved after 2-3 hours and remains in the mucous membrane for 8 hours. It is excreted mainly in the urine.

Dosage regimens

Carbocisteine ​​preparations are available only for oral administration (in the form of capsules, granules and syrups). Use the drug orally at a dose of 750 mg 3 times a day. Duration of treatment is 8-10 days. Long-term use is possible (up to 6 months, 2 times a day) in patients with COPD.

Interactions

Carbocysteine ​​is the drug of choice as a mucolytic for bronchial asthma, not only due to its mucoregulatory effect, but also due to its ability to potentiate the effects of β 2 -adrenergic agonists, antibacterial drugs, xanthines and glucorticoids. The combination of carbocisteine ​​with other drugs that suppress the secretory function of the bronchial glands (central-acting antitussives, macrolide antibiotics, first generation antihistamines, etc.) is undesirable; its use is not justified when secretion is poorly formed. When carbocisteine ​​is used simultaneously with atropine-like drugs, the therapeutic effect may be weakened.

III. Proteolytic enzymes

(trypsin, chymotrypsin, ribonuclease, deoxyribonuclease)

They reduce both the viscosity and elasticity of sputum, and have anti-edematous and anti-inflammatory effects. However, pre-

Parathas of this group are practically not used in pulmonology, as they can provoke damage to the pulmonary matrix, bronchospasm, hemoptysis, and allergic reactions. The exception is recombinant a-DNase (pulmozyme). The accumulation of viscous purulent secretion in the respiratory tract plays a role in reducing the functional capacity of the lungs and in exacerbations of the infectious process. Purulent secretions contain very high concentrations of extracellular DNA, a viscous polyanion released from collapsing white blood cells that accumulate as a result of infection. Alpha-DNase (pulmozyme) has the ability to specifically cleave high molecular weight nucleic acids and nucleoproteins into small and soluble molecules, which helps reduce the viscosity of sputum, and also has anti-inflammatory properties. The anti-inflammatory effect of Alpha-DNase (pulmozyme) and its ability to inhibit the reproduction of some RNA-containing viruses (herpes virus, adenoviruses) have been shown.

Pharmacokinetics and pharmacodynamics

Alpha DNase is a genetically engineered version of a natural human enzyme that cleaves extracellular DNA. DNase is normally present in human serum. Inhalation of DNase alpha in doses up to 40 mg for 6 days did not increase serum DNase concentrations above normal endogenous levels. The serum concentration of DNase did not exceed 10 ng/ml. After administration of alpha-DNase at 2500 units (2.5 mg) twice a day for 24 weeks, the average serum concentrations of DNase did not differ from the average values ​​before treatment, equal to 3.5 ± 0.1 ng/ml, which indicates a small systemic absorption or low accumulation.

The activity of the drug is determined biologically by the amount of acid-soluble substances as a result of DNA hydrolysis under certain conditions. One unit of activity (EA) corresponds to 1 mg of the drug.

Indications and contraindications

Recombinant human deoxyribonuclease (pulmozyme) is used in the treatment of cystic fibrosis, purulent pleurisy, resolution of recurrent atelectasis in patients with spinal cord injury, bronchiectasis, lung abscesses, pneumonia; in the preoperative and postoperative periods in patients with purulent lung diseases.

Dosage regimens

Used topically, in the form of aerosols for inhalation, intrapleurally, intramuscularly. For inhalation use a fine aerosol; dose - 0.025 mg per procedure; the drug is dissolved in 3-4 ml of isotonic sodium chloride solution or in 0.5% novocaine solution. A solution containing 0.025-0.05 g of the drug is administered endobronchially using a laryngeal syringe or catheter. The same dose is administered intrapleurally in 5-10 ml of isotonic sodium chloride solution or 0.25% novocaine solution. In case of cystic fibrosis, in addition to bronchodilators, glucocorticoids and recombinant DNase, antibiotics active against P. aeruginosa(colymycin, tobramycin, etc.). The maximum single dose for intramuscular injection is 0.01 g. Before starting treatment, sensitivity tests to the drug are carried out: 0.1 ml of solution is injected intradermally into the flexor surface of the forearm. In the absence of local and general reaction, treatment with the drug is carried out. As recently completed multicenter studies have shown, daily double inhalations of 2.5 mg of the drug reduce the number of exacerbations, improve the patient’s well-being, functional indicators and, ultimately, the patient’s quality of life. In the treatment of cystic fibrosis, the following recommendations have been developed: at the beginning of therapy (usually within 2 weeks), it is necessary to conduct a trial administration of pulmozyme, when it is possible that adverse events requiring discontinuation of the drug will be detected. In the next 3 months, it is necessary to monitor functional tests to determine the effectiveness of pulmozyme therapy. If there is no increase in respiratory function, but the patient feels a subjective improvement in his condition, easier breathing and coughing, therapy should be continued. If there is no response to the administration of pulmozyme, you can extend therapy for another 3 months and evaluate the effect of pulmozyme on the frequency of respiratory episodes. If this indicator has improved, it is recommended to continue pulmozyme therapy. Pulmozyme should be prescribed during a period of stable patient condition, when it is possible to more objectively assess the effect of therapy on the condition of the bronchopulmonary system and monitor possible adverse events. When prescribing pulmozyme, you should not immediately cancel the standard mucolytic therapy that the patient received before. Only when it is clear that the patient has responded well to pulmozyme therapy can we begin to gradually withdraw other mucolytic drugs. Children over 2 years of age can be prescribed Pulmozyme if they have good command of the inhalation technique through a mouthpiece or are comfortable with inhalation through a mask.

One should not strive to completely abolish other mucolytic therapy in seriously ill patients, since all known groups of mucolytics act on different parts of the pathogenesis of the formation of viscous sputum and its accumulation in the respiratory tract. It is more advisable to inhale pulmozyme after kinesitherapy, achieving maximum penetration into the lungs. Carrying out kinesitherapy after inhalation of pulmozyme should be dated to the time of the onset of the maximum mucolytic effect in each individual patient. If pharyngitis or laryngitis occurs in the first days of pulmozym administration, do not immediately discontinue the drug. Most likely, these phenomena will pass over time. If you experience hemoptysis, you should immediately consult a doctor, since perhaps this is not a reaction to pulmozyme, but the first signs of an exacerbation of the bronchopulmonary process. And only when pulmonary bleeding does not go away with the use of antibacterial and hemostatic therapy, Pulmozyme should be temporarily discontinued in order to conduct a new trial prescription of the drug some time after the condition has stabilized. In case of repeated episodes of hemoptysis coinciding with the start of the use of Pulmozyme, the drug should not be prescribed. If the condition worsens, shortness of breath increases, attacks of dry cough appear, or respiratory function decreases, the drug should be discontinued immediately. Early administration of pulmozyme helps improve lung function, prevent respiratory episodes, and reduce inflammatory activity in the lungs.

Drug interactions

There are no known drug interactions. In the nebulizer, Pulmozyme should not be mixed with other drugs or solutions. Pulmozyme can be used effectively and safely simultaneously with standard drugs for the treatment of cystic fibrosis, such as antibiotics, bronchodilators, digestive enzymes, vitamins, inhaled and systemic glucocorticoids and analgesics.

IV. Vasicinoids: bromhexine (bisolvan), ambroxol (ambrobene, lasolvan)

Bromhexine has a mucolytic (secretolytic) and expectorant effect, which is associated with depolymerization and destruction of mucoproteins and mucopolysaccharides that make up sputum, and has a slight antitussive effect. However, the availability of bromhexine, its relatively low cost, and the absence of side effects explain its fairly widespread use.

tion of the drug. Almost all researchers note a lower pharmacological effect of bromhexine compared to the new generation drug, which is an active metabolite of bromhexine - ambroxol hydrochloride.

Pharmacokinetics and pharmacodynamics

The bioavailability of bromhexine when taken orally is low - 80% due to the “first pass through the liver” effect; the drug is quickly metabolized to form active compounds. When taken orally in tablets or in the form of a solution, bromhexine is completely absorbed within 30 minutes, in the blood plasma it is 99% bound to proteins, the volume of distribution at steady-state concentration is 400 liters. In addition, bromhexine binds to the red blood cell membrane. The drug penetrates the blood-brain and placental barrier. Eliminated mainly in the form of metabolites, the unchanged drug is eliminated by the kidneys in a volume of only 1%, metabolites are also excreted by the kidneys. In severe liver failure, the clearance of bromhexine decreases, and in chronic renal failure, the clearance of its metabolites decreases. The pharmacokinetics of bromhexine is dose-dependent; the drug may accumulate with repeated use.

Indications and contraindications

For cystic fibrosis and bronchial asthma, the drug is used with caution, preferably against the background of bronchodilators, since it is capable of provoking a cough reflex; it is also used for acute and chronic bronchopulmonary diseases, but is not recommended during pregnancy and nursing mothers. Side effects: gastrointestinal disorders, skin reactions are rare. In case of severe chronic renal failure, dose adjustment and dosage regimen are necessary.

Dosage regimens

Bromhexine is used mainly orally, but inhalation administration of its solution through a nebulizer is also possible, and in surgery - parenteral administration intramuscularly or intravenously. After inhalation

2 ml of bromhexine solution, the effect occurs after 20 minutes and lasts for 4-8 hours. In tablets, adults are prescribed 8-16 mg 2-

3 times a day, and for children from 6 to 14 years old, 8 mg three times a day, under 6 years old -

4 mg 3 times a day. A solution for intravenous administration of 16 mg (2 ampoules) 2-3 times a day is also used, and for children under 6 years old - 4-8 mg once. There is a combined form - ascoril, which contains salbutamol sulfate, bromhexine hydrochloride, guaifenesin and menthol as components.

In terms of clinical effect, ambroxol hydrochloride is significantly superior to bromhexine, especially in terms of the ability to increase the level of surfactant, since, in addition to stimulating the synthesis of surfactant, it blocks its breakdown. This is the basis for its more pronounced ability to increase mucociliary clearance compared to bromhexine. Being a hydrophobic boundary layer, surfactant facilitates the exchange of non-polar gases and has an anti-edematous effect on the alveolar membranes. It is involved in ensuring the transport of foreign particles from the alveoli to the bronchial region, where mucociliary transport begins. Having a positive effect on surfactant, ambroxol hydrochloride indirectly increases mucociliary transport and, in combination with increased secretion of glycoproteins (mucokinetic effect), gives a pronounced expectorant effect. The mechanism of action of ambroxol is not completely clear. It is known that it stimulates the formation of low-viscosity tracheobronchial secretions due to changes in mucopolysaccharides in sputum. The drug improves mucociliary transport, stimulating the activity of the ciliary system. It is very important that ambroxol does not provoke bronchial obstruction. Literature data indicate the anti-inflammatory and immunomodulatory effect of ambroxol: it enhances local immunity, activating tissue macrophages and increasing the production of secretory IgA, and also has a suppressive effect on the production of interleukin-1 and tumor necrosis factor by mononuclear cells, which are one of the mediators of inflammation. It is suggested that inhibition of the synthesis of proinflammatory cytokinesis may improve the course of leukocyte-mediated pulmonary injury. The antioxidant properties of ambroxol have also been proven, which can be explained by its effect on the release of oxygen radicals and interference with the metabolism of arachidonic acid at the site of inflammation; the drug protects it from bleomycin-induced pulmonary toxin and fibrosis, inhibits neutrophil chemotaxis in vitro.

Pharmacokinetics and pharmacodynamics

After oral administration, the drug is quickly and completely absorbed, but 20-30% of it undergoes rapid hepatic metabolism due to the “first pass” phenomenon. The duration of action after taking one dose is 6-12 hours. Ambroxol passes through the placental and blood-brain barrier, as well as into breast milk, and is metabolized in the liver: dibromoantranilic acid and glucuronic conjugates are formed.

Dosage regimens and methods

Ambroxol hydrochloride has a wide selection of dosage forms: tablets, oral solution, syrup, retard capsules, solution for inhalation and endobronchial administration, solution for injection. The dose of the drug for children under 5 years of age is 7.5 mg 2-3 times a day, for children over 5 years of age - 15 mg 3 times a day. For patients over 12 years of age, ambroxol is prescribed 30 mg 3 times a day or 1 retard capsule per day. The duration of the course of treatment ranges from 1 to 3-4 weeks, depending on the effect and nature of the process. Adults and children over 12 years of age are prescribed 30 mg tablets 3 times a day for the first 3 days, and then twice a day; children aged 6-12 years - 15 mg 2-3 times, under 6 years - 15 mg once, from 2 to 5 years - 7.5 mg 2-3 times a day. The total volume of the inhaled substance should be 3-4 ml (if necessary, the drug is diluted with saline), the inhalation time is 5-7 minutes. It should be remembered that medicinal particles are almost not deposited in areas of atelectasis and emphysema. Obstructive syndrome also significantly reduces the penetration of aerosol into the airways, so inhalation of mucolytic drugs in patients with bronchial obstruction is best done 15-20 minutes after inhalation of bronchodilators. It must be borne in mind that when using a mask, the mucolytic helps to improve the rheological properties of sputum, but at the same time, using the mask reduces the dose of the substance inhaled into the bronchi. Therefore, young children need to use a mask of the appropriate size, and after 3 years it is better to use a mouthpiece rather than a mask. The combined use of an inhaled form of a mucolytic drug with its parenteral administration (intramuscular or intravenous) significantly improves the effectiveness of therapy, especially in patients with complicated and chronic bronchopulmonary diseases. The parenteral method of administering the mucolytic ensures rapid penetration of the drug, including in the presence of severe inflammatory edema, bronchial obstruction and atelectasis. However, if there is a lot of mucus in the lungs, the drug does not affect the parietal layer of the secretion, which does not allow achieving the most effective expectorant effect. In such cases, it is better to combine the endobronchial and inhalation methods of delivery with the use of retard capsules, the administration of which once a day is quite effective.

Indications and contraindications

Ambroxol hydrochloride is used for acute and chronic respiratory diseases, including bronchial asthma, broncho-

ectatic disease, respiratory distress syndrome in newborns. The drug can be used in children of any age, even premature infants. Possible use in women in the second and third trimester of pregnancy. Side effects are rare; These are nausea, abdominal pain and allergic reactions, sometimes dry mouth and nasopharynx.

Interactions

The combination of ambroxol with antibiotics certainly has advantages over the use of a single antibiotic, even if the effectiveness of the antibacterial drug has been proven. Ambroxol helps to increase the concentration of the antibiotic in the alveoli and bronchial mucosa, which improves the course of the disease in bacterial infections of the lungs. When used together with antibiotics, the drug increases the penetration into the bronchial secretions of amoxicillin, cefuroxime, erythromycin and doxycycline, which can be a significant factor affecting the effectiveness of antibacterial therapy. A statistically significant improvement in indicators of external respiratory function in patients with broncho-obstruction and a decrease in hypoxemia while taking ambroxol were shown.

Lazolvan can be used together with β 2 -adrenergic agonists in the same nebulizer chamber. Side effects when using it are rare and manifest themselves in the form of nausea, abdominal pain, allergic reactions, dry mouth and nasopharynx.

Evidence base for the use of expectorants

Opinions on the use of mucolytics (mucoregulators) in the treatment of patients with COPD are controversial. The mucolytic properties of these drugs, their ability to reduce adhesion and activate mucociliary clearance are successfully implemented in patients with COPD with discrimination and hypersecretion. Where bronchial obstruction is associated with bronchospasm or irreversible phenomena, mucolytics do not find a point of application. An analysis of 15 randomized, double-blind, placebo-controlled studies of the use of oral mucolytic drugs for 2 months revealed a slight reduction in the average number of days of disability and the number of exacerbations after treatment, indicating a minor role of mucolytics in the treatment of exacerbations of COPD. This did not allow these drugs to be included in the basic treatment of patients with COPD (level of evidence D). The GOLD program discussed the antioxidant effect of N-acetyl derivatives.

cysteine ​​and, like N-acetylcysteine, they have been shown to reduce the incidence of exacerbations of COPD. This is important for patients with frequent exacerbations (level of evidence B). The well-known National Mucolytic Study, conducted in the USA in stable patients with COPD, showed that mucoregulators (iodinated glycerol - organidine were studied) are capable of bringing subjective relief to patients, but no objective evidence was obtained of the effectiveness of the drugs. A study of oral N-acetylcysteine ​​by the Swedish Lung Society showed that mucolytic drugs can reduce the number of exacerbations in patients with chronic bronchitis. It has been shown that, despite the weak connection between the amount of tracheobronchial secretion and the severity of bronchial obstruction, there is a significant correlation between hyperproduction of secretions, the number of hospitalizations and even the risk of death in patients with severe impairment of ventilation functions. The results obtained in the study did not reveal a significant increase in FEV 1 in the general COPD group, but patients’ assessment of their well-being and discrimination shows significant positive dynamics, however, in the presence of discrimination syndrome, the most objective criterion for the effectiveness of a mucolytic in the treatment of COPD is FEV 1. Thus, when choosing therapy in patients with COPD, one should focus on a specific nosological form, taking into account the degree of severity of a particular pathogenetic mechanism: discrimination, bronchospasm, obstruction.

It is not recommended to prescribe cough suppressants to patients with bronchial asthma: this disrupts bronchial drainage, aggravates bronchial obstruction and ultimately worsens the patient’s condition. This applies to codeine and non-codeine drugs, for example libexin, sinekod, etc.

Most severe cases of asthma that do not respond to bronchodilators are associated with widespread obstruction of the airways by mucus plugs, which leads to the progression of the obstruction process, and, as a result, status asthmaticus may develop. This is confirmed by the fact that in the majority of those who die from asthma, the lumen of the bronchi is clogged with thick and viscous sputum. This happens in cases where the rate of accumulation of mucus exceeds the rate of its evacuation from the respiratory tract and the stagnation of mucus in the lungs can only be eliminated with the help of various expectorants. In Russia, mucolytics are widely used in patients with COPD, but in European and American guidelines they are given a modest role due to their unproven effectiveness.

Selection of drugs, monitoring their effectiveness and safety

Along with expectorant drugs, β 2 -adrenomimetics and theophylline enhance mucociliary transport, which, by dilating the bronchi, reducing spasm of the bronchial muscles, reducing swelling of the mucous membrane, accelerate the movement of the ciliated epithelium and increase mucus secretion.

When conducting pharmacotherapy with expectorants, a stable clinical effect is observed on the 2-4th day, depending on the nature and severity of the disease. In patients with acute bronchospastic syndrome, the effect is observed when prescribing beta 2-adrenergic agonists, theophylline in combination with acetylcysteine ​​or drugs that stimulate expectoration. It should be taken into account that in a number of patients with COPD, after the first day of expectorant therapy, an increase in sputum adhesion and viscosity was noted; this was apparently due to the separation of sputum that had accumulated in the bronchi and contained a large amount of detritus, inflammatory elements, proteins, etc. In the following days, the rheological properties of sputum improve, its quantity significantly increases, viscosity and adhesion decrease (usually by the 4th day of use of expectorant drugs), which indicates the correctness of their choice. Stabilization of the clinical effect was observed on days 6-8 and was characterized by a decrease in the level of adhesion when using lasolvan in patients with COPD by 49.8%, bromhexine - by 46.5%, potassium iodide - by 38.7%, bromhexine in combination with chymotrypsin - by 48.4%. Less significant changes were noted in patients taking chymotrypsin (30.0%) and mucaltin (21.3%).

In cases where there is diffuse damage to the bronchial tree, significant changes in the rheological properties of sputum and a decrease in mucociliary transport, complex use is necessary drugs that stimulate expectoration and bromhexine; It is also logical to combine proteolytic enzymes or acetylcysteine ​​with bromhexine.

In patients with chronic bronchospastic and inflammatory syndrome, β 2 -adrenomimetics, theophylline is best combined with ambroxol hydrochloride or acetylcysteine. In patients with chronic obstructive pulmonary disease (COPD), the effect of mucolytics on reducing the average number of days of disability and the number of exacerbations after treatment has not been proven, which indicates the insignificant role of mucolytics in the treatment of exacerbations of COPD. This did not allow these drugs to be included in the basic treatment of patients with COPD (level of evidence D). N-acetylcysteine ​​has been proven to reduce the frequency of exacerbations of COPD. This is important for patients

ents with frequent exacerbations. Despite the lack of connection between the amount of tracheobronchial secretion and the severity of bronchial obstruction, a significant correlation was found between hyperproduction of secretion, the number of hospitalizations and even the risk of death in patients with severe impairment of ventilation functions. In the presence of discrinia syndrome, the most objective criterion for the effectiveness of a mucolytic in the treatment of COPD is FEV 1. When choosing therapy for patients with COPD, one should focus on a specific nosological form, taking into account the degree of severity of a particular pathogenetic mechanism: discrimination, bronchospasm, obstruction.

A sharp decrease in viscosity and adhesion and a significant increase in the amount of sputum produced cause a deterioration in the general condition, increased cough and the appearance of shortness of breath in some patients, which is caused by bronchorrhea. With the development of these symptoms, it is necessary to discontinue expectorant drugs; it is possible to add M-anticholinergics such as ipratropium bromide (Atrovent) or tiotropium bromide (Spiriva).

It is not recommended to prescribe cough suppressants to patients with bronchial asthma: this disrupts bronchial drainage, aggravates bronchial obstruction and ultimately worsens the patient’s condition. Most severe cases of asthma that do not respond to bronchodilators are associated with widespread airway obstruction by mucus plugs, which requires the use of mucolytics. In Russia, mucolytics are widely used in patients with COPD, but in European and American guidelines they are given a modest role due to the lack of evidence of their effectiveness.

18.2. ANTI-COUGH MEDICINES

Drugs that have an antitussive effect include the following.

1. Medicines, central action

Narcotic antitussive drugs (codeine, dextramethorphan, dionine, morphine) suppress the cough reflex, inhibiting the cough center in the medulla oblongata. With prolonged use, physical dependence develops. These drugs depress the respiratory center.

Non-narcotic antitussive drugs (glaucine, oxeladin, petoxyverine, sinecode, tussuprex, broncholitin) have

They have antitussive, hypotensive and antispasmodic effects, do not depress respiration, do not inhibit intestinal motility, and do not cause addiction or drug dependence.

2. Peripheral drugs

Libexin. A drug with an afferent effect acts as a mild analgesic or anesthetic on the mucous membrane of the respiratory tract, reduces reflex stimulation of the cough reflex, it also changes the formation and viscosity of secretions, increases its mobility, and relaxes the smooth muscles of the bronchi.

Enveloping and local anesthetic agents. Enveloping agents are used for coughs that occur when the mucous membrane of the upper supraglottic sections of the respiratory tract is irritated. Their action is based on creating a protective layer for the mucous membrane of the nose and oropharynx. Usually these are lozenges or syrups of plant origin (eucalyptus, acacia, licorice, etc.), glycerin, honey, etc. Local anesthetics (benzocaine, cycline, tetracaine) are used only in a hospital setting according to indications, in particular for afferent inhibition of the cough reflex when performing bronchoscopy or bronchography.

A group of antitussive non-narcotic drugs of central action is indicated for cough associated with irritation of the mucous membranes of the upper (supraglottic) respiratory tract due to infectious or irritative inflammation (ARVI, tonsillitis, laryngitis, pharyngitis, etc.), as well as for dry, obsessive cough accompanied by pain. and/or disrupting the patient’s quality of life (aspiration, foreign body, oncological process), children with whooping cough. Use before meals 1-3 times a day (according to indications). In patients with dry cough in acute bronchitis, ingestion of foreign particles, the use of libexin and glaucine is not effective enough. In these cases, the administration of codeine or dionine at night (for 2-3 days) is justified. With pleurisy, stagnation in the pulmonary circulation, the development of cough aggravates the course of the underlying disease and requires the use of codeine.

With the development of a cough reflex caused by factors that are not associated with bronchopulmonary diseases, the use of both non-narcotic and narcotic antitussive drugs is indicated, depending on the severity of the syndrome.

There are a large number of cough medications on the drug market. Each group is designed to combat a specific type of it (wet or dry).

For pregnant women and children, the choice of drug should be made by a doctor. Many of them have contraindications.

Classification

According to the mechanism of action, cough medications are divided into three large groups:

1. Antitussives.
2. Expectorants.
3. Mucolytic.

These medicines have different release forms:

• Pills.
• Syrups.
• Drops.
• Pastilles.
• Solutions.
• Powders.
• Granules.

The choice of cough medicine depends on the type of cough. Cough is classified:

1. The nature:
   • Wet or productive - with sputum production.
   • Dry or unproductive - no phlegm.
2. By duration:
   • Acute – up to three weeks.
   • Subacute – from three weeks to three months.
   • Chronic – more than three months.

Table. Medicines used for cough.

The use of expectorants simultaneously with antitussive drugs is contraindicated. This provokes the accumulation of a large amount of sputum in the respiratory tract, which is dangerous due to the occurrence of severe pathologies of the lower respiratory system (pneumonia).

In addition to the three main groups of cough suppressants, there are combination drugs.

Herbal medicines

The popularity of using herbal medicines in the world is growing every day. Decoctions, extracts and extracts from medicinal plants are included in many modern cough medicines. Some of them:

• Gedelix - ivy.
• Bronkhin, Eucabalus - plantain.
• Altemix, Mukaltin - marshmallow.
• Eucabalus, Pertussin - thyme.
• Breast collection No. 1 - oregano, coltsfoot, marshmallow.
• Kofol, Cofrem, Doctor Mom, Suprima-Broncho are combination drugs.

The advantage of drugs based on medicinal herbs is their good tolerability, rare occurrence of complications and side effects. Herbal medicines also have a softening, anti-inflammatory and enveloping effect.

The bulk of drugs containing herbal components are expectorants of reflex action. These include:

• licorice;
• elecampane;
• marshmallow;
• anise;
• plantain;
• wild rosemary;
• oregano;
• thyme;
• coltsfoot;
• violet;
• thermopsis and others.

Synthetic medicines

Synthetic drugs contain chemical compounds such as:

• potassium iodide;
• potassium bromide;
• sodium iodide;
• ammonium iodide;
• sodium benzoate;
• sodium bicarbonate and others.

These substances are also used for inhalation. They have a thinning effect on sputum and increase its volume. But the effectiveness of such drugs is overshadowed by their short duration of action, unpleasant taste, frequent allergic reactions, and side effects such as vomiting, diarrhea, and constipation.

Often, to obtain inexpensive and effective drugs, they resort to combining these substances with herbal remedies. The result is combination drugs such as:

• anise and ammonium chloride (Ammonia-anise drops);
• thermopsis and sodium bicarbonate (cough tablets);
• thyme and potassium bromide (Pertussin) and others.

Rules for treating cough

Cough is a symptom of various diseases. To achieve a positive treatment result, you need to know which drugs should be taken for a particular pathology.

The best medicines for children

Treatment of children must be treated with special caution. Therefore, for the treatment of cough in children, there are drugs with a specific dosage approved for them.

The principle of treating cough in children is to transfer it from dry to wet for better discharge of bronchial secretions. This is due to the peculiarity of the formation of thick, viscous, difficult to separate sputum.

For dry, strained cough, children under seven years of age are prescribed mucolytics (Bromhexine, Stoptussin, ACC and others). For children over seven years old, antihistamines (Suprastin, Telfast and others) are added to relieve bronchospasm. Mucolytic agents are recommended in pediatric practice, as they do not increase sputum production and prevent its aspiration into the lungs. However, they are contraindicated for the treatment of asthmatic cough. Wet cough is treated with expectorants to remove mucus from the respiratory system (Ascoril, Mucaltin, Bronchipret).

The following are contraindicated for children:

• Codeine-based antitussive drugs (Codelac, Parcocet, Tercodin and others). The use of these drugs is possible only in critical cases and only in a hospital setting.
• Expectorant herbal medicines containing thermopsis and ipecac, as they provoke a gag reflex, which is dangerous by aspiration of sputum into the lungs.
• Medicines based on licorice, anise and oregano should not be given for diarrhea, as they have a laxative effect.
• Medicines containing iodides can cause poisoning.

All dosage forms of medications can be given to both adults and children. But the best preparations are in the form of syrups and drops.

List of the most effective medications for children.

Means allowed during pregnancy

During pregnancy, any medications should be used with caution, including cough medications. Many drug manufacturers list pregnancy as a contraindication to the use of their products. This is mainly due to the fact that tests on the effects of drugs on pregnant women were not carried out (for obvious reasons) or were carried out on animals.

But there are situations in which a pregnant woman cannot do without treatment. In this case, the safest are:

• Preparations based on dextromethorphan. This substance does not penetrate the placental barrier and does not affect the development of the embryo. Such drugs include Tussin Plus and Padevix.
• Herbal remedies based on ivy, linden, citrus peel, thyme. For example, Bronchipret or Bronchicum S.
• Products containing bromhexine. Drugs approved for all stages of pregnancy include Bromhexine and Solvin.
• Antitussives used from the second trimester: Stoptussin, Falimint, Coldrex Knight, Libexin.

The general rule for a pregnant woman is to be able to take cough medicines intended for children under three years of age.

Conclusion

The best remedies against wet cough are medications containing natural ingredients (Bronchipret, Pertussin). For the treatment of dry cough - antitussive drugs of peripheral action (Bitiodine, Libexin). Combination medications (Suprima-Broncho, Doctor Mom) also have a good effect.

But do not forget that each person’s body is unique. Therefore, before purchasing, it is necessary to consult a doctor to correctly diagnose the disease and exclude serious side effects.

Frequent colds, which people sometimes don’t even pay attention to, can develop into an inflammatory disease of the bronchi - bronchitis. Almost 90% of people have experienced this pathology. Chest pain, shortness of breath, painful cough, weakness - bronchitis symptoms. This disease is insidious, it has many types.

In medical practice, pulmonologists distinguish four main types of bronchial inflammation. The disease is classified based on the mechanism of development and the causes of bronchitis.

Acute bronchitis. The most common form of the disease. Acute bronchitis has a bacterial or viral etymology. But it can also develop due to exposure of the bronchial mucosa to aggressive allergens.

Chronical bronchitis. This type of pathology develops due to illiterate treatment of the acute phase. Chronic bronchitis is diagnosed when the patient experiences it (about 2.5-3 months annually). Relapses of the pathology are noted during the off-season against the background of respiratory infections.

Smoker's bronchitis. This type of disease affects experienced nicotine lovers. The main signs of the pathology are severe shortness of breath and coughing attacks with copious sputum discharge.

Obstructive bronchitis. This type of bronchitis manifests itself with loud whistling sounds when breathing, the formation of thick and difficult mucus and severe shortness of breath. The culprits of obstructive bronchitis are smoking, hereditary factors, polluted air, the activity of pathogenic viruses, and work in harmful conditions.

Bronchitis is also divided into varieties according to the type of inflammatory process and characteristics of sputum:

• purulent;
• fibrous;
• mixed;
• catarrhal;
• hemorrhagic.

According to the degree of the inflammatory process, pathologies are divided into limited (a certain area of ​​the bronchi is affected by inflammation) and diffuse, when the inflammatory process covers a significant part of the organ and spreads to nearby organs.

Bronchitis can be simple or complicated, occurring in mild, moderate and severe degrees.

Important. At the first signs of illness, be sure to visit a doctor. Bronchitis is an insidious disease, it is dangerous due to the development of serious complications and transition to the chronic stage.

A complete diagnosis allows you to detect bronchitis in its early forms and help the doctor develop an effective treatment regimen. Treatment should only be carried out under medical supervision. How does therapy work?

Removal of sputum using strong drugs (drugs) and tablets for expectoration of sputum during bronchitis in adults

The main treatment of inflammatory processes in the bronchi comes down to relieving swelling, relieving cough attacks and improving the patency of the respiratory tract. To cope with a painful cough, you need to help your body liquefy and remove mucus.

Important. Mucus formed in the bronchi protects the organs of the respiratory system from dust and pathogenic microorganisms.

With the development of bronchitis, mucus begins to be produced in large quantities. It becomes sticky.

The bronchi cannot cope with the removal of thick mucus. Along with sputum, pathogenic microorganisms accumulate in the organs, which worsens the patient’s condition.

What gives relief from pathogenic mucus?

1. Relief of cough syndrome.
2. Improvement in the general condition of the patient.
3. Cleansing the body of pathogenic toxins.

What does the doctor do to remove sputum?? Therapy methods are aimed at stimulating the work of the bronchial glands, which are responsible for “pushing out” mucus. Measures aimed at removing mucus include the following:

• postural drainage;
• plenty of warm drinks;
• breathing exercises;
• massage manipulations;
• complete air humidification;
• taking expectorants;
• steam and aerosol inhalations.

Expectorants are considered the most effective in terms of its removal. Similar drugs often combined with the use of mucolytic drugs.

Some medications have mixed effects: expectorant-mucolytic with simultaneous antimicrobial and anti-inflammatory effect.

We understand expectorants for bronchitis for sputum discharge in adults

To relieve cough syndrome, help cope with pathogenic mucus and speed up recovery, doctors are developing a course of therapy, which includes taking the following medications.

Expectorants for reflex bronchitis

Medicines of this type, when in contact with the gastric mucosa, provoke something like a gag reflex (but without obvious vomiting). At the same time, the peristalsis of the bronchial muscles noticeably improves, which leads to an increase in sputum volume.

At the same time, the cells of the epithelial tissue begin to work in an accelerated mode - mucus from the small alveoli is transported to the large bronchi and trachea. As a result, the process of expectoration of sputum improves. More often than not, doctors recommend taking the following medications.

Marshmallow-based expectorants. Herbal remedies of this type are intended for bronchitis of the obstructive and tracheal stages, pneumonia and emphysema. Such medications accelerate bronchial peristalsis, relieve inflammation and thin out mucus with a viscous consistency.

Attention. Medicines based on marshmallow are prohibited for use in case of ulcerative problems of the gastrointestinal tract and in children under 3 years of age. Rarely, but side effects are observed: allergies, nausea, vomiting.

Such expectorants include mucaltin and marshmallow syrup.

Expectorants based on thermopsis. Herbal medicines with thermopsis have powerful expectorant properties. They are not recommended for use on children under 10-12 years of age. Even the slightest overdose of the drug can cause vomiting, and the active substance cytisine affects breathing. This may frighten the baby.

Common expectorants containing thermopsis extract: Thermopsol, Codelac Broncho, Thermopsis sputum tablets. But these medications can provoke side effects (in case of overdose) in the form of gastrointestinal problems (diarrhea, constipation), lethargy, headache.

Other herbal remedies. Other expectorant drug complexes based on:

• thyme;
• thyme;
• plantain;
• coltsfoot;
• marsh wild rosemary.

Such drugs include“Pertussin”, “Gerbion”, “Tussamag”, “Stoptussin”, “Bronchicum”. Coldrex Broncho (an expectorant containing camphor, red pepper, macrogol and guaifenesin) and Gelomirtol, made from myrtol, showed good results.

The best expectorants with resorptive effects

Such medications stimulate the functioning of the bronchial glands, effectively liquefying viscous mucus. Resorptive expectorants stimulate the secretory secretions of bronchioles and the muscles of the bronchial walls. Resorptive expectorant drugs contain components that enhance the separation of fluid into mucous secretion. This effect is shown:

• baking soda;
• anise essential oils;
• ammonium chloride;
• marsh wild rosemary;
• sodium bicarbonate;
• oregano (oregano herb);
• ammonium chloride (ammonia);
• potassium/sodium iodides (iodine salts).

The most common and effective expectorant of this type is Amtersol. This medicine is contraindicated for expectant mothers and small children (under 3 years of age). The dosage of the medicine depends on the age of the patient.

The best mucolytic expectorants

The main task of mucolytics is to thin the mucus and speed up its evacuation from the bronchi. Next, we will consider which expectorant is better for coughing with phlegm.

Pathogenic microorganisms, deprived of a beneficial environment, die, which speeds up recovery. More often doctors It is recommended to take the following mucolytics:

1. "Acetylcysteine". The medicine is available in the form of tablets, powders and syrups. In pharmacies, acetylcysteine-based products can be found under the names: “Vicks Active”, “ACC”, “Fluimucil”. Such medications are prescribed to facilitate the removal of sputum in obstructive and acute bronchitis, otitis media and pneumonia and laryngitis.
2. "Bromhexine." Antitussive expectorant tablets, the effect of which is observed already on the 2nd day after administration. Bromhexine can be used either orally or by inhalation. The following expectorants have a similar effect: Solvin, Bronchosan and essential oils of mint, eucalyptus, oregano, anise and fennel.
3. "Ambroxol". One of the best medicines that works to liquefy and remove sputum. Analogs of "Ambroxol" include "Ambrobene", "Lazolvan", "Flavamed", "Halixol", "Ambrohexal", "Ambrosal". These mucolytics are recommended for various types of bronchitis, pneumonia, asthma and COPD, accompanied by a cough with difficult mucus.
4. "Carbocisteine". Effective expectorant mucolytic drugs. The drugs help reduce the viscosity of sputum and increase the elasticity of bronchial secretion. The following drugs have been created based on carbocysteine: Fluditec, Bronchobos, Libexin Muco and Fluifort.

In the world of pharmaceuticals, there are also effective combined expectorant drugs, containing several active components at once. Common medications in this category are “Joset”, “Kashnol” and “Ascoril”.

Attention, dangerous frivolity

Often people with bronchitis, not wanting to waste time in the clinic, try to cope with cough and phlegm on their own.

When purchasing antitussives at pharmacies, they do not think about the fact that such drugs may only be used for dry coughs. Antitussives include:

• "Libexin";
• "Levopront";
• "Stoptussin";
• "Tussin Plus";
• "Bronholitin";
• "Glaucin" ("Glauvent");
• “Sinekod” (“Butamirat”);
• "Codeine" ("Methylmorphine");
• "Libexin" ("Prenoxdiazine");
• "Sedotussin" ("Pentoxyverine");
• "Ethylmorphine" ("Dextromethorphan");
• "Tusuprex" ("Oxeladin" or "Paxeladin").

As soon as mucus begins to be coughed up, such drugs should be stopped. Otherwise, mucus will accumulate in the bronchi and provoke attacks of suffocation, aggravating the course of the disease. The situation is aggravated by the simultaneous use of antitussive drugs and expectorants.

Important. When sputum is produced in copious amounts and cannot leave the body, congestion occurs in the bronchi and lungs. This situation can lead to a dangerous complication - pulmonary emphysema (rupture of organ tissue).

Traditional expectorants

Increasingly, doctors, in addition to drug therapy in the treatment of bronchitis, use an expectorant course. Such remedies “get along well” with taking medications and are effective help remove mucus from the bronchi.

Important. Despite the safety of folk recipes (they are suitable for children and pregnant women), home treatment must be agreed upon with the attending physician. Some herbs used in folk medicine have a number of contraindications.

In practice, decoctions from the roots of licorice, marshmallow, oregano and mint are more often used. Steam inhalations using soda and medicinal herbs. Of the drugs used internally, the most effective are drugs prepared from milk with the addition of soda, oats, honey:

Banana decoction. Grind a couple of ripe bananas until smooth. Add sugar (25 g) to them. Dilute the mixture with a glass of water and mix thoroughly. Bring to a boil and cool. Take a tablespoon of this delicious medicine 2-3 times a day.

"Redkin" honey. Take a large black radish and cut off the top. Make a small hole and fill it completely with honey. Cover the hole with the top (like a lid). After 6-7 hours, the radish will give juice. Mixed with honey, this juice is an effective expectorant. It should be taken 20-25 ml three times daily.

Oat milk. To prepare the next expectorant, you will need a glass of oat grains. They need to be filled with milk (300-400 ml) and brought to a boil. You can add honey for taste. The finished drug is taken 5-6 times daily in small sips of 100-150 ml.

Baking soda. A good old time-tested product. This is an excellent expectorant. Soda can be used in the form of inhalations or taken orally, after mixing with hot milk (5-6 g of soda per glass of milk).

Medicinal. Since ancient times, healing plants have been successfully used in folk recipes to help remove mucus. The most effective recipes include the following:

1. Birch. Mix young leaves of the tree with wild rosemary (40-50 g each), oregano (25 g), nettle and birch buds (15 g each). Mix all components and crush. Pour the herbal mixture (12 g) with water (500 ml) and boil. Then leave the mixture to infuse for 30-40 minutes. The finished medicine is drunk 50 ml three times a day.
2. Herbal collection. Mix coltsfoot, chamomile (10 g each) and oregano (5 g). Steam the mixture with boiling water (200 ml) and leave to steep for an hour. Drink 100 ml of the drug 3-4 times a day. You can add honey for taste.

The best expectorants for bronchitis

The modern world of pharmaceuticals is replete with a rich selection of products, having an expectorant effect.

In order not to get confused among the pharmacy display cases, know that, according to experts, herbal medicines are considered the best expectorants for bronchitis based on medicinal plants:

• thyme, valued for its powerful antibacterial effect;
• marsh wild rosemary with analgesic and bactericidal effects;
• coltsfoot with an excellent expectorant and antiseptic effect;
• plantain, which has antimicrobial and analgesic effects;
• marshmallow, which has a softening effect on the bronchi and does not cause allergies;
• thermopsis, which in addition to liquefying and removing sputum, strengthens the patient’s immunity;
• Source, in medical practice I use the roots of this plant, which have expectorant properties.

Important. When treating bronchitis, you should not self-medicate. The wrong choice of drug will only worsen the situation and provoke the development of dangerous complications.

Be sure to consult a doctor if the cough is accompanied by copious purulent sputum, sweating, fever and severe weakness. Parents should be especially attentive. Sputum in childhood is very dangerous; it can provoke attacks of suffocation in little ones.

Gentle, effective expectorants for children and pregnant women with bronchitis

Treatment of children. Not all expectorants can be given to children when treating bronchitis. The most appropriate medicine is the one prescribed by the pediatrician. When selecting treatment for a child, the doctor takes into account his age and health condition. Carefully read the instructions for the drugs, where age categories are prescribed.

For example, Lazolvan, often prescribed by pediatricians, can be used to treat children over one year of age. But in certain situations, Lazolvan injections are also prescribed to infants (this is done only in a hospital setting).

Important. Infants are not able to cough up mucus on their own. Abundant mucus accumulates in the bronchi of the baby, leading to the development of congestion and the appearance of pneumonia.

For the treatment of children, they are often prescribed, based on thermopsis: "Pectussin", "Doctor Mom", "Doctor Tice". These tasty, aromatic kids drink with pleasure. Syrups based on « Ambroxol».

At home (after preliminary consultation with a doctor), the baby can be given breast expectorant mixtures and given tasty medicines based on bananas, honey, and milk.

Treatment of pregnant women. Doctors are no less scrupulous when choosing expectorants for a pregnant woman. Many medications can harm the body of the expectant mother and her baby. Only doctors select safe and effective expectorants. Doctors first take into account the severity of bronchitis and the current condition of the pregnant woman.

More often doctors neutral ones are prescribed, gentle medications for thinning and removing sputum. Such expectorants include syrups based on ivy and licorice roots, marshmallow (they are prescribed by pediatricians for the treatment of young children). Become effective medicines with thyme and thermopsis.

When carrying out treatment, doctors take into account that a pregnant woman may experience unpredictable reactions while taking the prescribed medication. At the slightest negative symptomatology, the prescribed drug is canceled and prescribe a medicine with a more gentle effect.

Take care of yourself and don't get sick!

Video about cough medicine for a child

Dr. Komarovsky will tell you what cough medicines are available for a child, and will draw parents’ attention to the differences between cough medicines and expectorants.

Expectorants are needed to release mucus from the tracheobronchial tree. How often can you hear from patients that potions, herbs or other cough remedies do not help.

This is due to the fact that cough treatment is carried out either by unfortunate doctors or by patients who themselves buy all the medicines in pharmacies.

The approach to therapeutic therapy, first of all, should be based on the cause of the disease, and it is also necessary to clearly determine what kind of cough we are dealing with - wet or dry. Only then will a specialist be able to select an effective cough remedy.

If the cough lasts more than 14 days, seek help from a pulmonologist, where you will be asked to undergo extensive diagnostics (X-ray, spirometry, sputum culture, body plethysmography, CT). Based on the results of the study, the pulmonologist will draw up a treatment regimen.

Are expectorants and mucolytics the same thing?

When coming to the pharmacy, many of us do not ask ourselves what pharmacological agent we are purchasing. Usually, patients at the pharmacy ask for something for their cough.

Expectorants (transporting secretions out) and mucolytics (thinning sputum) actually serve to treat cough. The task of mucolytics is to reduce the viscosity of mucus (sputum), while expectorants are to remove pathological secretions from the bronchi.

It should be noted that expectorants have direct and reflex action. Direct-acting drugs stimulate the process of producing liquid secretions by irritating the bronchial mucosa. Reflex agents stimulate the bronchial glands by irritating the walls of the stomach.

Are expectorants used in pediatrics?

There is a lot of debate on this issue. If the inflammatory process of the bronchi proceeds without complications, then some pediatricians believe that cough medicines should not be used, but that it is better to use gentler methods. There are also specialists who, from the first days of illness, introduce expectorant drugs into the treatment regimen, believing that the body needs to be helped and prevent the inflammatory process from spreading further.

Many parents listen to the opinion of Dr. Komarovsky. So, in this regard, the doctor recommends the following action plan:

• indoor air humidification;
• moisturizing the nasopharynx with saline solutions (no more than twice a day);
• walks in the fresh air (in the absence of high body temperature);
• strengthening the drinking regime (juices, water, fruit drinks);
• frequent ventilation of the room where the child is.

The creation of such conditions allows you to transform a dry cough into a productive (wet) one. Moisturizing perfectly thins thickened mucus and stimulates the production of liquid secretion.

If, for example, you still need a cough medicine for bronchitis, the pediatrician will primarily be guided by the following:

• the age and weight of the child;
• the nature of the cough;
• proneness to allergies;
• medical history (are there any other pathologies);
• the presence of accompanying symptoms at the moment.

Important! Remember, prescribing expectorants without medical supervision may harm your child's health.

Expectorants - what to choose?

Of course, patients are more interested in inexpensive drugs, but so that the effect is at the highest level. The incomes of citizens vary, so we will consider inexpensive drugs to be those whose price does not exceed 200 rubles. Now, let's take a closer look at the most popular expectorants for adults and children.

Pertussin

This drug has been produced for decades, and there is probably no person who has not heard of this medicine. Our compatriots remember the sweetness of pertussin from childhood.

Pertussin contains thyme (creeping thyme - an expectorant herb) and potassium bromide. The main components are supplemented with ethyl alcohol and sugar syrup. Due to its herbal composition, pertussin is widely used in pediatrics. The range of use of the drug is as follows:tracheitis, bronchitis, tracheobronchitis, whooping cough, pneumonia and other infectious and inflammatory diseases of the respiratory tract.

1. Usually the syrup is used for about 7 days. According to the instructions, pertussin is recommended from the age of three, but in practice, it is often used from the age of one. Pediatricians recommend diluting the syrup with water for the youngest patients. This is explained by the presence of alcohol in the composition of pertussin.
2. As for side effects, they occur extremely rarely. This could be nausea, allergies, weakness. Such phenomena are possible only with prolonged use of the drug or its overdose.
3. For children under three years of age, pertussin is indicated in a dose of 1.25 ml at a time. Under the age of 6 years, the syrup is taken three times a day, 2.5 ml. For older children, the dose can be from 5 to 10 ml per dose, for adults up to 12.5 ml.

Pertussin is a cheap product; a bottle of syrup costs about 25 rubles on average.

Fluditek

The drug in question is a mucolytic with an expectorant effect, and that’s not all, the drug exhibits an immunostimulating and anti-inflammatory effect. The active substance of Fluditec is carbocysteine. While taking the drug, the viscosity of sputum decreases, the epithelium of the respiratory tract and the function of cleansing the bronchi are restored.

The drug is used for bronchopulmonary pathologies, including bronchial asthma and bronchiectasis. The product is also effective for diseases of the nasopharynx and ears: pharyngitis, otitis media, sinusitis.

• Fluditec is used in children's practice from the age of two. Usually the syrup is prescribed in a dose of 5 ml 2-3 times a day, or as the doctor decides. The dose of syrup depends on the age, weight and condition of the patient. There are practically no side effects.
• In extreme cases, diarrhea, nausea, rash, and malaise may occur. If the drug is not suitable for the patient, it is recommended to replace it with analogues: bronchobos, libexin muco or others.

Please note that carbocysten is contraindicated for gastric and duodenal ulcers, glomerulonephritis, and cystitis.

Fluditec syrup 20 mg/ml 125 ml costs about 320 rubles, so the product is not cheap.

Bronchipret

The syrup, tablets or drops contain two main active components - extracts of thyme herbs and ivy leaves. The drug is more popular in the form of a light brown syrup.Bronchipret belongs to the pharmacological group of expectorants of plant origin.

The drug has a pronounced anti-inflammatory, bronchodilator (relieves bronchospasm), secretolytic, and also dilutes phlegm. It is used for inflammation of the tracheobronchial tree, accompanied by cough. Bronchipret effectively removes mucus, which allows the patient to breathe easier.

• Bronchipret is well tolerated by patients and is approved for use from 3 months of age.
• The dosage of syrup is calculated according to the age category. For infants (up to one year) - 15 drops three times a day, and so adding 3 drops of bronchiprete for each year of life. For adults, it is recommended to use 5 ml of syrup three times a day.

The price of bronchipret ranges from 300 to 400 rubles for various forms of the drug.

Stoptussin

The drug is presented in tablets, drops and syrup. Active ingredients -butamirate dihydrogen citrate and guaifenesin. Stoptussin belongs to the non-opioid cough medicines, therefore, it does not depress the respiratory center.

The composition of stoptussin helps to liquefy viscous sputum and rapid evacuation of mucus. The drug is used for various types of cough, especially those of a paroxysmal nature.

Stoptussin is used in the form of drops even in infants whose weight is at least 7 kg.

Drops of 50 ml cost about 320 rubles, tablets (20 pieces) cost about 220 rubles, syrup (100 ml) - 240 rubles.

Expectorants at home

In addition to medicines, traditional methods of treatment also remain popular. They are cheaper, easy to prepare and do not harm health like synthetic drugs. It should be noted that plants, substances of animal or mineral origin cannot be called completely safe. Especially when it comes to treating a child, you should definitely take the advice of a pediatrician.

And now, we present to your attention time-tested recipes for removing mucus from the bronchi.

Milk with butter, honey, soda and sage

This remedy will help eliminate cough, relieve inflammation and get rid of mucus in the tracheobronchial tree.

Compound:

• milk (boiled, about 40 degrees) - 200 ml;
• May honey - 10 ml;
• butter and soda - on the tip of a knife;
• sage infusion - 10 ml.

Mix all the ingredients and drink before bed. If the patient is in bed rest, then this remedy is used several times a day.

Oatmeal broth

This decoction is suitable for everyone, even those people who have a history of allergic diseases. Oatmeal grains are poured with milk (200 ml) and boiled until tender. Strain the remaining liquid. Drink the decoction three times a day, one tablespoon at a time. For those who are not allergic, you can add a little honey to the broth. Only whole grains are suitable for preparing oatmeal broth with milk.

A wet cough and profuse sputum are indications for using the presented recipe.

Lemon juice + honey

Lemon juice and honey will help eliminate cough and remove phlegm. The lemon is thoroughly washed, the peel is cut off, and passed through a juicer. Add honey to the resulting juice (to taste). The resulting mixture can be added to tea or consumed separately, one teaspoon three times a day.

The medicine is not suitable for people suffering from gastritis and stomach ulcers, as well as allergy sufferers.

Honey with horseradish

Grate the peeled horseradish on a fine grater and mix with liquid honey in a 1:1 ratio. Take 10 ml 30 minutes before meals three times a day. This mixture thins thickened mucus, causes sweating, and the illness quickly recedes. The product is suitable for patients not prone to allergies.

Honey + butter

For the treatment of bronchitis, pneumonia, tuberculosis, the following recipe is suitable. Honey must be melted with fresh butter in a water bath until a homogeneous consistency is obtained. Proportions may vary, but usually take 1 part butter to 3 parts honey.

The resulting mixture is also useful to take during periods of epidemic instability. Such prevention will be associated with normal eating. Pour raspberry, currant or sea buckthorn tea, spread the honey-butter mixture on the bread, and enjoy.

Sea buckthorn infusion

Sea buckthorn exhibits anti-inflammatory and enveloping effects. As an expectorant, it is better to prepare sea buckthorn in advance, and it is very easy to do. For 1 kg of sea buckthorn berries you need to take 1.5 kg of sugar. Twist the berries and add sugar. After the sugar has completely dissolved, the mixture is placed in clean jars and covered with nylon lids. The resulting product should be stored in a cool place.

If a cough occurs, take a tablespoon of the mixture along with tea. It is better to make tea from chamomile, calendula, raspberry or currant leaves.

banana drink

Banana is not only a food product, but also a delicious healer. Its pulp regulates the functioning of the gastrointestinal tract and is perfect for the treatment of bronchopulmonary pathologies.

As an expectorant, remember the following recipe. Place one ripe banana, 100 ml of milk and 5 ml of honey in a blender. All ingredients are mixed for 20 seconds. Drink the resulting drink in the morning and evening between meals. Tasty and healthy!

Expectorant herbal tea

Ingredients:

• plantain leaf;
• coltsfoot;
• liquorice root.

Take 5 grams of all plants and pour 300 ml of boiling water. After 30 minutes the infusion is ready. To improve the taste, it is recommended to add a spoonful of jam, jam or honey. This herbal mixture can be used in pediatrics, only reduce the dose of infusion according to age.

For example, 50 ml of infusion is enough for a five-year-old child, 100 ml for older children.

Milk + figs

The following mixture will help eliminate a cough and free the bronchi from phlegm: take 400 ml of milk for 5 large figs, crushed into pulp. Boil the mixture over low heat for about 10 minutes. Divide the resulting broth into 2-3 servings.

Be sure to warm until warm before use. Honey-type figs are best suited for this recipe; they are yellow in color and slightly flattened. Dark figs are more recommended for diseases of the heart and blood vessels.

Milk with propolis

For 100 ml of milk we take 5-7 drops of 10% propolis tincture (purchase from beekeepers or at a pharmacy). Take the mixture twice daily between meals.

Propolis is a natural antibiotic. It not only fights cough, but also eliminates the cause of its occurrence. The effectiveness of propolis has been scientifically proven in the treatment of tuberculosis, when the nature of the cough varies.

Viburnum with honey

Viburnum is an excellent cold and antiviral remedy. While taking viburnum berries, patients note an improvement in their general condition, a decrease in body temperature, and a decrease in cough. The ground berries are mixed with honey, the amount of the latter is determined by taste. There are no special restrictions on taking this remedy; usually during illness it is recommended to use the proposed mixture with tea.

In addition to the fact that viburnum perfectly relieves cough, at the same time it will solve problems with blood thickness and high blood pressure.

Conclusion

Cure cough quickly and effectively is the desire of most patients. The first condition is to start treatment in a timely manner and not to progress the disease. The second condition is diagnosis. If the patient notices that the cough lasts a long time, and the usual antitussives do not help, contact a pulmonologist; do not delay the visit! Treatment of cough in children is the task of pediatricians. Even the most seemingly harmless remedy can harm a child, remember this.

At the beginning of the disease, and in consultation with your doctor, try using folk remedies - this is the key to strengthening the immune system. Never start therapy with strong antitussives, especially opiates. Trust your doctor and the cough will go away. Take care of your health!

Exercise 1. Learn the main symptoms of cough.

Cough- a complex reflex act that allows you to clear the airways.

Dry(non-productive) cough - without sputum production.

Wet(productive) cough - with sputum production.

Dry painful cough may cause loss of consciousness,

muscle ruptures, rib fractures.

Treatment: Should be suppressed with antitussive drugs.

Moist cough

Treatment: it is necessary to use drugs to facilitate evacuation

sputum, but not suppressing the cough reflex (expectorants and

mucolytic agents).

Task No. 2 .Study the assortment of a group of medicines and highlight:

Antitussives_______________________________________________________________________________________________________________________________

Mucolytic _____________________________________________________________________________________________________________________________________

Task No. 3. Study contraindications to the use of medications.

CONTRAINDICATED! ! !

Antitussives:

With increased bronchial secretion, copious sputum production.

Drugs Codeine during pregnancy, lactation and children under 2 years of age.

Drugs Codeine with alcohol, sleeping pills,

psychotropic drugs.

Drugs Codeine transport drivers.

- Glaucine hydrochloride with low blood pressure.

- Libexin should not be chewed (numbness in the mouth)

Expectorants:

With antihistamines (thickening of sputum);

In high doses (vomiting);

For stomach diseases;

Iodine preparations during pregnancy;

Iodine preparations for acute inflammatory processes;

Iodine preparations for tachycardia;

Iodine preparations for increased excitability;

Iodine preparations for insomnia;

- Ambroxol in the 1st trimester of pregnancy;

- Bromhexine children under 3 years old;

- Bromhexine incompatible with alkaline solutions;

When taking expectorants, you should not prescribe diuretics.

facilities;

Laxatives (dehydration);

- ACC for bronchial asthma (provokes bronchospasm);

- ACC in the 1st trimester of pregnancy.

Task No. 4 Study some medicines used in

therapy of respiratory diseases in children and fill in

table column “Application Features”

Antitussives ___________________________________________________________________

Expectorants_______________________________________________________________________________________________________________________________

Mucolytic__________________________________________________________________________________________________________________________________________________________________________________________