Antitussive medicines for children. Cough medicines: pharmacological groups and their action, applicability, review of representatives. Wet cough in a child: symptoms

»» No. 2 1999 PROFESSOR G.A. SAMSYGINA, HEAD OF THE DEPARTMENT OF CHILDREN'S DISEASES N1, RUSSIAN STATE MEDICAL UNIVERSITY

Cough is a well-known, but very complex in its mechanism, reflex aimed at restoring airway patency. Cough is one of the most common manifestations of respiratory tract diseases. And in this regard, it is usually considered as a phenomenon that can be dealt with by any person who does not have special knowledge (parents, relatives or friends), a pharmacy pharmacist and, of course, a doctor. This opinion is erroneous and even harmful, since incorrectly chosen antitussive therapy is often based on it.

This is especially true in pediatrics, since both the child’s body itself and diseases at this age have their own characteristics. In addition, not only the mechanisms, but also the causes of cough in children may differ significantly from those in adults. Therefore, the use of drugs used in adult therapeutic practice, especially combined antitussive drugs, may not only not help a coughing child, but even worsen his condition. Unfortunately, even doctors know a relatively small range of drugs and often do not have complete information about the mechanisms of their pharmacological action. The rational choice and use of antitussive therapy in pediatrics presupposes knowledge of at least two main points: the causes of cough and the peculiarities of the mechanism of formation of the cough reflex in childhood and knowledge of the mechanisms of action of the antitussive drugs used. As noted above, the main function of cough is to remove secretions from the airways to improve their patency and restore mucociliary transport of bronchial secretions (mucociliary clearance).

There are many causes of cough in children:

• Infectious and inflammatory process in the upper respiratory tract (acute respiratory viral infections, tonsillitis, pharyngitis, sinusitis, exacerbation of tonsillitis, laryngitis)
• Infectious and inflammatory process in the lower respiratory tract (laryngotracheitis, tracheitis, bronchitis, pneumonia)
• Irritative inflammation of the mucous membranes of the respiratory tract
• Allergic inflammation of the mucous membranes of the respiratory tract
• Bronchospasm
• Obstruction of the airways with viscous bronchial secretions, aspirated foreign bodies, fluids, endogenous and exogenous formations, etc.
• Edema of the pulmonary parenchyma
• Other factors

Impaired mucociliary clearance in children can also be due to several reasons. This is hyperplasia of the bronchial mucosa under the influence of infectious, allergic or other inflammation; swelling of the mucous membrane of the bronchial tree; increased secretion of mucus; increase in secretion viscosity; decreased surfactant formation; bronchospasm; bronchial dyskinesia, that is, a decrease in their caliber during exhalation by more than 25% compared to the caliber during inhalation; Finally, impaired mucociliary clearance may be caused by a combination of two or more of these factors.

Clinical manifestations vary from a severe, painful cough, accompanied by vomiting, anxiety and/or pain that disrupts the child’s sleep and well-being, to a constant cough that is invisible to the patient and has almost no effect on his behavior. In the latter case, the child usually does not need special antitussive treatment, but finding out the cause of the cough is necessary.

Treatment of cough is indicated only in cases where it interferes with the patient’s well-being and condition. However, you should always start by eliminating its cause.

The need to treat the cough itself, that is, to prescribe so-called antitussive therapy, arises mainly when the child has a non-productive, dry, obsessive cough. Its peculiarity is that it does not lead to the evacuation of secretions accumulated in the respiratory tract and/or does not relieve the receptors of the respiratory tract mucosa from irritating effects, for example, during irritative, infectious or allergic inflammation. It should be emphasized once again that in children, especially young children, nonproductive cough is often caused by increased viscosity of bronchial secretions, impaired “sliding” of sputum along the bronchial tree, insufficient activity of the ciliated epithelium of the bronchi and contraction of the bronchioles. Therefore, the purpose of prescribing antitussive therapy in such cases is to dilute sputum, reduce its adhesiveness and thereby increase the effectiveness of cough.

Thus, the effectiveness of antitussive therapy essentially lies in strengthening the cough, provided it is transferred from dry, unproductive to wet, productive. This ultimately leads to its disappearance.

Treatment of productive cough, which consists of suppressing the cough reflex, is carried out in children only in special situations: when the cough is very intense and exhausts the baby, is accompanied by vomiting, disrupts the child’s sleep, or when there is a high risk of developing aspiration (for example, in children with severe central nervous system pathology ).

Thus, for the correct choice of antitussive treatment it is necessary: ​​firstly, to establish a diagnosis of the disease that caused the child’s cough, and secondly, to evaluate its productivity, duration and intensity, and the degree of influence on the patient’s condition. Based on anamnestic, physical and, if necessary, additional laboratory and instrumental data, it is advisable to assess the nature of the bronchial secretion (mucous or purulent, degree of viscosity, “mobility,” quantity, etc.) and the presence or absence of bronchospasm.

Therefore, in resolving questions about the need and rational choice of antitussive treatment for a child, the participation of a pediatrician is simply necessary. Moreover, the correct choice of antitussive therapy is always based on a good knowledge of the mechanisms of action of drugs with an antitussive effect.

Among them are:

• antitussives themselves (central and peripheral action);
• drugs with an indirect antitussive effect (bronchodilators, anti-inflammatory, antiallergic, decongestants and others);
• combination drugs.

Centrally acting antitussives suppress the function of the cough center of the medulla oblongata or other nerve centers of the brain associated with it. These include drugs with a narcotic effect (codeine, dionine, morphine, dextromethorphan) and drugs that have a non-narcotic antitussive effect in combination with an analgesic, sedative and, as a rule, weak antispasmodic effect. These are glaucine hydrochloride (Glauvent), libexin, Sinecode, Tusuprex and others. This also includes broncholitin, a combined antitussive drug that includes glaucine hydrochloride, ephedrine, sage essential oil and citric acid.

Narcotic drugs are used extremely rarely in pediatrics, in hospital settings and for special indications: mainly for oncological diseases of the respiratory tract (opiates, dextromethorphan) to suppress the cough reflex during bronchography, bronchoscopy and other surgical interventions on the respiratory tract.

Non-narcotic drugs are used more widely, but, unfortunately, often incorrectly and unreasonably. The indication for their use is the urgent need to suppress cough. In pediatrics, although such a need occurs, it is rare. In young children, it occurs with whooping cough and in cases of very intense productive cough with excessively abundant and liquid bronchial secretions (bronchorrhea), when there is a real threat of aspiration.

It should be noted that bronchospasm is also rare in young children. Typically, obstructive syndrome, and especially pronounced, at this age is caused by hyperplasia and infectious-inflammatory edema of the bronchial mucosa, impaired motility of bronchioles, decreased mobility of the secretion due to its increased viscosity and low level of surfactant. Therefore, centrally acting antitussives simply do not have a point of application. Moreover, by suppressing the cough reflex, they slow down the release of secretions from the airways, worsen the aerodynamics of the respiratory tract and the processes of oxygenation of the lungs.

In older adults, these drugs may be useful in cases of cough associated with moderate bronchospasm. At the same time, they are used independently or as an addition to bronchodilators and drugs that suppress allergic or irritative inflammation.

A group of centrally acting non-narcotic antitussives is also indicated for coughs associated with irritation of the mucous membranes of the upper (supraglottic) respiratory tract due to infectious or irritative inflammation. In these cases, the result of their administration is usually enhanced when combined with peripherally acting drugs with an enveloping effect. A partial example of such a combined effect is broncholithin. But its use is justified only in the absence of pronounced changes in the mucous membrane of the lower sections of the bronchial tree, since the ephedrine included in it “dries out” the bronchial mucosa, increases the viscosity of bronchial secretions and aggravates the disturbance of mucociliary transport, and, accordingly, increases the unproductiveness of cough in the presence of bronchitis and pneumonia. In addition, ephedrine has an stimulating effect on the central nervous system, disrupts the child's sleep and increases unproductive cough and shortness of breath.

Peripheral antitussives influence either the afferent or efferent components of the cough reflex, or have a combined effect. Drugs with an afferent effect act as mild analgesics or anesthetics on the mucous membrane of the respiratory tract and reduce reflex stimulation of the cough reflex. In addition, they change the formation and viscosity of secretions and relax the smooth muscles of the bronchi. Drugs with efferent action increase the mobility of the secretion, as if improving its “sliding” along the mucous membrane, reduce the viscosity of mucus or increase the efficiency and strength of the cough mechanism itself.

One of the effective afferent antitussives of peripheral action is moisturizing the mucous membranes. This is primarily the use of aerosols and steam inhalations, which reduce irritation of the mucous membrane and reduce the viscosity of bronchial secretions. Inhalation of water vapor alone or with the addition of medications (sodium chloride or benzoate, sodium bicarbonate, ammonium chloride, plant extracts such as eucalyptus) is the simplest, most accessible and common method of hydration. Along with this, heavy drinking can be used (including medicinal teas, when efferent and afferent mechanisms of action are combined), and in severe cases (in a hospital setting) intravenous infusions of fluids.

Enveloping agents also belong to the peripheral antitussive agents of afferent action. These drugs are mainly used for coughs that occur due to irritation of the mucous membrane of the upper supraglottic parts of the respiratory tract. Their action is based on creating a protective layer for the mucous membrane of the nasopharynx and oropharynx. They are usually in the form of oral tablets or syrups and teas containing plant extracts (eucalyptus, acacia, licorice, wild cherry, etc.), glycerin, honey and other components. Local anesthetics (benzocaine, cycline, tetracaine) are also agents of afferent action, but are used only in a hospital setting according to indications, in particular for afferent inhibition of the cough reflex during bronchoscopy or bronchography.

Efferent drugs include expectorants. These are plant extracts (marshmallow, anise, ninesil, wild rosemary, oregano, ipecac, coltsfoot, plantain, sundew, licorice, pine buds, violet, thyme, thermopsis, etc.), terpin hydrate, iodides.

The mechanism of action of these drugs is based on the removal of bronchial secretions from the respiratory tract by reducing its viscosity with an increase in volume. Most expectorants increase mucus secretion due to reflex irritation of the glands of the bronchial mucosa. Some, for example, iodides and a number of herbal preparations (thyme, sundew, thermopsis, ipecac, etc.) also have a direct effect on secretory bronchial cells and are released into the lumen of the bronchial tree, thereby increasing the secretion of mucus and increasing its volume. They partially activate the motor function of the bronchioles and ciliated epithelium of the bronchial mucosa. Along with this, thermopsis and ipecac also enhance the activity of the vomiting and respiratory centers of the medulla oblongata.

Plant extracts are included in syrups, drops and cough tablets, and are components of chest preparations.

EXPECTORANTS OF PLANT ORIGIN

Ingredients: extracts of marshmallow, anise, wild rosemary, deyasil, oregano, ipecac, coltsfoot, sundew, plantain, licorice, pine buds, violet, thyme, thermopsis.

Dosage forms:

• decoctions, infusions, teas
• tablets (cough tablets based on thermopsis and sodium hydrochloride, mucaltin based on marshmallow extract, glycyram based on the ammonium salt of glycyrrhizated acid isolated from licorice, bronchicum lozenges)
• syrups (bronchicum based on honey, thyme, rose hips, pimpinella root, primrose and grindelia, eucabal based on plantain and thyme)
• drops (bronchicum based on thyme, soapwort, quebracho bark and menthol, eucabal based on sundew and thyme).

A significant increase in sputum volume is also observed with the use of iodides (potassium iodide, sodium iodide, iodized glycerol). The use of these drugs in pediatrics should also be limited, since the expectorant effect of iodides is observed only when prescribed in doses close to intolerable, which is always dangerous in pediatric practice. In addition, they have an unpleasant taste (the exception is iodized glycerol, but its effect is extremely insignificant).

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. A feature of mucolytics is that, liquefying sputum, they practically do not increase its volume. The liquefying effect of proteolytic enzymes is based on the rupture of peptide bonds of bronchial secretion protein molecules. Acetylcysteine, carbocysteine ​​and N-acetylcysteine, bromhexine and ambroxol disrupt the integrity of the disulfide bonds of acidic mucopolysaccharides of the sputum gel, thereby liquefying it. Bromhexine and Ambroxol also has the ability to stimulate the production of endogenous pulmonary surfactant (anti-atelectatic factor). The latter ensures the stability of alveolar cells during breathing, protects them from the effects of external adverse factors, improves the "sliding" of bronchopulmonary secretions along the epithelium of the bronchial mucosa. Reducing the viscosity of mucus and improving its sliding facilitates secretion of mucus from the respiratory tract.

MAIN INDICATIONS FOR THE CHOICE OF ANTI-COUGH DRUGS IN CHILDREN

Acetylcysteine, bromhexine and ambroxol can be widely used in pediatrics in the treatment of cough caused by diseases of the lower respiratory tract (tracheitis, laryngotracheitis, bronchitis, pneumonia, etc.), especially in children of the first five years of life, in whom increased viscosity of bronchial secretions is the main pathogenetic factor in the formation of cough. The tendency to insufficient surfactant synthesis justifies the use of drugs such as ambroxol in neonatological practice and in children in the first weeks of life.

But one of the disadvantages of acetylcysteines (ACC, carbocysteine ​​and fluimucil) and, partly, bromhexine is their ability to enhance bronchospasm. Therefore, the use of these drugs in the acute period of bronchial asthma is not indicated.

Acetylcysteine, bromhexine and ambroxol have proven themselves well in chronic bronchitis, bronchiectasis, cystic fibrosis, and other enzymopathies, which are characterized by increased viscosity and often purulent or mucopurulent sputum. But in this situation, mucolytics such as proteolytic enzymes and dornase have advantages, since they dilute purulent sputum more effectively.

Currently, the drug guaifenesin is widely used. It is included in such products as Coldrex-Broncho, Robitussin - a cough medicine, Tussin (a combination drug that, along with guaifenesin, includes caramel, glycerin, citric acid, sodium benzoate, corn syrup) and a number of other widely advertised over-the-counter antitussives. The dose of guaifenesin is usually 100 to 200 mg per dose every 4 hours. Guaifenesin can be used in children over 3 years of age. In its action, guaifenesin occupies an intermediate position between expectorants and mucolytic drugs. Unlike the expectorants described above, the effect of guaifenesin is based on reducing the surface tension and adhesion of mucus to the bronchial mucosa and reducing its viscosity due to the depolymerization of acidic mucopolysaccharides of mucus. But the ability to increase mucus secretion (albeit less viscous) makes guaifenesin similar to expectorants. No side effects have been noted with guaifenesin, but there is no reliable data on its effectiveness.

The use of drugs with an indirect antitussive effect in pediatrics has very limited indications. For example, antihistamines are not recommended for use in the treatment of cough in children, especially young children, since their “drying” effect on the bronchial mucosa increases the unproductive cough caused by the already viscous nature of the secretion. For the same reasons, decongestants (decongestants) used for acute rhinitis and cough in adults are not used in children.

Bronchodilators (aminophylline, theophylline) are indicated if cough is associated with bronchospasm. The use of atropine is generally undesirable in both children and adults - it thickens sputum, making it more viscous and difficult to remove.

I would like to particularly focus on the use combination 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 include a bronchodilator (solutan, trisolvin) and/or an antipyretic component, antibacterial agents (hexapneumin, Lorraine). Such drugs relieve cough during bronchospasm, manifestations of respiratory viral (for example, rhinitis) or bacterial infection, but they should be prescribed according to the appropriate indications (see table). 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, can combine medications that have opposite effects, for example, antihistamines and expectorants (Zvyagintseva powder and its variants). Many prescriptions contain suboptimal or low concentrations of drugs, which reduces their effectiveness. But, of course, there are also completely justified combinations of drugs.

If the main complaint is the cough itself, it is always better to use one drug in full dose, but one that acts on the patient-specific component of the cough reflex. For example, to relieve cough associated with acute infection of the upper respiratory tract, tablets or syrups with an enveloping peripheral effect or their combination (in older children and adolescents) with non-narcotic drugs of central action such as libexin are indicated. In acute laryngitis, tracheitis, bronchitis and pneumonia, the use of airway humidification is most effective to enhance bronchial secretion and dilute viscous sputum. If it is ineffective, expectorants and/or mucolytics are added to treatment.

Mucolytics are the drugs of choice in the presence of viscous, mucopurulent or purulent sputum and in children with reduced surfactant synthesis (early age, prematurity, long-term bronchitis, pneumonia, cystic fibrosis, alpha1-antitrypsin deficiency).

When a patient coughs with symptoms of bronchospasm, it is advisable to prescribe bronchodilators, antiallergic and anti-inflammatory drugs, along with moisturizing and expectorants, but centrally acting antitussives and mucolytics such as acetylcysteine ​​are not indicated.

In young children, in children with a pronounced gag reflex, in children with a high risk of aspiration, expectorant drugs that increase the volume of secretions and enhance the gag and cough reflexes are contraindicated. And for the targeted suppression of a non-productive cough, for example with whooping cough, on the contrary, it is possible to use antitussive non-narcotic drugs of central action.

Literature

1. Artamonov R.G. Condition of the bronchi in prolonged and chronic segmental and lobar pneumonia in children of the first years of life. Author's abstract. diss. Ph.D. honey. Sciences, M., 1958.
2. Ignatieva E.P., Makarova O.V., Ponikav V.E. Modern expectorants. In the world of drugs, N 1, 1998, p. 10-13.
3. Mashkovsky M.D. Medicines. M., Medicine, 1993.
4. Rachinsky S.V. et al. Bronchitis in children. L., Medicine, 1978, p. 211.
5. Tatochenko V.K. et al. Acute respiratory diseases in children. M., Medicine, 1981, p. 206.
6. Guide to medicine. Diagnostics and therapy. M., 1997, vol. 1, p. 407-410.
7. Vidal reference book. Medicines in Russia. M., 1999.
8. Anmmon N.P. Incrisde the glucose by ACC during hyperglycern Arsne, 1992, 42, 642-645.
9. Bianchi M. el al. Ambroxol inhibits interleucin 1 and tumor necrosis factor production in human mononuclear cell. Agents and Actions, vol. 31, 3/4.
10. Ziment I. Acetylcysteine: a drug with interest in the past end a future. Respiration, 1986, 50 suppl 1; 20-30.

Cough is a complex reflex reaction of the airways, the main function of which is to restore their normal patency.
The occurrence of a cough can be caused by irritation of the cough receptors of the nose, ears, posterior wall of the pharynx, trachea, bronchi, pleura, diaphragm, pericardium, esophagus. External and internal factors (foreign bodies, cold and dry air, aeropollutants, tobacco smoke, nasal mucus, sputum, inflammation of the mucous membranes of the respiratory tract, etc.) excite cough receptors, which are divided into irritant, quickly responding to mechanical, thermal, chemical irritants, and C-receptors, predominantly stimulated by inflammatory mediators (prostaglandins, kinins, substance P, etc.). The resulting impulse is transmitted through the afferent fibers of the vagus nerve to the cough center located in the medulla oblongata. The reflex arc is closed by the efferent fibers of the vagus, phrenic and spinal nerves going to the muscles of the chest, diaphragm and abdominals, the contraction of which leads to the closure of the glottis, followed by its opening and expulsion at high air speed, which is manifested by a cough.
In addition, cough can be caused or suppressed voluntarily, since the formation of the cough reflex is under the control of the cerebral cortex.
Cough is classified by nature (non-productive, or dry, and productive, or wet cough), by intensity (coughing, mild and severe cough), by duration (episodic, paroxysmal and persistent cough), by course (acute - up to 3 weeks, prolonged - more than 3 weeks and chronic - 3 months or more).
In some cases, cough loses its physiological purpose and not only does not contribute to the resolution of the pathological process in the respiratory system, but also leads to the development of complications.
The reflex arc of the cough reflex includes receptors, the cough center, afferent and efferent nerve fibers, and the executive link - the respiratory muscles. Cough is most effectively suppressed at two levels - the receptor level and the level of the cough center. In this regard, antitussive drugs are divided into 2 groups: central and peripheral action. In turn, centrally acting drugs can be divided into narcotic and non-narcotic drugs.

Mechanism of action and pharmacological effects Centrally acting narcotic antitussives
These include morphine-like compounds such as codeine, ethylmorphine and dextromethorphan, which suppress the function of the cough center of the medulla oblongata. The most well-known narcotic antitussive drug is codeine, which is a natural narcotic analgesic from the group of opiate receptor agonists. Medicines from the codeine group are very effective, but have significant drawbacks. Their antitussive effect is not selective; they simultaneously depress the respiratory center. Dextromethorphan is a synthetic antitussive drug, similar in chemical structure and activity to opiates ( codeine); has a central effect, increasing the cough threshold.

Non-narcotic antitussive drugs of central action
These include oxeladine, butamirate, glaucine, pentoxyverine, ledin and pholcodine, which have a selective central effect. They partially suppress the cough center without exerting a pronounced inhibitory effect on the respiratory center. Not inferior in potency to codeine, they do not cause addiction or addiction, do not depress breathing and do not affect intestinal motility (do not cause constipation). Some antitussive drugs have additional effects that improve their effect. Thus, oxeladine, butamirate and ledin are characterized by some bronchodilator action. Butamirate also has expectorant and anti-inflammatory effects.

Non-narcotic antitussive drugs of peripheral action
This group of drugs includes prenoxdiazine, levodopropizine, benpropyrine and bithiodine, which affect the afferent component of the cough reflex, acting on the mucous membrane of the respiratory tract as an anesthetic and reducing reflex stimulation of the cough reflex. In addition, they have a local anti-inflammatory effect and help relax the smooth muscles of the bronchi.

Enveloping drugs also refer to peripheral antitussive drugs of afferent action. Their action is based on creating a protective layer on the mucous membrane of the nasopharynx and oropharynx. They are oral tablets or syrups and teas containing plant extracts of eucalyptus, acacia, licorice, wild cherry, linden, etc., glycerin, honey, etc.
One of the ways to influence the afferent part of the reflex arc is also the use of aerosols and steam inhalations to moisturize the mucous membranes of the respiratory tract. Steam inhalation, alone or with the addition of sodium chloride or herbal decoctions or extracts, is the most accessible method of hydration. Along with inhalations, drinking plenty of fluids can be used.
Antitussive drugs with local anesthetic activity reduce the feeling of soreness and irritation in the throat, reduce sensitivity to various irritating factors, weakening the cough reflex. The drugs are used in the form of medicines for resorption in the oral cavity.
Local anesthetics (benzocaine, cycline, tetracaine) are also drugs with afferent action, but are used only in a hospital setting for special indications.

Pharmacokinetics
Most drugs are well absorbed after oral administration. The maximum concentration in the blood plasma of codeine is achieved after 1 hour, butamirate citrate - after 1.5 hours. In the latter case, it is 6.4 μg/ml, protein binding is 95%. Both drugs undergo biotransformation in the liver and are almost completely excreted in the urine in the form of metabolites and unchanged. T1/2 of codeine - 3-4 hours, butamirate citrate - 6 hours. The pharmacokinetics of most other drugs and their components have not been studied.

Tactics for choosing medications for cough
If the reason for prescribing medications is the cough itself, it is better to use medications that act on the specific cause of the cough for this case. Antitussive drugs are symptomatic therapy. To relieve cough associated with acute respiratory infection, moisturizing inhalations and drugs with enveloping peripheral action or their combination with non-narcotic drugs of central action such as prenoxdiazine are indicated. In the presence of sputum, it is advisable to prescribe expectorants or mucolytics. When a patient coughs with symptoms of bronchospasm, along with hydration, it is advisable to prescribe bronchodilators and anti-inflammatory drugs, however, narcotic antitussive drugs and mucolytics, with the exception of bromhexine and ambroxol, are contraindicated. For targeted suppression of non-productive cough caused by irritation of the mucous membrane of the respiratory tract (for example, with whooping cough), in children it is possible to use antitussive non-narcotic drugs of central action.

Place in therapy
Antitussive drugs are used to suppress frequent dry coughs that disturb the patient's condition. For coughs associated with irritation of the upper respiratory tract, the use of antitussive drugs with local anesthetic activity is indicated. They are drugs for symptomatic therapy in the treatment of inflammatory processes in the pharynx (sore throat, pharyngitis) and larynx (laryngitis). Actually, local anesthetics are used for afferent inhibition of the cough reflex during bronchoscopy or bronchography.

Contraindications and precautions
Prescribing antitussive drugs to a patient with a wet cough leads to stagnation of sputum in the respiratory tract, which worsens bronchial obstruction and can contribute to the development of pneumonia. Narcotic antitussives may cause respiratory depression.

Literature

1. Belousov Yu.B., Moiseev V.S., Lepakhin V.K. Clinical pharmacology and pharmacotherapy. M., 1997; 530.
2. Danilyak I.G. Cough: Etiology, pathophysiology, diagnosis, treatment. Pulmonology. 2001; 3:33-7.
3. Clinical pharmacology. Ed. V.G. Kukesa. M., 1991.
4. Lekmanov A. Cough: if treated, then with what? Materials of the VII Russian National Congress "Man and Medicine". Educational news. 2001; 19.
5. Rational pharmacotherapy of respiratory diseases: Hand. for practicing doctors / A.G. Chuchalin, S.N. Avdeev, V.V. Arkhipov, S.L. Babak et al.; Under the general editorship. A.G.Chuchalina. - M.: Litterra, 2004. - 874 p. - (Rational pharmacotherapy: Series of manuals for practicing physicians; T.5).
6. Samsygina G.A. Antitussive drugs in pediatrics. Consilium medi- sit. 2001; 2: 18-22.
7. Chuchalin A.G., Abrosimov V.N. Cough. Ryazan, 2000.

There are many remedies to combat children's cough. But the choice of a specific drug primarily depends on the presence or absence of sputum in the patient. From this point of view, all antitussive drugs are divided into 2 large groups.

Preparations for the treatment of dry cough

With a dry (or non-productive) cough, there is no sputum at all or very little is produced. This condition can be caused by both diseases of the upper respiratory tract (for example), and various non-respiratory pathologies (heart disease, nervous disorders). Doctors prescribe special medications aimed at suppressing the reflex only if attacks occur with great regularity, exhaust the child and disturb his sleep.

The action of such drugs is based either on the inhibition of cough centers in the brain (central-acting drugs) or on reducing the sensitivity of the respiratory tract mucosa (peripheral antitussives).

The first include:

• Codelac,
• Tussin-plus,
• Sinekod.

Codelac and Tussin-plus can cause respiratory depression, so in childhood they are used with great caution and only with a doctor’s prescription. Codelac in the form of syrup or tablets is prescribed to children over 2 years of age. Tussin-plus syrup - for children over 6 years old.

Sinecode, in addition to exhibiting antitussive activity, has a slight anti-inflammatory effect. In rare cases, it may cause drowsiness and dizziness. In the form of drops, the medicine is recommended for children over 2 months, in the form of syrup - after 3 years.

The most popular peripheral agent is Libexin tablets. This is a synthetic drug that reduces the excitability of cough receptors in the throat. It also has local anesthetic and bronchodilator properties. When taken, Libexin causes an unpleasant feeling of numbness in the mouth, so it can be recommended to a child only at an age when he is able to swallow a tablet whole without chewing (after 7–8 years).

Preparations for the treatment of wet cough

For wet coughs, mucolytics and expectorants are effective, facilitating the evacuation of mucus from the bronchi.

For thick, viscous sputum, it is preferable to use mucolytics. They thin out the mucus, thereby facilitating its better sliding along the walls of the respiratory tract. Such products can be used internally (in the form of syrups, tablets) or (special solutions are produced for these purposes). Since mucolytic molecules are destroyed when heated, inhalations with them are carried out only in a cold way - using.

Of the existing drugs in pediatric practice, drugs based on:

• ambroxol (Ambrobene, Lazolvan),
• bromhexine (Bromhexine Berlin-Chemie),
• acetylcysteine ​​(ACC, Fluimucil),
• carbocisteine ​​(Libexin Muco, Fluditec).

Acetylcysteine ​​and carbocisteine ​​have a stronger effect, but have an irritating effect on the mucous membranes of the digestive tract, so their use is undesirable for gastritis, colitis, and peptic ulcers.

From the first days of life, children can use drugs containing ambroxol. All other mucolytics are allowed to be used from 2–3 years of age.

Expectorants enhance the formation of mucus and peristalsis of the bronchial muscles. This group includes baking soda and various herbal remedies:

• Mukaltin,
• Pertussin,
• dry medicine for children,
• Gedelix,
• overslept,
• Gerbion,
• plantain syrup,
• Travisil,
• decoctions of coltsfoot, thyme, oregano, etc.

A special feature of herbal remedies is their reflex action. This means that they stimulate the functioning of the bronchial glands indirectly - through irritation of stomach receptors. The effect may be accompanied by a feeling of nausea, so it is better to avoid taking such drugs at an early age (up to 1 year).

Baking soda works directly. Absorbed in the intestines, it reaches the bronchi along with the blood and increases the secretion of mucus.

Expectorants are used not only orally, but also in the form of hot inhalations. Essential oils or herbal decoctions are used for procedures. Contraindications to therapy are age under 3 years and febrile conditions.

Another form of expectorant is warming rubs:

• Pulmex Baby,
• Doctor Mom,
• Barsukor,
• Eucalyptus Doctor Theiss.

They contain essential oils that have an irritating effect on the skin, increase blood flow to the lungs and stimulate the bronchial glands. Ointments are rubbed into the upper chest or back. Their use in children under 6 months is prohibited.

The “Doctor Komarovsky School” program also talks about cough suppressants for children:

When a child or adult coughs, others consider them sick. This is true, but cough itself is not a disease, but only one of the symptoms of an existing disease. Therefore, it is necessary to treat not only the cough, but also the main ailment, which everyone can have their own: from a common cold to severe pneumonia and a tumor of the mediastinum.

The causes of dry cough are varied:

• acute bronchitis and tracheitis, ARVI, bronchial asthma, COPD (chronic obstructive pulmonary disease), pleurisy, tuberculosis, tumors of the lungs and mediastinum. Read about how to treat cough with tracheitis;
• bronchial irritation from tobacco smoke, gases, dust;
• pharyngitis, laryngitis, sinusitis, rhinitis with the flow of mucus from the nasal passages into the bronchi along the back wall of the pharynx;
• heart disease with symptoms of heart failure;
• problems of the digestive system and, in particular, GERD (gastroesophageal reflux disease);
• adverse reaction of the body to inhalation of oxygen;
• consequences of taking a number of medications, for example, Amiodarone;
• pathologies of the psycho-emotional sphere, the so-called. habitual cough, etc.

The goal of the doctor (and the patient himself) is to correctly select medications to soften a dry cough and transform it into a wet one, accompanied by expectoration (separation of mucus from the respiratory tract).

In this article, we will perform a detailed analysis of antitussive drugs for dry cough. Their choice depends on the age and condition of the patient, clinical symptoms, the presence of other diseases and a number of other reasons.

Classification of antitussive drugs and agents

Cough suppressants can be classified according to various criteria, such as:

• release form;
• country and manufacturing company;
• composition: natural or synthetic components;
• mechanism of action.

In turn, antitussive drugs can be produced in various dosage forms:

• pills;
• syrup, elixir;
• drops;
• teas with extracts of medicinal plants;
• herbs and herbal preparations;
• chewing lozenges, lollipops;
• rectal suppositories.

There are other types of classifications intended for specialists. The last item in this list (mechanism of action) means that the antitussive drug belongs to one group or another. Let's take a closer look at this point.

How do cough medicines work?

Drugs

They block the cough reflex by inhibiting brain function. Prescribed with caution, especially to children, because addictive. However, there are cases when you cannot do without them: pleurisy or whooping cough with bouts of debilitating cough. Find out when and to whom they do it. Examples of a narcotic antitussive drug include: Codeine, Dimemorphan, Ethylmorphine.

Non-narcotic antitussives

Unlike the drugs in the group described above, non-narcotic drugs do not affect brain function and block the cough reflex without causing consequences in the form of addiction to the drug. They are usually prescribed for severe forms of influenza and ARVI, accompanied by a severe dry cough that is difficult to treat. An example of a non-narcotic antitussive drug is Butamirate, Glaucine, Oxeladin, Prenoxyndiosine.

Medicines - mucolytics

They are used to make a dry, non-productive cough productive. They do not suppress the cough reflex, but the patient’s well-being improves due to the dilution of sputum. With bronchitis or pneumonia, the patient's bronchi are clogged with viscous mucus, which is not released on its own due to its thick consistency. Mucoltic antitussives help clear the bronchi of sputum and, accordingly, colonies of microorganisms. Often their medicinal basis is herbs. An example of a mucolic antitussive drug is ACC, Ambroxol, Mucaltin, Solutan.

Combined action agents

In some cases, doctors prescribe combination drugs that give multiple effects to their patients. With their help, you can stop the inflammatory process, eliminate bronchospasm, and increase cough productivity. An example of a combination antitussive drug is Doctor MOM, Codelac phyto.

List of the most effective medicines

Below is a list of popular and effective antitussive drugs.

• Codeine (Methylmorphine)
  Effectively reduces the cough reflex. A single dose of the drug provides a period of rest from attacks of dry cough for 5-6 hours. It has a depressant effect on the respiratory center, which is why Codeine is rarely prescribed. Reduces the degree of ventilation of the lungs and leads to other undesirable consequences - addiction, drowsiness, intestinal lethargy, constipation. When taken simultaneously with alcohol, sleeping pills or psychotropic drugs, it can cause life-threatening conditions. This cough medicine is contraindicated in children aged 0-2 years, as well as pregnant women.
• Ethylmorphine (Dextromethorphan)
  A synthetic substitute for methylmorphine, demonstrating equally high antitussive activity. At the same time, the number and severity of side effects with this drug are much lower.
• Glaucine (Glauvent)
  This antitussive drug is available in several dosage forms - antitussive tablets, tablets, syrup. Effectively transforms a non-productive cough into a wet one, it is relatively inexpensive, but can cause arterial hypotension, weakness, dizziness or allergic reactions. This drug is not prescribed to patients with low blood pressure, who have had a myocardial infarction, or who are prone to allergies.
• Levopront
  An inexpensive, but quite effective medicine for adults and children, available in the form of drops and antitussive syrup with a pleasant taste. Side effects from taking it include upset stool, nausea, heartburn, drowsiness, weakness, skin rashes. The drug is not prescribed to pregnant and nursing mothers, as well as to patients with renal failure.
• Libexin
  Effectively fights dry cough, reduces bronchospasm, and has a local analgesic effect. The effect of taking this antitussive drug for dry cough lasts about four hours. Indications for use: ARVI, pleurisy, bronchial asthma, pneumonia, emphysema, etc. There are also side effects that can manifest themselves in the form of dry mouth, sluggish digestion, nausea, allergies.
• Sedotussin (Pentoxyverine)
  There are two forms of release of this antitussive drug - syrup and rectal suppositories. It is prescribed for dry, exhausting cough, acute and chronic forms of bronchitis, and pneumonia. A contraindication for use is a history of the following diseases: allergies to certain components of the drug, bronchial asthma, some forms of glaucoma, pregnancy, lactation, old age and age under 4 months.
• Tusuprex (Paxeladin, Oxeladin)
  A synthetic drug aimed at relieving attacks of dry cough. Side effects from taking it are possible in the form of nausea, vomiting, increased fatigue, decreased concentration, and drowsiness.
• Butamirat (Sinekod)
  The drug has a combined effect, has anti-inflammatory and expectorant effects, dilates the bronchi, and facilitates external breathing.
• Prenoxdiazine (Libexin)
  A drug of combined action and selective effect on brain activity. It does not depress breathing, relieves pain when coughing, relieves bronchospasm, and reduces the excitability of peripheral receptors. It is prescribed with special caution to expectant mothers.
• Tussin Plus
  Syrup based on guaifenzine and dextromethorphan, which has expectorant and antitussive effects. Can be used in the treatment of adults and children from six years of age.
• Stoptussin
  Two dosage forms: oral drops and tablets. The main active ingredient is butamirate, which has a bronchodilator, analgesic, and antitussive effect. Another component in this antitussive drug is guaifenzine, which acts as a mucolytic.
• Bronholitin
  A combination drug, one of the most popular among ENT doctors and their patients. The active ingredients in it are ephedrine and glaucine, thanks to which a dry cough becomes less painful and painful, inflammation and bronchospasm are reduced, and the patient’s well-being improves. Available in syrup form for children from three years of age and adults.

Safe antitussives for children

• Lazolvan (Ambrohexal, Ambrobene)
  They are based on ambroxol, which strengthens the child’s body’s immunity and has an anti-inflammatory effect. These antitussive drugs for dry cough are even given to premature babies.
• Bronkatar (Mukopront, Mukodin)
  The active ingredient in them is carbocisteine, which helps thin the sputum and increase the activity of cells that produce bronchial secretions.
• Bromhexine
  Effectively thins mucus and removes it from the respiratory tract.
• Bronchicum
  A herbal preparation available in the form of syrup, elixir and lozenges. Indicated for children from six months of age with a dry cough with difficult to separate sputum.
• Linux
  Another drug based on herbal raw materials with antitussive, antispasmodic and mucolytic effects. Indicated for children from one year of age and only with a doctor's prescription, because has an effect on blood glucose levels.
• Libexin
  Can be taken at the first sign of a cold. The drug suppresses the cough reflex without inhibiting respiratory functions at the level of the central nervous system. Bithiodine pills have approximately the same effect.
• Chest collection No. 1, 2, 3, 4; Phytopectol No. 1,2
  Collections of medicinal herbs for self-preparation of decoctions and infusions. The composition includes marshmallow root, licorice, oregano; plantain, sage, coltsfoot, wild rosemary, chamomile, mint, violet, pine buds, etc.

In this vein, the question arises: are drugs that block cough at the brain level (for example, codeine, ethylmorphine, dimemorphan) used in the treatment of children?

Answer: this happens extremely rarely and only in emergency cases, when it is urgently necessary to stop a painful attack of dry cough due to whooping cough, pleurisy, or a malignant tumor of the mediastinum.

Drugs allowed during pregnancy

While waiting for a baby, the expectant mother's body is extremely vulnerable, and her immunity is reduced. We can say that the pregnant woman and the fetus share the same metabolism. Therefore, the choice of antitussive drugs during pregnancy should be approached very carefully and nothing should be taken without a doctor’s prescription. Without going into details of how this or that substance crosses the placental barrier, we will provide general information about which antitussive drugs for dry cough can be taken during pregnancy.

• I trimester
  Mucaltin, Equabal, marshmallow root are herbal preparations that can be consumed without fear.
  Bronchicum, Gedelix, Doctor IOM - used as prescribed by a doctor. The possible effect on the embryo has not been studied enough.
  Libexin is a synthetic drug prescribed to a pregnant woman in the first trimester only in exceptional cases.
  As an addition to the main treatment, dietary supplements can be used: Floraforce, Mamavit, Bifidophilus, Pregnacare.
• II and III trimesters
  In the second and third trimesters of pregnancy, in case of dry cough, you can use the drugs recommended for the first trimester.
  In particularly difficult cases, instead of the above-mentioned Libexin, you can (as prescribed by a doctor!) use Acodin, Bromhexine, Stoptussin.

Find out about antibiotics allowed during pregnancy.

Patient Guide: Important information about cough treatment

In the process of treating dry cough, patients make many mistakes. This guide will help you avoid them.

1. Before starting treatment, you should make sure that it is a dry (and not wet) cough.
2. The choice of antitussive therapy is the prerogative of the doctor, because He is the one who knows the mechanism of action of a particular drug, indications, contraindications and side effects.
3. The simultaneous use of mucolytics and drugs that suppress the cough reflex is prohibited.
4. A cough accompanied by vomiting and severe shortness of breath cannot be treated at home. Especially if the patient is a child.
5. A dry cough that lasts more than six weeks and cannot be treated using standard regimens should be a reason to visit a doctor.
6. The doctor selecting medications for dry cough must be informed about existing chronic diseases, such as diabetes, allergies, hypertension, glaucoma, etc. This will reduce the risk of side effects.

Don’t forget about traditional medicine - inhalations, irrigations, mustard plasters, cups, etc. In combination with traditional medicine, they will help you get rid of dry cough as quickly and effectively as possible.

Antitussive drugs occupy a special niche in the science of pharmacology, since cough is one of the common symptoms of most pathologies.

Being a reflexive and protective reaction, the cough reflex accompanies almost all acute respiratory tract infections, tuberculosis, cardiac pathology, neoplastic processes and chronic damage to the bronchopulmonary system, some diseases of the digestive tract.

When are antitussives prescribed?

Antitussives and expectorants have a wider range of uses:

Acute respiratory tract infections viral and bacterial etiology (pneumonia, influenza, bronchitis, parainfluenza, laryngitis, etc.).

In most cases, mucolytic and expectorant agents are used, which help reduce viscosity and remove mucus from the lungs and bronchial tree.

However, for a disease such as whooping cough, antitussive drugs with a central mechanism of action are prescribed, since irritation of the cough center by bacterial toxins plays a leading role in the pathogenesis of the disease.

Chronic bronchopulmonary pathology, accompanied by coughing attacks and the formation of thick purulent sputum in the bronchi and alveoli (bronchial asthma, cystic fibrosis, bronchiectasis, chronic bronchitis, alpha1-antitrypsin deficiency and much more).

Medicines that dilate the bronchi and reduce the amount of sputum are part of the ongoing pathogenetic therapy for the above pathologies.

For broncho-obstructive syndrome as a result of accumulation of mucus in the lumen of the bronchi, aspiration of a foreign body or liquid; compression of the bronchi by endo- or exogenous neoplasms. In this case, antitussive medications act as relieving symptomatic therapy.

Edema of the lung parenchyma due to heart or pulmonary failure. The accumulation of transudate in the alveoli not only makes breathing difficult, but also provokes the appearance of a cough reflex, the elimination of which will alleviate the patient’s condition.

Other reasons: to prepare the patient for a bronchoscopic examination or contrast bronchography, in the first 24-48 hours after inhalation anesthesia, to relieve cough in case of diaphragmatic hernia, gastroesophageal reflux disease.

Thus, there are quite a large number of reasons for prescribing certain antitussive drugs.

Antitussive drugs: classification by mechanism of action

Having a completely different composition of active components from each other, cough remedies are also divided into three main classes depending on the mechanism of action.

List of the best medicines:

1. Substances that depress the cough center(Codeine, Omnitus, Sinekod, Stoptussin, Sedotussin, Kodipront, Tussal, Libexin, Dionin, Ledin, etc.).
2. Combination medications(Codelac, Redol, Glycodin, Codterapin, Bronholitin).
3. Secretolytics and expectorants(Erespal, ACC, Lazolvan, Bronchorus, Ambroxol, Bromhexine).

Most of them are successfully used in pediatrics, as proven by experimental and clinical medical experience.
Source: website

Drugs that suppress the cough center

First of all, medicinal substances that have a direct effect on the cough center are divided into opioid and non-opioid, which depends on their point of application.

In the first case, the chemical components of the drug competitively bind to opioid receptors in the medulla oblongata and other nerve centers, suppressing their function.

The most popular narcotic antitussive medications from this group are Codeine, Dionine and Folkodin.

They not only weaken the severity of the cough reflex, but are especially effective for dry, painful coughs.

Among the side effects of the above medications, it is worth highlighting dryness of the mucous membrane of the respiratory tract. This will slow down recovery or aggravate the course of the disease in the case of a productive cough.

In addition, addiction to Codeine and its analogues often develops, which limits the use of the drug.

The drugs of choice from this group are Tussal and Dastozin, since they do not have a narcotic effect, do not contribute to the development of addiction and have a small number of adverse reactions, both from the whole body and from the respiratory tract.

Non-opioid drugs affect non-opioidergic tracts, due to which they do not cause tachyphylaxis, drug addiction.

This allows them to be used much more often and even in children. The mechanism of action is to inhibit the peripheral part of the cough reflex and tension receptors in the bronchial mucosa.

The most well-known drugs from this group are Sinekod, Tusuprex, Sedotussin.

Peripheral antitussive medications

These medications reduce the activity of the cough reflex by inhibiting sensitive receptors of nerve fibers from the vagus nerve, which are located in the organs of the respiratory system.

Libexin is a peripheral antitussive agent with anesthetic properties and a slight bronchodilator effect.

The drug does not depress the respiratory center at all and does not contribute to the formation of drug dependence.

When used as a symptomatic treatment of chronic bronchitis, local anti-inflammatory effects were also noted.

Bithionil and Levopront mainly act on peripheral receptors in the mucous membrane of the bronchial tree, reducing their activity and sensitivity.

Combined action antitussives

In this case, the medications not only affect the cough center, but also have a number of other effects that improve the functioning of the bronchopulmonary system:

1. Codipront - contains methylformint (a substance that acts on opioid receptors in the medulla oblongata) and phenyltoloxamine, an antihistamine that inhibits the production of inflammatory mediators. The remedy is especially effective for dry allergic cough.
2. Codelac - due to its composition (licorice root, thermopsis, sodium bicarbonate and methylmorphine) has an antitussive and mucolytic effect.
3. Redol contains salbutamol and dextromethorphan, which achieves an additional bronchodilator effect.
4. Bronholitin contains ephedrine, basil camphor oil, and glaucine. This gives the drug an additional antimicrobial and bronchodilator effect.
5. Stoptussin (of the active ingredients contains butamirate and guaifenesin) also has a good expectorant and mucolytic effect.

It is worth noting that cough medications with a central or peripheral mechanism of blocking the center or receptors should not be prescribed in the presence of thick and difficult to separate sputum.

Mucolytics and mucokinetics

Antitussive tablets and syrups used for wet coughs are also divided into subgroups:

1. Mucolytics - tablets and syrups that dilute sputum (Ambroxol, or Lazolvan, Bromhexine, Acetylcysteine, proteolytic enzymes).
2. – stimulate the work of bronchial smooth muscles (Mukaltin, marshmallow root, Terpinhydrate, thermopsis herb).
3. Combined - have a number of additional effects (Ascoril, Solutan, Erespal).

Ambroxol, which is part of Lazolvan, stimulates the secretion of mucus in the respiratory tract.

In addition, the substance enhances the biosynthesis of alveolar surfactant and activates the work of cilia of the bronchial epithelium. All this dilutes the mucus and increases its discharge.

The drug is available in tablets, ampoules for intravenous administration and inhalation, and syrup for children. Among the side effects, it is worth noting the possibility of developing bronchospasm, so the drug is not used for bronchial asthma.

Most often, the medicine is used for bronchitis, especially chronic, severe bronchopulmonary pathology (cystic fibrosis, bronchiectasis, pneumonia).

Mucaltin is a fairly cheap and effective medicine that is often used in pediatrics. Due to the marshmallow content, the medication stimulates the functioning of the bronchial glands, ciliated epithelium and smooth muscles of the respiratory tract.

Often used for pneumonia, bronchial obstruction, bronchiectasis.

Ascoril is a combination medication containing salbutamol, bromhexine and guaifenesin. It has a pronounced mucolytic effect and also expands narrowed bronchi.

Indicated for use in cases of pneumonia, acute bronchitis, whooping cough, tracheitis and bronchial asthma. The instructions indicate that the product is only suitable for children over 6 years of age.

Antitussives for dry cough

The most powerful antitussive for dry cough is, of course, Codeine. However, the high frequency of adverse reactions allows only rare use of the drug in a short course. In addition, any medications containing codeine are prohibited in childhood.

If a medicine with an anesthetic effect for cardiac cough is needed, doctors opt for Dastosin or Folkodin.

Both drugs act on opioid receptors, thereby inhibiting the cough center and achieving analgesia. As a rule, Dastosin is dosed per capsule no more than four times per day.

Effective medications for dry cough for adults are Codelac (in the form of syrup and tablets), Codipront, Omnitus capsules (take 1 piece three times a day until the cough disappears).

For dry cough in children, the following are most often prescribed:

• Codelac Neo drops (allowed from 2 months) – 10-25 drops four times a day.
• Sinekod - has a similar dosage and frequency of use with Codelac.
• Omnitus in syrup (allowed from 3 years of age) – 2-3 scoops three times a day.
• Stoptussin - used from 6 months, 8-30 drops (depending on body weight) three times a day.

All of the listed medications can be given to a child only

Antitussives for children

Before giving your child any medicine, you must consult with your doctor, otherwise you can seriously harm the baby’s health. Not all medications are approved for children.

The most effective and safe antitussives for children: Mucaltin (from infancy), Lazolvan (from the neonatal period), Bromhexine (in tablets only from 6 years), Omnitus (from 3 years), Bronholitin (from three years).

Remember! You should not prescribe strong antitussives or, conversely, mucolytic medications to children on your own, since there is a high risk of stagnation of secretions in the lungs and reflex bronchospasm.

Drugs for pregnant women: what is possible?

If during pregnancy there is a need to prescribe medications, then the doctor faces a serious task, since he must weigh all the possible risks for the unborn child and the potential benefits for the woman.

The safest products for a pregnant woman are plant-based Mucaltin, Sinekod, Bronchicum, breast preparations, Ascoril, Thermopsis, Ambroxol and Broncholitin.

Antitussive syrups

Not all medications intended for cough relief are available in liquid form.

The best and most famous of them:

• Bronholitin.
• Ambroxol.
• Erespal.
• Sinekod.
• Stoptussin.
• Omnitus.
• Bronchorus.

The liquid form allows the drug to be used in childhood, reduces pain in the throat and behind the sternum during a hacking cough. However, it is not recommended to abuse syrups if there is a tendency to spontaneous laryngo- or bronchospasm.

Antitussives for wet coughs

For diseases with a wet cough and sputum in the lungs, mucolytic or expectorant medications are used. In some cases, a combination of these is possible.

Mucaltin is approved from childhood and is available in tablet form, which can be dissolved in water or taken directly orally with liquid.

Prescribe 1-4 tablets three to four times a day for up to two weeks. If necessary, the duration of treatment can be increased.

Bronholitin perfectly stimulates the discharge of sputum and is used in adults 10.0 ml up to 4 times a day. Lazolvan is prescribed 5.0 ml three times a day.

Erespal is dosed as follows: from 3 to 6 scoops per day, preferably before meals. Bromhexine stimulates mucus production when two tablets are used at least twice a day.

Folk antitussives

Among folk recipes for cough elimination, special chest preparations are often used, which are numbered from 1 to 4.

They include calendula, sage, licorice, marshmallow, eucalyptus, hawthorn and many other herbs. You can buy the medicine at any pharmacy, and at a low price.

Effective herbal cough remedies - coltsfoot, wild rosemary herb, plantain leaf, herbion, thyme.

All herbs can be easily found at the pharmacy; the main thing is to brew and take according to the included instructions.

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