Phlegm increases inflammatory processes in the bronchi and lungs - expectorants are needed to remove it from respiratory tract. For a dry cough, such medications are usually not prescribed so as not to worsen the patient’s condition.
Expectorants are necessary to remove mucus
A reflex cough occurs when the body’s normal process of mucus elimination is disrupted. In case of illness, it helps remove mucus, pus, and sputum from the tracheobronchial tree.
Expectorants are prescribed to help the human body cope with difficult-to-clear phlegm.
They have different effects:
Before using expectorant medications, it is important to consider their contraindications and follow the instructions for use.
Herbion with ivy extract helps against cough with phlegm and respiratory diseases.
When not to take:
Gerbion - syrup to improve expectoration
Admission rules:
How it can harm:
Price – from 250 rubles.
Mucolytic tablets ACC thin sputum due to the action of acetylcysteine.
Indications:
When not to take:
ACC tablets contain acetylcysteine.
Admission rules:
How it can harm:
Price – from 200 rub.
An effective remedy that helps cope with phlegm in adults thanks to the active ingredient – ambroxol hydrochloride.
Indications:
Ambrobene is an effective expectorant
When not to take:
Admission rules:
How it can harm:
Ambrobene capsules can be purchased at a price of 250 rubles.
Thanks to bromhexine, chloride has a mucolytic effect. Bromgeskine is a children's medicine, but can also be prescribed to adults.
Indications:
Bromgeskin syrup is suitable for children and adults
When not to take:
Admission rules:
How it can harm:
Price – from 85 rub.
Used for wet cough. Active ingredient medicinal product– ivy leaf extract. Prospan is manufactured at plant based, so it is often prescribed for children.
Indications:
When not to take:
Prospan drops contain ivy leaf extract
Admission rules:
How it can harm:
Price – from 340 rub.
A mixture that removes mucus from the bronchi, diluting it. The active ingredient of Pertussin is thyme herb extract. This product is inexpensive, but quite good.
Indications:
When not to take:
Pertussin helps remove phlegm
Admission rules:
How it can harm:
Price – from 23 rub. per bottle.
Prescribed to a child when it is necessary to improve sputum discharge. The active ingredient is carbocisteine.
Fludetec is a mucolytic and has an anti-inflammatory effect.
Indications:
When not to take:
Fluditec - syrup for the treatment of cough in children
Admission rules:
How it can harm:
Price – from 370 rub.
Cheap tablets with a herbal active ingredient - marshmallow extract. Mucoltin is prescribed to clear mucus from the respiratory tract.
Indications:
When not to take:
Mucaltin - affordable cough tablets
Admission rules:
How it can harm:
Price – from 12 rub.
The active ingredients of Broncholitin syrup are glaucine hydrobromide and ephedrine hydrochloride.
Indications:
When not to take:
Broncholitin is an effective expectorant
Admission rules:
How it can harm:
Price – from 250 rub.
Lazolvan sputum-thinning tablets contain the active ingredient amboxol hydrochloride.
Indications:
When not to take:
Lazolvan tablets thin sputum
Admission rules:
How it can harm:
Price – from 153 rub.
The list of active ingredients is as follows: thermopsis extract, ambroxol, sodium bicarbonate, sodium glycyrrhizinate.
Indications:
When not to take:
Codelac broncho - combination drug for cough treatment
Admission rules:
How it can harm:
Price – from 180 rub.
There are many folk remedies, which and other diseases accompanied wet cough. Take after consulting a doctor. Usually, medicine prepared at home must be taken together with medications.
The following recipes are popular:
Simple lemon juice and honey effective remedy for expectoration
Mukaltin has herbal composition and fewer contraindications. The doctor may think that this remedy is the best.
Mucaltin cannot replace Ambroxol. Therefore, if the doctor prescribed a second drug, then it is worth purchasing it. Syrup is often prescribed to children with pneumonia as part of complex therapy.
Children are often prescribed Ambroxol. It acts more gently and is less harmful to the child’s body.
For an adult, ACC is the best. Ambroxol is more often prescribed to children because it is sold in syrup form and is easier to give to the child.
They have the same effect. If it is more convenient for the patient to drink syrup, then Pertussin will be prescribed. During pregnancy, Mucaltin will be prescribed.
If a medicine is prescribed to a child, then ACC is a priority. Codelac Broncho should not be taken by children under 12 years of age. For smokers, Codelac will be prescribed because it can relieve cough smoking man.
Mucolytics are substances that help “breathe deeply” by thinning mucus and clearing the airways. Most often, the indications for their use are acute bronchitis, chronic bronchitis, chronic obstructive pulmonary disease. Which drug is more effective, and can they be taken together? To answer these questions, let's get acquainted with the features of these medicines and compare them therapeutic effect.
They belong to the pharmaceutical group of mucolytic drugs, however active ingredients they are different. In Ambroben active component is ambroxol, and in ACC - N-acetyl-L-cysteine.
Manufactured by MERCKLE (Germany) in the form of:
Long-acting capsules (75 mg) - 20 pcs. ACC is produced in Germany and Austria(Hermes Arzneimittel, Hermes Pharma) for SANDOZ. It also has several dosage forms:
The work of the system that cleanses our lungs and bronchi does not stop for a second. Millions of cilia located on the epithelial cells of the respiratory tract oscillate smoothly (and very quickly - 25 times/sec!) and promote mucous secretion from lower sections respiratory tract to the upper.
According to some estimates, 1 cm 3 of air can contain up to 10,000 tiny dust particles. They inevitably end up in respiratory system when inhaled and settle on the surface, adhering to the mucous layer. Therefore, secretion and expectoration of small amounts of mucus is a natural physiological process of cleaning our lungs. Otherwise, they would become clogged with dust, soot and other harmful substances that would not allow normal gas exchange to occur.
During inflammation, the production of mucous secretion increases, it thickens, and it becomes more difficult for the ciliated cells to lift it to the surface. In this case, breathing becomes difficult, and with obstruction (narrowing of the airway) it can generally lead to dangerous consequences. Mucolytic and expectorant drugs, such as acetylcysteine and ambroxol.
Mucolytic agents usually have three points of action:
Ambroxol has all of the above properties. It stimulates the production of surfactant in type II pneumocytes. This substance is called pulmonary surfactant, and it helps maintain the shape of the alveoli (vesicles) of the lungs, preventing them from collapsing. Surfactant reduces the adhesion of mucus to the bronchial wall, which improves its elimination.
In addition, ambroxol increases the secretion of serous cells, which leads to a decrease in mucus viscosity. It increases the motility of the ciliated epithelium, which is expressed in accelerating the removal of sputum from the bronchopulmonary tree.
It's interesting that in lately others were installed beneficial properties ambroxol. It turned out that he has:
Recent studies have shown that ambroxol reduces the accumulation of the toxic protein alpha-synuclein in brain neurons. Aggregation of this protein is one of the factors in the pathogenesis of Parkinson's disease. Scientists believe that using ambroxol can slow down the progression of the disease.
N-acetylcysteine(ACC) thins mucus in a different way. It destroys the chemical bonds between the molecules of mucopolysaccharides, which are the basis of the mucous secretion. As a result, the mucus becomes less viscous.
In addition, acetylcysteine has a number of other positive effects:
Together, the doctor can prescribe them for moderate and severe forms bronchopulmonary diseases. Wide range dosage forms of both drugs and the complementary mechanism of action allows their combined use, for example, in the form of Ambrobene inhalations and ACC tablets.
The compatibility of ambroxol and acetylcysteine is also supported by their presence in combination in some preparations, where each component is presented in half the dosage. However independent decision You should not take these medications together or alone. Both drugs have side effects and contraindications, so you should consult your doctor about the possibility of taking them for your illness.
ACC in any form (syrup, granules, effervescent tablets) is contraindicated in children under 2 years of age. According to the instructions, children
Ambrobene (in the form of syrup and solution for oral administration and inhalation) can be given to children under 2 years of age. The instructions for the drug contain a mandatory instruction that use should be under the supervision of a physician. For children from 6 years of age it is possible to use it in the form of tablets of 30 mg, and from 12 years of age - in capsules of 75 mg.
From all of the above we conclude that Ambrobene would be better suited for infants. However, in general pediatric practice both drugs show good results. For example, this is evidenced clinical trials conducted to compare what is more effective. In children with spastic bronchitis aged 2 to 13 years, after a 10-day course of treatment with 30 mg ambroxol or 0.2 mg acetylcysteine, both drugs were found to be effective and well tolerated by patients.
It was noted that signs of improvement, assessed by the quantity and quality of sputum, the presence or absence of shortness of breath, difficulty expectorating - occurred faster when taking ambroxol than acetylcysteine.
So, if you have already consulted with a doctor about what is best for your disease, then it will be useful to find out about the cost of a course of treatment with the chosen drug.
For adults with a cold, a course of treatment of 7 days at the rate of 3 sachets of 0.2 g per day will require 21 sachets. Price ACC packaging(20 bags) approximately 145 rub. The same amount will be required effervescent tablets(200 mg), but their cost is 2 times higher.
For adults, Ambrobene tablets (30 mg) are recommended to be taken for 5 days: 3 tablets in the first three days and 2 tablets in the remaining days, although there is a caveat that at first the dose can be increased to 4 tablets. This means you may need from 13 to 16 tablets. A package of tablets (20 pcs.) costs about 160 rubles.
ACC is a mucolytic agent that thins viscous sputum, which facilitates its removal from the bronchi. Combines well with other cough medicines and increases the effectiveness of antibiotics. The active substance includes acetylcysteine. ACC is available in different dosage forms for adults and children with younger age.
In case of intolerance or persistent side effects medicine replaced with analogues. Some of them are identical in structure to the original and are called generics. Others contain other active substances, but have the same therapeutic effect. The cost of analogues is often cheaper, which reduces treatment costs. The effectiveness of such drugs is not inferior to the original, and in some cases they have advantages in therapy.
Manufacturer: Sandoz (Slovenia) or Hexal (Germany), depending on the dosage form.
Active substance ACC is represented by acetylcysteine, a derivative of the amino acid cysteine. This is the main component of the drug, which determines the therapeutic effect on the body. Acetylcysteine affects the rheological properties of sputum, which leads to a decrease in its viscosity. It can dilute both mucous and purulent bronchial secretions.
In addition to mucolytic, it has an antioxidant effect. Neutralizes free radicals, formed during inflammation, thereby protecting the bronchial mucosa from damage. Prevents the attachment of pathogenic bacteria and can be used for prevention respiratory diseases.
Included excipients includes sucrose and lactose. This must be taken into account when prescribing therapy for patients with diabetes mellitus and impaired absorption of carbohydrates in the body.
>>Recommended: if you are interested effective methods getting rid of chronic runny nose, pharyngitis, tonsillitis, bronchitis and constant colds, then be sure to take a look at this site page after reading this article. Information based on personal experience author and has helped many people, we hope it will help you too. Now let's return to the article.<<
ACC is available in several dosage forms for ease of use by adults and children. All options are presented in a liquid consistency, which improves absorption in the digestive tract and softens the irritating effect on the gastric mucosa.
The drug can be purchased in effervescent tablets of 100 mg, which must be dissolved in a glass of water. They have a pleasant blackberry flavor. Mostly prescribed to adults. Children may not like the drug due to the presence of a faint sulfuric odor.
The next dosage form is granules in sachets of 100 mg for the preparation of a solution that is taken orally. They are poured into a glass of water and stirred until a homogeneous liquid appears. The granules can also be diluted in juice or iced tea. The solution has a citrus smell and taste and is prescribed to adults and children.
Transparent viscous syrup is the third form of the drug. It has a cherry flavor and a sweet smell. Recommended for use by children, especially at an early age. To take the prescribed dose, use a measuring syringe or cup, which is included in the package.
The drug is used for diseases of the lower, less often the upper, respiratory tract. ACC is highly effective when coughing due to viscous sputum, which is difficult to separate from the bronchi. In case of chronic pathology of the respiratory system, the drug is included in maintenance therapy along with other medications.
Cough is often the real problem - this cold symptom lasts the longest and, as a rule, causes the most inconvenience. Moreover, an untreated cough can cause serious complications. This is why it is worth using the most effective, proven means to treat cough.
The choice of cough suppressants should be determined by a number of nuances. Chief among them is whether the cough is wet or dry. Mucolytics and expectorants are used to treat wet cough. Treatment of dry cough requires the use of drugs that suppress the cough reflex. Both for the treatment of dry cough and for the fight against wet cough, many products are produced so that it is quite difficult to navigate among them. We bring to your attention the most effective cough remedies: perhaps our review will help you choose the best treatment option.
ACC is one of the most popular drugs for wet cough. The product helps to thin the mucus, making it clear quickly and making the cough more productive. ACC acts quite quickly - significant relief occurs already in the first days of use. The drug can be used by nursing mothers and children starting from the 10th day of life. It is not recommended for pregnant women.
When using ACC, it is important to consider that the drug is not combined with paracetamol. Also, it should not be used together with other antitussive medications - otherwise there is a danger of respiratory tract congestion.
Cost - about 250 rubles.
"Doctor Mom" is a herbal preparation that is used as an expectorant for wet coughs. The medicine contains aloe, basil, ginger, licorice, elecampane and other herbal ingredients. "Doctor Mom" has a very wide scope of application and can be used in the treatment of a whole range of diseases, from pneumonia to laryngitis. The medicine provides rapid liquefaction and removal of sputum. If you use Doctor Mom to treat a dry cough, it quickly turns into a productive wet cough.
"Doctor Mom" is available in syrup form, as well as in the form of fruit-flavored tablets. Lozenges can be used from the age of 14; the syrup form is used to treat cough in children over 3 years of age.
The cost of syrup is about 170 rubles.
Falimint is a local remedy - these are lozenges that are effective for dry, unproductive cough. Falimint relieves irritation, thins mucus, and anesthetizes. The product is quickly absorbed, resulting in relief almost instantly. Falimint tablets can be dissolved up to 10 times a day, but they should not be used for more than a few days. This drug is not prescribed to children under four years of age, nursing women or pregnant women.
Cost - about 170 rubles.
Libexin is used in the treatment of dry cough, the appearance of which is associated with colds, flu or bronchitis. These cough tablets are very affordable and quite effective. The action of Libexin is to reduce the sensitivity of cough receptors and suppress the cough reflex. At the same time, Libexin does not have an inhibitory effect on the respiratory center. Libexin has an anti-inflammatory effect and also provides sputum thinning.
Video recipe for the occasion:
The drug is used to treat dry cough in adults and children; it has no serious contraindications. For young children, Libexin should be used with caution.
Cost - about 350 rubles.
Stoptussin is a popular antitussive drug that simultaneously inhibits the cough reflex and provides a mucolytic effect. Stoptussin is a very effective remedy, but the tablets have a large list of contraindications. In particular, they should not be used by pregnant or breastfeeding women, or children under 12 years of age. Stoptussin can cause a whole range of side effects, from allergic reactions to headaches. Therefore, it is better to use it only in cases where the cough is very severe and requires intensive treatment.
Cost - about 160 rubles.
Bronholitin is a syrup with a combined effect. It has an antitussive effect and at the same time expands the bronchi. The action is complemented by an anti-inflammatory effect. Broncholithin is used in the treatment of many diseases, from whooping cough to asthma. The syrup quickly alleviates the condition and is considered quite safe - it is also actively used in pediatrics, for the treatment of cough in children over 3 years of age. At the same time, it is not recommended to use Bronholitin during pregnancy and breastfeeding.
Cost - about 150 rubles.
Bromhexine is used in the treatment of wet cough. It is available in the form of tablets and mixtures and has a mucolytic and expectorant effect. Bromhexine can be used to treat cough, including in children aged 3 years and older. If necessary, the product can be used for a long time - up to 4 weeks without breaks. It has a pronounced effect and helps to quickly cope with cough.
The cost of the medicine is about 160 rubles.
Ambroxol is one of the most popular remedies for wet cough. The tablets have an expectorant and mucolytic effect, helping to cope with cough very quickly. Ambroxol combines well with a number of other drugs, increasing the effectiveness of antibacterial and anti-inflammatory therapy.
Ambroxol is an inexpensive drug that has many complete analogues (for example, the rather expensive Arobene, Lazolvan, etc.). The drug is often prescribed even to small children - it is safe and at the same time effective.
Cost - about 40 rubles.
Mucaltin is a very well-known remedy; these are tablets that contain only one active ingredient - marshmallow extract. Mucaltin is used for wet coughs to thin sputum and facilitate coughing. The tablets also have an anti-inflammatory effect and increase bronchial secretion. This drug is considered one of the most effective in treating wet cough.
Cost - about 10 rubles.
When coughing, Doctor Mom ointment is recommended to be applied to the chest or back. It has a warming effect and helps cope with both wet and dry coughs. The main active ingredients are menthol and eucalyptus oil. This ointment can also be used to treat coughs and colds in young children. The only limitation is that you should not use Doctor Mom ointment at high temperatures (due to the warming effect, it may increase further).
Cost - about 80 rubles.
In any case, it is better to trust a doctor when selecting cough remedies - self-medication can be dangerous. When using this or that cough remedy, it is important to strictly follow the dosage and instructions for use.
Thus, when treating patients with chronic obstructive bronchitis, there is a need not only to influence the rheology of sputum, but also to protect the tracheobronchial tree and lung parenchyma from the destructive effects of mucolytic drugs.
It became such a drug ambroxol(Lazolvan, Ambrosan, Ambrobene, Mukosolvan), synthesized at Boehringer Ingelheim, which is an active metabolite of bromhexine (Table 18.1).
Table 18.1
Comparative characteristics of the most commonly used mucolytics
Ambroxol*, Bromhexine | Acetylcysteine | Carbocisteine |
|||||
Molecule | N-(2-amino-3,5-dibromobenzyl)-N-methylcyclohexamine. Derivative of the alkaloid vasicine, *active metabolite of bromhexine | N-acetyl-L-cysteine. Cysteine derivative with a free thiol group | S-carbocysteine. Cysteine derivative with a blocked thiol group |
||||
Mechanism of action | Stimulation of the production of alveolar and bronchial surfactant, neutral mucopolysaccharides (more pronounced in ambroxol), depolymerization of acidic mucopolysaccharides. Secretolytic, secretomotor and antitussive effect | Effect on disulfide bridges of sialomucins in the surface layer of bronchial mucus. Has a quick effect. Active in vitro. Only mucolytic effect | Stimulation of sialic transferase activity. Stimulation of regeneration of the mucous membrane of the respiratory tract and the production of normal physiological mucus. Active only in vivo. Mucolytic and mucoregulatory effect |
||||
Ambroxol*, Bromhexine | Acetylcysteine | Carbocisteine | |||||
Application point | Type II pneumocytes - stimulation of surfactant production. Goblet cells - a change in the nature of mucus produced. Bronchial mucus - thinning of mucus. Effect on mucus requires penetration through the mucous membrane (if taken orally) | Bronchial mucus. Locally active in aerosol. Oral administration requires mucosal penetration to initiate action | Bronchial mucus - change in viscosity, goblet cells - decrease in the viscosity of the mucus produced, respiratory mucosa - decrease in the number of goblet cells. Penetration into mucus through the mucous membrane is not required for the onset of action | ||||
Mucolytic effect | Reduces adhesion of bronchial secretions; the effect on viscosity and elasticity is less noticeable | Reduces the viscosity and elasticity of bronchial mucus, even if they are very low. The mucus becomes too liquid, and there is a risk of “flooding” the bronchi | It has a normalizing effect on the viscosity and elasticity of mucus, regardless of whether these indicators are increased or decreased, which, in turn, optimizes mucociliary transport | ||||
Mucoregulatory effect and mucosal protection | Activates the activity of the ciliated epithelium by increasing the content of surfactant and reducing the viscosity of mucus | There is no mucoregulatory effect. Reduces IgA secretion, has an antioxidant effect | Activates the activity of the ciliated epithelium, reduces the number of hyperplastic goblet cells, activates the secretion of IgA, increases the amount of SH-containing mucus components | ||||
see continuation
Table 18.1 (continued)
Ambroxol*, Bromhexine | Acetylcysteine | Carbocisteine |
|||
Methods of administration | Orally (tablets, capsules, drops, syrups). Intratracheal (inhalation and instillation). Parenteral (i.m., i.v., s.c.). | Oral (tablets, capsules, effervescent powders and tablets). Intratracheal (inhalation, instillation). Parenteral (i.m., i.v.) | Oral only - syrups |
||
Pharmacokinetics | Completely absorbed from the respiratory tract and gastrointestinal tract; metabolized in the liver to form active metabolites; bioavailability 80%; Ti/2=l hour, capable of cumulation; eliminated by the kidneys; in case of liver failure, the clearance of bromhexine decreases, in case of renal failure - the clearance of ambroxol | Completely absorbed from the respiratory tract and gastrointestinal tract, metabolized in the liver, bioavailability is low - 10%, maximum saturation after 1-3 hours, T1/2 = 1 hour, in case of liver cirrhosis - up to 8 hours; elimination is predominantly hepatic, the main metabolite is pharmacologically active, onset of action after 30-90 minutes, duration of action up to 2-4 hours | Completely absorbed from the gastrointestinal tract, Ti/2=3 hours 15 minutes, maximum blood level by the 2nd hour, duration of action up to 8 hours |
||
Ambroxol*, Bromhexine | Acetylcysteine | Carbocisteine | |||
Side effect | Ambroxol (extremely rare): runny nose, vomiting, diarrhea; rash on the skin and mucous membranes with or without itching; shortness of breath (when using injection forms); anaphylactic reactions (oral solutions contain sulfates); Bromhexine: risk of increased bronchial obstruction in particularly sensitive individuals. | Risk of worsening bronchospasm; risk of bronchial “flooding”, the need for immediate aspiration of liquefied bronchial contents; high risk of anaphylactic reactions with injection forms (used only in hospitals); runny nose, stomatitis when using aerosols | Minor: gastralgia, constipation | ||
Ambroxol stimulates the formation of tracheobronchial secretion of low viscosity by changing the chemistry of sputum mucopolysaccharides: firstly, depolymerizing, destroying acidic mucopolysaccharides of bronchial mucus, and secondly, stimulating the production of neutral mucopolysaccharides by goblet cells. Also important is the ability of the drug to restore mucociliary clearance by stimulating the motor activity of the cilia of the ciliated epithelium.
A distinctive feature of the drug is its ability to increase the synthesis and secretion of surfactant and block the breakdown of the latter under the influence of unfavorable factors. This ability of ambroxol makes it necessary to use it in patients on long-term oxygen therapy (which destroys surfactant) or mechanical ventilation. Having a positive effect on surfactant production, ambroxol indirectly increases mucociliary transport, which, in combination with increased secretion of glycoproteins (mucokinetic effect), causes a pronounced expectorant effect of the drug.
The drug does not have a teratogenic effect, so it is one of the few that can be used in pregnant women and during lactation. The ability to potentiate the synthesis of surfactant and the absence of a teratogenic effect makes it possible to use the drug for the prevention of respiratory distress syndrome in newborns, when prescribing the drug to pregnant women in the last trimester of pregnancy. 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. The course of treatment with average therapeutic doses is usually 7-10 days. Multicenter studies on long-term use of ambroxol showed that taking 75 mg of the drug for six months significantly reduces the frequency and severity of exacerbations of chronic obstructive bronchitis and the duration of antibacterial therapy (Prevention of Chronic Bronchitis Exacerbation With Ambroxol, 1989). In severe chronic renal failure, it is necessary to reduce the dose or increase the interval between doses.
Bromhexine(Bizolvon, Phlegamine, Fulpen) is a synthetic derivative of the alkaloid vasicine (see Table 18.1). Vasicine (Adhatoda vasica) has been used in the East as an expectorant since ancient times. When taken orally, the drug turns into an active metabolite - ambroxol. In general, the effect of the drug is similar to that of ambroxol - a decrease in the viscosity of the secretion of the bronchial glands, an effect on the production of mucopolysaccharides, and the release of lysosomal enzymes. Also important is the ability of the drug to restore mucociliary clearance (secretolytic effect) by stimulating the synthesis of surfactant by alveolar pneumonitis of the second order, although less pronounced than that of ambroxol. Thus, bromhexine dilutes the viscous, sticky bronchial secretion and ensures its movement through the respiratory tract. A distinctive feature of the drug is its independent antitussive effect. However, the antitussive effect of bromhexine may be undesirable.
The course of treatment with average therapeutic doses is usually 7-10 days. The pharmacokinetics of bromhexine is dose-dependent; the drug can accumulate with repeated use. Used in tablets for adults, 8-16 mg 2-3 times a day. A solution for intravenous administration of 16 mg (2 ampoules) 2-3 times a day is also used. The expectorant effect when using tablet forms is achieved when taking 24 mg/day on the 4-6th day of administration; in mild cases, the drug may be effective when taken at 12-16 mg/day. The increased amount of sputum usually begins to decrease by the 7th day, its character clearly changes (the purulent component disappears). The viscosity of sputum decreases by 50 times compared to the initial state.
Inhalation of 2 ml of solution gives a positive effect 20 minutes after administration, lasting for 4-8 hours (repeated inhalations 2-3 times a day are possible). The drug is especially effective when used simultaneously by inhalation and orally. In severe cases, it is recommended to use parenterally (s.c., i.m., i.v.), especially in the postoperative period and during mechanical ventilation to prevent the accumulation of viscous sputum.
It is necessary to adjust the dose and dosage regimen of bromhexine in case of severe liver failure. It is not prescribed simultaneously with codeine-containing drugs, as this makes it difficult to clear liquefied sputum.
Acetylcysteine(Mukomist, Mukobene) - a derivative of L-cysteine - an active mucolytic, free from the damaging effects of proteolytic enzymes. The reactive sulfhydryl groups contained in its molecule break the disulfide bonds of sputum mucopolysaccharides
(Ventresca G. R., 1989). As a result of depolymerization of macromolecules, sputum, including purulent one, becomes less viscous and adhesive. Stimulation of mucosal cells, the secretion of which is capable of lysing fibrin and blood clots, also leads to liquefaction of sputum.
Acetylcysteine increases the synthesis of glutathione, which takes part in detoxification processes. It is known that the drug has certain protective properties directed against free radicals, reactive oxygen metabolites responsible for the development of acute and chronic inflammation in the lung tissue and airways, which is especially important in tobacco smokers (Gillisen A. et al., 1997).
The drug for exacerbations of chronic obstructive bronchitis is used orally at a dose of 200 mg 3 times a day for 1-2 weeks. Long-term (up to 6 months) intake of acetylcysteine during the cold season can prevent the development of exacerbations and progression of the disease. Unfortunately, high doses or long-term use of acetylcysteine reduce the production of IgA, lysozyme, suppress the activity of ciliated cells, reducing mucociliary clearance, which limits the use of the drug if long-term treatment is necessary.
Acetylcysteine is mainly used in the form of inhalations (2-5 ml of a 20% solution 3-4 times a day), intratracheally in the form of slow instillations (1 ml of a 10% solution every hour). To wash the bronchi during therapeutic bronchoscopy, use a 5-10% solution. If intratracheal use is impossible (comatosis, trauma, etc.), it can be administered intramuscularly (1-2 ml of 10% solution 2-3 times a day) or intravenously (10 ml of 5% solution 2 times a day ) introduction. Excessive liquefaction of sputum during intratracheal administration of the drug is undesirable, which requires the use of suction to prevent “flooding” of the lungs.
Sodium 2-mercaptoethanesulfonate has a similar effect - mesna(Mistabron), which also has a free sulfhydryl group in its formula. The drug acts faster and more effectively than acetylcysteine. It is used only in the form of inhalations or intrabronchial drip infusions to prevent the formation of a mucus plug, especially in conditions of intensive treatment (IVL). In case of severe weakness of the patient, leading to ineffective cough, the drug can be prescribed only with suction.
Carbocisteine(Broncatar, Mucodin, Mucopront) - has both mucoregulatory and mucolytic effects. The mechanism of its action is associated with the activation of sialic transferase, an enzyme of goblet cells of the bronchial mucosa. Carbocisteine normalizes the quantitative ratio of acidic and neutral sialomucins in bronchial secretions (reduces the amount of neutral glycopeptides and increases the amount of hydroxysialoglycopeptides), which restores the viscosity and elasticity of mucus. Under the influence of the drug, regeneration of the mucous membrane occurs, restoration of its structure, reduction (normalization) of the number of goblet cells, especially in the terminal bronchi, and therefore a decrease in the amount of mucus produced.
In addition, the secretion of immunologically active IgA (specific protection) and the number of sulfhydryl groups (nonspecific protection) are restored; mucociliary clearance improves (the activity of ciliated cells is potentiated).
Thus, the drug demonstrates a dual effect - as a mucolytic, reducing the pathological viscosity and stringiness of mucus, facilitating its expectoration, and as a mucoregulator, improving the regeneration of the respiratory tract mucosa. In this case, the effect of carbocisteine extends to all damaged parts of the respiratory tract (upper and lower respiratory tract, paranasal sinuses), as well as the middle and inner ear.
It can be used in preparation for bronchoscopy and/or bronchography. Prophylactic use of mucolytic drugs during the cold season for 6 months leads to a significant reduction in the frequency and duration of exacerbations of chronic bronchitis, including severe ones, and a reduction in the use of antibiotics (Allegra L. et al., 1996).
The drug is available in the form of syrups or capsules. Average daily doses for adults: 1 measuring spoon or capsule 3 times a day, for long-term use (up to 6 months) - 2 times a day. The duration of treatment is usually from 8-10 days to 3 weeks. At the beginning of treatment, the volume of sputum increases after 3-5 days, and later (by the 9th day) it decreases.
Tactics for prescribing mucolytics for chronic obstructive bronchitis
Therapy with mucolytic drugs is indicated when the viscosity of mucus secreted by the inflamed mucous membrane of the airways increases. And if during acute infectious and inflammatory processes mucociliary clearance does not suffer significantly, then in chronic bronchopulmonary diseases significant defects in mucociliary clearance are observed associated with damage to the structure of the mucous membrane by microbial toxins (slowing of ciliary vibrations, destruction of cell membranes, cell necrosis with the production of active hydroxyanions, desquamation of the epithelium etc.).
In case of exacerbation of chronic obstructive bronchitis, average therapeutic doses of drugs are prescribed in the form of tablets, syrups, drops, “effervescent” tablets for 9-14 days, and in some cases for a longer period. The duration of taking mucolytic drugs depends on the achievement of clinical effect.
The effectiveness of mucolytic therapy (efficacy criteria according to Wettengel et al.) can be discussed by assessing its effect on:
Well-being (improved quality of life);
Symptoms (reduction or disappearance of shortness of breath at rest or during exertion, reduction and relief of cough, change in the nature of sputum);
Indicators of external respiration function (especially such as FEV 1, FVC, Tiffno index, maximum volumetric velocities, as well as blood gases characterizing the presence and severity of respiratory failure).
When treated with mucolytic drugs, a stable clinical effect is observed on the 2-4th day, depending on the nature and severity of the disease.
Lungs Moscow JSC « Publishing houseBINOMIAL"2000 Ch81 Chuchalin A.G. Chronic obstructive pulmonary diseases - M.: JSC « Publishing houseBINOMIAL", 1999. ... in Developed Countries 1950- 2000 . - Oxford, Oxford University ... dose of 1500 mcg/day and 2000 mcg/day - at...
BINOMIAL for2000 publishing house Ch81 T 384 Technotronic...
... / Dyachkov, Pavel Nikolaevich. - M.: BINOMIAL. Knowledge Laboratory, 2011. - 488 p. ... Russian Federation for2000 -2008. ... the work develops as formulated in the released publishing house"Yurlitinform" in 2008 ... -1 1794707 823. Ch81 T 384 Technotronic...
