Cough tablets: what they are and how they work

The main groups of drugs that are used to treat cough:

• Drugs that improve sputum discharge: expectorants,
• mucolytics.

Antitussives:

central action,

peripheral action.

The choice of medication should be individual for everyone. Before you start taking the drug, be sure to consult your doctor.

How to treat a wet cough?

Thursday, November 4
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Content

• Causes of wet cough
• Symptoms of a wet cough
• How to treat a wet cough
• 8 most effective drugs for wet cough
• Ascoril
• Ambrohexal
• Fluimucil
• Mukaltin
• ACC
• Ambrobene
• Plantain and coltsfoot syrup from Evalar
• Lazolvan
• Traditional methods of treating wet cough

A cough is called “wet” when it is accompanied by the formation of sputum. And the main task of antitussives in this case is to liquefy this sputum and remove it. In the first days of treatment, a wet cough may intensify, but it will no longer be as severe. Today, pharmacies offer a variety of cough medications: these include syrups, tablets, and lozenges. Such drugs should be prescribed exclusively by a doctor who will determine the cause of the cough; self-medication is inappropriate here.

Antitussives

Antitussives include drugs that reduce the susceptibility of the ciliated epithelium of the respiratory system to irritants. At the same time, many antitussives act directly on the cough center of the brain. This way the cough reflex is “turned off”. Such drugs can be useful only in special cases:

• with whooping cough;
• allergic irritating cough;
• with laryngitis;
• with pharyngitis.

In other situations, the use of antitussives is not recommended, since other respiratory diseases require the removal of sputum from the lungs. And suppression of the cough reflex will lead to complications and increase the recovery period.

Antitussive tablets include:

• Rengalin;
• Codelac;
• Terpincode;
• Sinecode;
• Omnitus.

Since Codelac and Terpincode contain the narcotic drug codeine, the drugs cannot be purchased at a pharmacy without a prescription.

Causes of wet cough

A wet cough occurs when there is inflammation in the respiratory system. Coughing is a reflex defense reaction of the body designed to clear the airways of sputum and germs.

Among the most common causes of wet cough are:

• respiratory viral diseases;
• bronchitis;
• pneumonia (pneumonia);
• bronchial asthma;
• whooping cough.

In addition, a wet cough is possible with chronic diseases such as tuberculosis, heart failure, bronchiectasis, and cystic fibrosis.

Read also How to treat dry cough: top 5 drugs The best drugs for dry cough in adults.

Rengalin

This cough medicine comes in tablet form and can be bought without a prescription. "Rengalin" contains affinity-purified antibodies to bradykinin, histamine, morphine, which have an antitussive effect. The drug reduces the cough reflex, relieves inflammation and has an antihistamine effect.

Rengalin is prescribed for dry cough due to ARVI, influenza and respiratory infections. Treats cough due to bronchitis, pharyngitis, laryngitis, as well as cough due to allergies.

The product is contraindicated for children under three years of age, pregnant and lactating women, and those with allergies to the components of the product. There is no data on negative combinations with other medications; it does not affect driving.

Rengalin

Symptoms of a wet cough

With the help of a wet cough (with the release of thick sputum), the bronchi and lungs are cleared of mucus. In addition to coughing, a person may experience chest pain and wheezing in the lungs. Usually a person coughs most at night, which significantly impairs his sleep. In addition to a debilitating cough, there is a deterioration in general health, dizziness, shortness of breath, lacrimation, runny nose and increased body temperature.

A wet cough must be treated, because it is fraught with complications. If sputum stagnates in the bronchi and lungs, bacteria will begin to multiply in it (in this case, ARVI will be complicated by purulent bronchitis or pneumonia). If a bacterial infection is added to a viral infection, the person will have the following symptoms: fever, deterioration in general health, sputum mixed with pus. In such cases, the doctor prescribes antibiotics.

How to distinguish a dry cough from a wet one

Photos from open sources

How to understand the cause of a cough

To understand the cause of a cough, you need to answer several questions:

• When does a cough occur? At night during sleep, after exercise or after eating?
• Have you had contact with people with ARVI in the last few days?
• Do you have any gastrointestinal disease or symptoms of stomach upset?
• Is there sputum, what does it look like?
• Did the cough appear during birch flowering or after contact with other allergens?
• Is the cough accompanied by other symptoms? Do you have fever, chills, weakness, or are you losing weight?
• Have you been under a lot of stress recently?
• Is the office or apartment well ventilated, is there a humidifier?
• How long does the cough last? Is it decreasing or increasing?

If you characterize a cough, it will be approximately clear where to look for the cause and how urgently you need to see a doctor. Any type of cough that lasts more than a few days, interferes with sleep, is accompanied by a high fever, or produces a pronounced colored discharge is a reason to see a doctor. You need to go to an appointment especially quickly if your cough makes it difficult to inhale and exhale when you are short of breath.

How to treat a wet cough

Treatment of wet cough is aimed at stopping the development of the inflammatory process, liquefying and removing mucus, and relieving bronchial spasm. In each specific case, the doctor selects an individual cough treatment regimen, taking into account its causes, the severity of symptoms, existing chronic diseases, etc. Typically, the treatment of a wet cough involves prescribing the following drugs (one or more):

• Mucolytics.
  These drugs stimulate the formation of sputum, thin it and help it come out faster.
• Expectorants.
  Such drugs stimulate the cough reflex, due to which mucus leaves the bronchi faster.
• Bronchodilators (antispasmodics).
  They are used to expand the lumen of the bronchi, relieve spasms, due to which the airways are quickly cleared of thick mucus.
• Anti-inflammatory and antiviral agents.
  Such drugs can be in tablets, spray or syrup form.
• Antibiotics.
  Prescribed if the cause of the cough is a bacterial infection (or a bacterial infection has joined the viral one).

In order to improve the general condition while treating a wet cough, a person needs to consume enough fluids and eliminate foods that irritate the throat from the diet. Now let’s look in more detail at each medicine that is prescribed for cough.

1. Mucolytics.
   Mucolytics increase the volume of sputum, dilute it and remove it from the respiratory tract. Active ingredients of mucolytics: bromhexine, acetylcysteine, ambroxol, carbocisteine. If the drug is chosen correctly, you can get rid of a wet cough in a week.
2. Expectorants.
   If the sputum is excessively viscous, expectorants help thin it and remove it faster. Typically, such preparations contain extracts of plantain, marshmallow, and thyme. The active synthetic substances are bromhexine, chymotrypsin, trypsin.
3. Bronchodilators.
   These are serious medications that should only be prescribed by a doctor. Similar cough medications relieve spasms in the bronchi. Typically, spasm is observed with bronchitis, asthma, bronchopulmonary dysplasia. Bronchodilators can also be used as inhalations.
4. Anti-inflammatory drugs.
   Such drugs are prescribed for both wet and dry coughs, the cause of which is viruses, bacteria or allergens.
5. Antihistamines.
   Remedies from this group are used if the cause of the cough is an allergy.
6. Drugs to inhibit cough receptors.
   These drugs affect the cough centers located in the brain, as well as the cough receptors and nerves located in the respiratory tract. They also work as anesthetics and are prescribed to adults and children to treat both wet and dry coughs.
7. Combined drugs.
   These cough remedies are the most effective and relieve negative symptoms literally on the second or third day. Combination cough medications contain expectorants, bronchodilators, mucolytics and antihistamines. Some even have an antipyretic effect, so they are prescribed for influenza and ARVI.

   
   Causes of wet cough

   Photos from open sources

Mucolytic agents in the treatment of chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD), regardless of severity, is a chronic inflammatory process affecting predominantly the distal airways. An important role in the development and further progression of bronchial inflammation is played by exposure to tobacco smoke, environmental pollutants, and infectious agents [13, 14]. One of the main clinical manifestations of inflammation of the respiratory tract mucosa is cough with sputum production.

The process of formation of bronchial secretion and its movement in the proximal direction is one of the protective functions of breathing. The layer of bronchial mucus humidifies the inhaled air, normalizes its temperature, precipitates and evacuates dust, and fixes microbes and their toxins. Bronchial secretion not only mechanically protects the epithelium from microorganisms, but also has a bacteriostatic effect. The normal daily volume of bronchial secretion ranges from 10-15 to 100-150 ml, or an average of 0.1-0.75 ml per 1 kg of body weight. A healthy person usually does not feel an excess of bronchial secretion; in addition, it does not cause a cough reflex, since there is a physiological mechanism for removing mucus from the tracheobronchial tree - mucociliary clearance (transport) (MCC). It is ensured through the coordinated activity of ciliated cells, which are located in the structure of the multirow prismatic ciliated epithelium. On their free surface there are about 200 ciliated cilia, making 15-16 vibrations per second and moving the mucus layer at a speed of 4-10 mm per minute. Contact of mucus with the cell surface does not exceed 0.1 s, which limits the time of contact of bacteria with the cells of the bronchial mucosa, the possibility of their adhesion and intracellular invasion. Through the MCC, bronchial secretions are transported to the pharynx and then swallowed. MCC is the most important protective mechanism of the respiratory system, ensuring cleansing of the lungs from various inhaled substances, metabolic products, etc. [1, 5, 10].

Bronchial secretions are produced by several types of cells. Goblet cells—unicellular glands of the mesocrine type—secrete a mucous secretion. Their maximum number is observed in the extrathoracic part of the trachea; as the diameter of the bronchi decreases, their number progressively decreases, and in bronchioles less than 1 mm they are completely absent. In a healthy person, the ratio of ciliated to goblet cells is 10:1. Clara secretory cells synthesize phospholipids and bronchial surfactant. They are most numerous in the small bronchi and bronchioles. It is believed that it is they who turn into goblet cells during the development of inflammation in the tracheobronchial tree. Alveolar type II pneumocytes synthesize alveolar surfactant, which, in addition to maintaining the surface tension of the alveoli and improving their distensibility, takes part in the transport of foreign particles from the alveoli to the airways, where, in fact, mucociliary transport begins. Submucosal bronchial glands, related to the glands of the tubular-acinous type, secrete a mucous-serous secretion. Plasma cells, located over the entire surface of the mucous membrane of the tracheobronchial tree, produce immunoglobulins (in the proximal sections they produce mainly IgA, and in the distal sections - IgG). IgA prevents the fixation of bacterial toxins to the mucous membrane and their penetration into the deeper layers of the bronchial wall. At the same time, bacteria are agglutinated and eliminated in sputum [10].

Normally, bronchial mucus consists of 89-95% water, which contains ions Na+, Cl-, Ca+, etc. This liquid part of sputum is necessary for normal mucociliary transport. The consistency of the sputum depends on the water content in the gel. The “dense” part of the bronchial secretion consists of insoluble macromolecular compounds: high and low molecular weight glycoproteins (mucins) (2-3%), represented by two subtypes: neutral (fucomycins) and acidic (sialomucins and sulfamucins), the ratio of which determines the viscous nature of the secretion ; complex plasma proteins - albumins, globulins, plasma glycoproteins (the molecules of which are interconnected by disulfide and hydrogen bonds); immunoglobulins classes A, G, E (2-3%); antiproteolytic enzymes - (1-antichymotrypsin, (1-antitrypsin (1-2%); lipids - mainly phospholipids of bronchial and alveolar surfactant and a small amount of glycerides, cholesterols and free fatty acids (0.3-0.5%). Bronchial secretion characterized by certain physicochemical properties, and primarily by rheological characteristics such as viscosity and elasticity, on which its ability to flow depends [1, 9, 10].

According to the physicochemical structure, bronchial secretion is a multicomponent colloidal solution, which consists of two phases: sol and gel. Sol - a liquid, soluble phase, is a deep layer 2-4 microns thick, which is adjacent directly to the mucous membrane, cilia float and contract in it, the energy of which is transferred to it without delay. The sol contains electrolytes, serum components, locally secreted proteins, biologically active substances, enzymes and their inhibitors. Sol is produced in the respiratory zone (alveoli and respiratory bronchioles), where it participates in air purification, as it has moderate adhesive properties. As the secretion moves further, the contents of goblet cells and seromucoid glands are added to it, forming a gel. The gel, an insoluble, viscoelastic phase, is the upper, outer layer of bronchial secretion, 2 µm thick, located above the cilia. The gel consists of glycoproteins that form a fibrillar structure, which is a wide cellular network, the elements of which contain hydrogen bonds. The gel is able to move only after the minimum shear stress (yield stress) has increased, that is, when the interconnected rigid chains are broken. The ratio of the two phases of gel and sol is determined by the activity of the serous and mucous glands. The predominant activity of the serous submucosal glands leads to the formation of a large amount of secretion with a low content of glycoproteins - bronchorrhea. In contrast, hyperplasia of mucus-forming cells with an increase in their functional activity, observed in chronic bronchitis, bronchial asthma, etc., is characterized by an increase in the content of glycoproteins, the gel fraction and, accordingly, an increase in the viscosity of bronchial secretions [1, 10].

The adhesive properties of the secretion, due to its connection with the dense surface of the bronchi, are also of certain importance. Adhesion reflects the ability for parts of the bronchial secretion to be torn off by air flow during a cough and depends on the condition of the surface of the bronchial mucosa, their ability to be wetted by mucus and the characteristics of the secretion itself.

Thus, the bronchial secretion is a complex complex consisting of the secretion of the bronchial glands and goblet cells, surface epithelium, metabolic products of motile cells, alveolar surfactant, and tissue transudate. In its pure form, bronchial secretions can only be obtained by bronchoscopy. In clinical practice, the concept of sputum is more often used; the latter consists of bronchial secretions and saliva (see figure) [1].

In response to exposure to damaging infectious and non-infectious agents, the first reaction of the mucous membrane of the tracheobronchial tree is the development of an inflammatory reaction with hypersecretion of mucus and restructuring of the mucous membrane, especially the epithelium. Up to a certain point, hyperproduction of mucus is protective in nature, but subsequently not only the quantity, but also the quality of bronchial secretion changes, which disrupts the drainage function of the bronchi and affects bronchial patency. The secretion-forming elements of the inflamed mucosa begin to produce viscous mucus, as its chemical composition changes - the content of glycoproteins increases, a shift occurs towards the predominance of neutral mucins and a decrease in acidic ones, which leads to an increase in the gel fraction, its predominance over the sol and, accordingly, to an increase in viscosity. elastic properties of bronchial secretions. This is also facilitated by a significant increase in the number and area of ​​distribution of goblet cells up to the terminal bronchioles. The adhesiveness of sputum also increases significantly, which reflects a violation of the integrity of the bronchial mucosa and the physicochemical properties of sputum. In parallel with the increase in the volume and viscosity of sputum, a decrease in its elasticity is observed due to an increase in the activity of proteolytic enzymes of bacterial origin and neutrophil elastase of leukocytes. A change in the viscoelastic properties of bronchial secretions is accompanied by significant qualitative changes in its composition: a decrease in the content of secretory IgA, interferon, lactoferrin, lysozyme, which are the main components of local immunity and have antiviral and antimicrobial activity [6, 9, 10].

The deterioration of the rheological properties of bronchial secretions also leads to impaired mobility of the cilia of the ciliated epithelium, which blocks their cleansing function. As viscosity increases, the speed of sputum movement slows down or stops altogether. Thick and viscous bronchial secretions with reduced bactericidal properties are a good breeding ground for various microorganisms (viruses, bacteria, fungi). An increase in viscosity and a slowdown in the rate of movement of bronchial secretions promotes fixation, colonization and deeper penetration of microorganisms into the thickness of the bronchial mucosa, which leads to aggravation of the inflammatory process, an increase in bronchial obstruction, and the formation of oxidative stress. All this contributes to the development of centrilobular emphysema, respiratory failure and cor pulmonale. The formation of emphysema leads to a gradual loss of the reversible component of bronchial obstruction and an increase in its irreversible component. It is in the early stages of the disease that reversible obstruction predominates, which consists of three components: spasm of smooth muscles, inflammatory edema of the bronchial mucosa, hypersecretion and discrimination of bronchial secretions in combination with a violation of the MCC [6, 12].

Thus, when treating patients with COPD, it is necessary to use drugs that improve or facilitate the separation of pathologically altered bronchial secretions, prevent mucostasis and improve the MCB. With the facilitation of secretion, one of the important factors of reversible bronchial obstruction is eliminated, and the likelihood of microbial colonization of the respiratory tract is reduced. This is achieved largely through the use of mucolytic (mucoregulatory) drugs [10]. However, it should be remembered that according to the mechanism of action, mucolytics are not means of influencing the main link of COPD - the inflammatory reaction. They are used during symptomatic therapy, as they affect the symptoms of the disease [6].

The most common are three groups of mucolytic drugs: ambroxol, acetylcysteine, carbocisteine ​​and their derivatives.

Ambroxol (lasolvan, ambrosan, ambrobene, ambrohexal, mucosolvan, chalixol) (see table) is an active metabolite of bromhexine (N-desmethyl metabolite). Derivatives of ambroxol chloride and hydrochloride are successfully used in wide therapeutic practice. Ambroxol has a secretolytic and secretokinetic effect, restores MCC, increases the penetration of antibiotics into the lung tissue. It stimulates the formation of tracheobronchial secretion of low viscosity. The ability of ambroxol to restore MCC by stimulating the motor activity of the cilia of the ciliated epithelium is also important. A distinctive feature of ambroxol and its derivatives is the ability to increase the production of surfactant by increasing its synthesis, secretion and inhibiting its breakdown. As one of the components of the local lung defense system, surfactant prevents the penetration of pathogenic microorganisms into epithelial cells. The surfactant also enhances the activity of the cilia of the ciliated epithelium, which, in combination with improving the rheological properties of bronchial secretions, leads to a pronounced expectorant effect.

In recent years, studies have appeared whose authors point to the anti-inflammatory and antioxidant properties of ambroxol, which can be explained by its effect on the release of oxygen radicals and interference with the metabolism of arachidonic acid at the site of inflammation [22]. However, these data need further clarification [6].

Ambroxol does not have a teratogenic effect, so it can be used in pregnant women. The daily dose of the drug when taken orally ranges from 60 to 120 mg. Typically, adults and children over 12 years of age are prescribed 30 mg tablets or 4 ml of solution 3 times a day in the first three days, and then twice a day. The course of treatment with average therapeutic doses is usually 7–10 days. In severe chronic renal failure, it is necessary to reduce the dose or increase the intervals between doses. Side effects are rare and manifest themselves in the form of nausea, abdominal pain, allergic reactions, dry mouth and nasopharynx. The drug is not used in conjunction with antitussives, as this contributes to the accumulation of bronchial secretions in the respiratory tract.

Bromhexine (bisolvone, bronchosan, phlegamine, fulpen) is a synthetic derivative of the alkaloid vasicine, which has been used in the East as an expectorant since ancient times. When taken orally, bromhexine is converted into an active metabolite, ambroxol, and its effect is similar to that of ambroxol, although less pronounced. Bromhexine is administered orally in a daily dose of 32-48 mg, divided into 2-3 doses. Unlike ambroxol, in severe liver failure the clearance of bromhexine decreases, so adjustment of the dose and dosage regimen is necessary. The drug may accumulate when used repeatedly. It is not recommended for pregnant women and nursing mothers [1].

Acetylcysteine ​​(mucomist, mucobene, ACC, fluomycil) (see table) is an N-derivative of the natural amino acid L-cysteine. N-acetylcysteine ​​derivatives are active mucolytic drugs. These drugs are characterized by a direct effect on the molecular structure of mucus. The acetylcysteine ​​molecule contains sulfhydryl groups, which break the disulfide bonds of acidic mucopolysaccharides of sputum, depolymerization of macromolecules occurs and sputum becomes less viscous and adhesive, and is easier to separate when coughing. The liquefaction of sputum is also caused by stimulation of mucosal cells, the secretion of which has the ability to lyse fibrin and blood clots. The drug is effective for both purulent and mucous sputum. Data on the effect of acetylcysteine ​​on mucociliary transport are contradictory [1, 2].

An important property of acetylcysteine ​​is its ability to stimulate glutathione synthesis by enhancing the activity of glutathione-S-transferase, which takes part in detoxification processes [16]. A significant advantage of acetylsteine ​​is its antioxidant activity, which is realized in various ways. The drug increases the intracellular concentration of glutathione, which performs a protective function in the respiratory system, preventing the action of oxidizing agents. Acetylcysteine ​​also has a direct anti-enzyme effect on free radicals. In addition, it reduces the production of free radicals by alveolar macrophages and enhances the phagocytic activity of monocytes, polymorphonuclear macrophages [15, 17, 20]. Acetylcysteine ​​has certain protective properties directed against reactive oxygen metabolites, free radicals responsible for the development of inflammation in the airways, which is especially important for heavy smokers and elderly patients in whom oxidative processes are activated and the antioxidant activity of blood serum decreases [2, 6, 10 , 18].

Acetylcysteine ​​is prescribed orally at a dose of 200 mg 3 times a day (maximum daily dose 1200 mg) for 1-2 weeks, the duration of its use can be increased to 6 months. Acetylcysteine ​​can also be used in the form of intrabronchial instillations of 1 ml of a 10% solution and bronchial lavage during therapeutic bronchoscopy. There is evidence that long-term use of acetylcysteine ​​in COPD leads to a decrease in the frequency, severity and duration of exacerbations [19, 21]. However, high doses and long-term intake of acetylcysteine ​​can reduce the production of IgA and lysozyme, as well as suppress the activity of ciliated cells, which leads to disruption of the MCB. Undesirable in some cases, especially with intratracheal administration of the drug, is excessive liquefaction of sputum, which can cause the syndrome of “flooding” of the lungs and in this case requires the use of suction [10]. Among the side effects, in some cases, disturbances in the functioning of the digestive tract (nausea, vomiting, heartburn, diarrhea) are observed, and hypersensitivity in the form of urticaria and bronchospasm occurs occasionally.

Among acetylcysteine ​​preparations, the greatest activity is observed in fluimucil. This drug has the least pronounced side effects, since it almost does not irritate the gastrointestinal tract. An important advantage of fluimucil is the possibility of using its solution through a nebulizer in the complex therapy of patients with COPD, taking into account not only the mucolytic properties of the drug, but also its antioxidant activity [6]. It also protects a1-antitrypsin from the inactivating effect of HOCl, a powerful oxidizing agent produced by the myeloperoxidase enzyme of active phagocytes, and also reduces the adhesion of bacteria to the epithelial cells of the bronchial mucosa.

Carbocisteine ​​(broncator, mucodin, mucopront, fluditec, fluifort) (see table) has both a mucolytic and mucoregulatory effect. As a mucolytic, it reduces the viscosity and stringiness of bronchial secretions, ensuring its expectoration, and as a mucoregulator, it increases the synthesis of sialomucins. The mechanism of action of carbocisteine ​​is associated with the activation of sialic transferase, an enzyme of goblet cells of the bronchial mucosa, which form the composition of bronchial secretions. At the same time, under the influence of carbocysteine, regeneration of the mucous membrane occurs, restoration of its structure, reduction (normalization) of the number of goblet cells, especially in the terminal bronchi, and, consequently, 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, and the MCC is improved, since the activity of ciliated cells is potentiated. In addition to the direct effect on the mucinogenic cell, other effects were identified: antichemotactic, antioxidant and ion-regulatory [9]. The effect of carbocysteine ​​extends to all parts of the respiratory tract involved in the pathological process - upper and lower, as well as the paranasal sinuses, middle and inner ear.

Carbocisteine ​​preparations are available only for oral administration (in the form of capsules, granules and syrups). Average daily doses for adults: one capsule or measuring spoon 3 times a day. Typically, the duration of treatment ranges from 8–10 days to 3 weeks. Long-term use of the drug is possible for 6 months. For long-term use, the drug is used 2 times a day. At the beginning of treatment, after 3-5 days, the volume of sputum increases, and later (by the 9th day) decreases [10].

Side effects include nausea, bowel movements, and abdominal pain. When prescribing carbocysteine ​​preparations, certain precautions should be observed: it is not advisable to simultaneously use drugs that suppress bronchial secretory function and cough suppressants. Carbocysteine ​​preparations should not be prescribed to patients with diabetes mellitus, since one tablespoon of syrup contains 6 g of sucrose. It is not recommended to use carbocisteine ​​for pregnant and nursing mothers [6].

Fluifort is a carbocisteine ​​lysine salt. Lysine increases the water solubility of carbocisteine, ensuring rapid and complete absorption; neutralizes the acidity of carbocisteine, reducing the risk of side effects from the gastrointestinal tract. Fluifort continues to act for 8 days after stopping the drug.

The use of proteolytic enzymes as mucolytics is currently not recommended due to possible damage to the pulmonary matrix and a high risk of serious side effects such as hemoptysis, allergic reactions and bronchospasm [11].

It is possible to use phytotherapeutic agents [1, 8]. The mechanism of action of medicinal herbs is multifaceted, which is associated with the action of various alkaloids and saponins contained in them. The advantage of herbal preparations is that biologically active substances isolated from medicinal plants are more naturally included in the body's metabolic processes (than synthetic ones). They are noted to be better tolerable and less likely to develop side effects and complications. The current level of development of the pharmaceutical industry makes it possible to produce high-quality combined herbal preparations containing optimally selected dosages of active ingredients, for example, Suprima-Broncho cough syrup.

Recently, a new drug, fenspiride (erespal), has been used to treat bronchopulmonary diseases accompanied by broncho-obstructive syndrome. It does not have directly mucolytic and expectorant properties, but due to the anti-inflammatory effect of this drug it can indirectly be classified as a mucoregulator. Erespal affects the main links of the inflammatory process in the respiratory tract and has tropism for the respiratory system. It reduces swelling of the bronchial mucosa and hypersecretion, significantly increases the rate of MCC and counteracts bronchoconstriction, which leads to improved sputum separation, reduced shortness of breath and cough [3, 7].

In accordance with the Federal program (1999) [11], which presents recommendations for the treatment of COPD, mucolytic drugs are prescribed during the period of remission in the presence of symptoms of mucostasis in patients with COPD of any severity, as well as during exacerbation of the disease.

Usually, average therapeutic doses of drugs are prescribed, available in the form of tablets, syrups, drops, “effervescent” tablets, for a period of 9-14 days, and in some cases longer. The duration of taking mucolytic drugs depends on the achievement of the clinical effect, which is assessed based on the improvement in the patient’s well-being and quality of life; changes in symptoms (reduction or disappearance of shortness of breath, reduction and relief of cough, change in the nature of sputum); improvement of external respiration function indicators. It should, however, be taken into account that in a number of patients with chronic bronchitis, after the first day of treatment, the adhesion and viscosity of sputum may increase significantly as a result of the separation of sputum that has accumulated in the bronchi and contains a large amount of cellular detritus, inflammatory elements, proteins, etc. In subsequent days days, with the correct choice of drug, the rheological properties of sputum improve approximately on the 4th day of use of expectorant drugs, its quantity significantly increases, viscosity and adhesion decrease, and on the 6-8th day of treatment the clinical effect stabilizes [10].

When treating patients with COPD, good results can be achieved by prescribing a combination of mucolytic drugs and bronchodilators. The presence of viscous sputum prevents the access of inhaled drugs to the bronchial mucosa. Therefore, ensuring expectoration and freeing the bronchial mucosa from mucus helps to enhance the effectiveness of the drugs and reduce their dose. On the other hand, bronchodilator therapy potentiates the effect of mucolytics and enhances their activity. β2-agonists (formoterol, salbutomol, terbutaline) and theophylline are known to potentiate mucociliary clearance; M-anticholinergics (ipratropium bromide) and theophylline, reducing inflammation and swelling of the mucous membrane, facilitate sputum discharge [5, 10].

In case of severe COPD in remission, in case of exacerbation of moderate and severe disease, administration of drugs through a nebulizer is indicated. For this, special solutions of ambroxol (lazolvan) and acetylcysteine ​​(fluimucil) are used.

Lazolvan is available as a solution for inhalation, 100 ml in a bottle (1 ml of solution contains 7.5 mg of ambroxol hydrochloride). Prescribe 2-3 ml of solution for inhalation, 1-2 times a day. Before use, the drug is mixed with saline in a 1:1 ratio. Lazolvan is contraindicated if there is a history of hypersensitivity to ambroxol.

Fluimucil (acetylcysteine) is a solution for inhalation in ampoules of 3 ml (100 mg of N-acetylcysteine ​​in 1 ml). Prescribe 6 ml of a 5% solution once a day. If necessary, the dose of the drug can be increased. Saline solution is used as a solvent. It can be divided into 2-3 inhalation doses. Fluimucil is contraindicated in case of hypersensitivity to acetylcysteine. It is prescribed with caution to patients with bronchial asthma. If bronchospasm occurs, the drug should be discontinued.

To avoid a cough reflex caused by a deep breath during inhalation, the patient should breathe calmly. It is recommended to warm the inhaled solution to body temperature. Patients with bronchial asthma are recommended to take inhalations after using bronchodilators. Considering that bronchodilator therapy in the treatment of COPD is basic, as well as the fact that it potentiates the effect of mucolytics, it is possible to use lazolvan together with bronchodilators in the same nebulizer chamber.

With exacerbation of COPD, the importance of infectious factors increases, which requires the prescription of antibacterial agents. However, during antibacterial therapy, the viscosity of sputum increases markedly due to the release of DNA due to the lysis of microbial bodies and leukocytes. In addition, thick viscous sputum is a significant obstacle to the penetration of antibiotics into the bronchial mucosa and bronchial secretions. In this regard, it is necessary to carry out measures aimed at improving the rheological properties of sputum and promoting its better discharge. One of these methods is the prescription of mucolytics in combination with antibiotics. Their combined use reduces the period of unproductive debilitating cough by half [10].

When prescribing mucolytics and antibiotics simultaneously, information about their compatibility should be taken into account. Ambroxol, bromhexine and carbocisteine, when used in combination with antibiotics, enhance the penetration of the latter into bronchial secretions and the bronchial mucosa, increasing their effectiveness. This is especially true for amoxicillin, cefuroxime, erythromycin, doxycycline, rifampicin and sulfonamide drugs. Thus, carbocisteine ​​enhances the effect of antibiotics at the bronchial level by 20%. When prescribing acetylcysteine ​​orally, antibiotics (penicillins, cephalosporins, tetracyclines) should be taken no earlier than 2 hours after taking it. Acetylcysteine ​​preparations for inhalation or instillation should not be mixed with antibiotics, as this results in their mutual inactivation [10]. The exception is fluimucil, for which a special form has been created: fluimucil + antibiotic IT (thiamphenicol glycinate acetylcysteinate). Fluimucil is available for inhalation, parenteral, endobronchial and local use. Thiamphenicol glycinate acetylcysteinate (this is a complex compound that combines the antibiotic thiamphenicol and the mucolytic fluimucil. Thiamphenicol has a wide spectrum of antibacterial action and is effective against bacteria that most often cause respiratory tract infections. Fluimucil effectively thins sputum and facilitates the penetration of thiamphenicol into the area of ​​inflammation, inhibits the adhesion of bacteria on the epithelium of the mucous membrane of the respiratory tract [6].

Despite the positive effects that are observed with the use of mucolytic, mucoregulatory agents, data on their use in patients with COPD are very contradictory. Due to the mucolytic properties of these drugs, their ability to reduce adhesion and activate mucociliary clearance, they have proven themselves in the treatment of COPD patients with discrinia and hypersecretion. However, mucoregulators (mucolytics) do not find application points where bronchial obstruction is associated with bronchospasm or irreversible phenomena. Ambiguous data from studies on COPD do not allow the use of these drugs as basic agents in the treatment of patients with this pathology [6]. The GOLD program (2001) [4] notes that although the use of mucolytics (mucokinetics, mucoregulators) in some patients with viscous sputum leads to an improvement in the condition, in general the effectiveness of these drugs is low. From the point of view of evidence-based medicine, reports demonstrating the effectiveness of the use of mucolytics in the treatment of patients with COPD are clearly insufficient (level D). The same program indicates that N-acetylcysteine, as an antioxidant, reduces the frequency of exacerbations of COPD, which may be important in the treatment of patients with frequent exacerbations of the disease (evidence level B). However, before the widespread use of these drugs in medical practice, it is necessary to obtain and carefully evaluate the results of ongoing research [4].

Thus, the prescription of mucolytic drugs is indicated in the complex therapy of patients with COPD, in whom the processes of hypersecretion and discrimination predominate, since these drugs change the rheological properties of bronchial secretions, affect the process of mucus formation, have a normalizing effect on the biochemical composition of mucus, facilitate the separation of sputum, and prevent mucostasis and improve mucociliary clearance. However, mucolytics are not basic therapy for COPD, since they do not directly affect the inflammatory response (the main pathogenetic link of the disease.

For questions about literature, please contact the editor

I. V. Mayev, Doctor of Medical Sciences, Professor G. A. Busarova, Candidate of Medical Sciences

MGMSU, Moscow

Ascoril

"Ascoril" is a combination drug for the complex treatment of wet cough, which contains several active substances: salbutamol, guaifenesin and bromhexine. "Ascoril" is a mucolytic and bronchodilator with an expectorant effect. The drug is usually prescribed for such serious problems as obstructive bronchitis and pneumonia, that is, in cases where the sputum is difficult to clear and is very thick. "Ascoril" acts quickly - relief occurs literally in the first days of taking it. But you need to remember about the side effects of Ascoril: some patients experience tachycardia, increased sweating, and dry mouth.

Ascoril

Glenmark Pharmaceuticals, India

As part of combination therapy for acute and chronic bronchopulmonary diseases, accompanied by the formation of difficult-to-separate viscous secretions: bronchial asthma;
tracheobronchitis; obstructive bronchitis; pneumonia; emphysema; whooping cough; pneumoconiosis; pulmonary tuberculosis. from 113

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Ambrohexal

This mucolytic drug is used for wet coughs to thin out mucus and remove it faster. "Ambrohexal" is inexpensive, but quite effective. The remedy is prescribed for acute and chronic bronchitis, pneumonia, asthma and other problems, one of the symptoms of which is a prolonged cough. "Ambrohexal" can be taken by adults and children from 6 years of age. To enhance the positive effect, in addition to the mucolytic, an antiviral or antibacterial agent is usually prescribed (you need to look at the clinical manifestations). Reviews from doctors and patients about the drug are mostly positive due to its complex action - the product removes phlegm in the most natural way possible. The cost of Ambrohexal is quite affordable, and there are no serious contraindications or side effects.

Ambrohexal

Hexal, Germany

Ambrohexal is a mucolytic and expectorant.
Indications for use: Acute and chronic diseases of the respiratory tract, accompanied by the formation of viscous secretions: - acute and chronic bronchitis; - pneumonia; - COPD; - bronchial asthma with difficulty in sputum discharge; - bronchiectasis; - treatment and prevention of respiratory distress syndrome (for syrup and solution for oral administration and inhalation). from 92

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Fluimucil

This Swiss drug for wet coughs perfectly thins and removes mucus from the respiratory tract, being an analogue of “ACC”, although they have the same active substances. Some doctors are sure that Fluimucil is better than ACC because it is of better quality. And it costs much less, which is good news. Patients write in reviews that Fluimucil helps quickly remove phlegm from a wet cough. The only disadvantage of this product is that it is not available in all pharmacies.

Fluimucil

Zambon, Italy

Respiratory diseases accompanied by impaired sputum discharge (including bronchitis, tracheitis, bronchiolitis, pneumonia, bronchiectasis, cystic fibrosis, lung abscess, pulmonary emphysema, laryngotracheitis, interstitial lung diseases, pulmonary atelectasis /due to blockage of the bronchi by mucus plug/);
catarrhal and purulent otitis, sinusitis, incl. sinusitis (to facilitate the passage of secretions); for removing viscous secretions from the respiratory tract in post-traumatic and postoperative conditions. from 46

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Mukaltin

These sour cough tablets have been familiar to us since childhood. The active ingredient “Mukaltina” is marshmallow root (that’s where this herbaceous smell comes from). "Mukaltin" is safe and cheap, it thins mucus and removes it. The positive effect of “Mukaltin” has been confirmed for decades, so doctors continue to prescribe it for coughs. The only drawback is that children often do not want to take these pills because they have a specific sour taste.

Mukaltin

Vifitech/Vilar, Russia; Medisorb, Russia; JSC "Tatkhimfarmpreparaty", Russia; Update, Russia; CJSC "Moscow Pharmaceutical Factory", Russia; JSC Avexima, Russia; JSC Pharmstandard-UfaVITA, Russia

Respiratory tract diseases (including laryngitis, tracheitis, bronchitis, bronchial asthma), gastritis, gastric and duodenal ulcers.
from 6

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ACC

"ACC" is perhaps the most popular tablet for the treatment of wet cough. "ACC" is prescribed for bronchitis and pneumonia. The product thins mucus and helps it drain better. "ACC" is sold in the form of effervescent soluble tablets, which are prescribed to adults and children over 14 years of age. Doctors note the excellent effectiveness of the drug if you need to get rid of very viscous sputum. But ACC should not be taken at night - this can lead to congestion in the lungs. It is also contraindicated to take ACC alone in combination with other cough medications. Buyers in reviews say it works quickly, treats coughs well, is inexpensive and is available in all pharmacies.

ACC

Hermes Pharma, Germany; Wernigerode Pharma, Germany; Lindopharm, Germany

Respiratory diseases accompanied by the formation of viscous, difficult to separate sputum (acute and chronic bronchitis, obstructive bronchitis, tracheitis, laryngotracheitis, pneumonia, lung abscess, bronchiectasis, bronchial asthma, COPD, bronchiolitis, cystic fibrosis);
acute and chronic sinusitis; Otitis media from 100

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It is not advisable to self-medicate with a wet cough, it is fraught with complications

Photos from open sources

Mucolytics

Modern drugs, which are mainly prescribed for infectious and inflammatory diseases of the respiratory system, combine mucoregulatory and mucolytic properties, and also have a secretomotor effect.

• Mucolytics change the physicochemical properties and structure of bronchial mucus, causing it to liquefy and facilitate the removal of sputum.
• Mucoregulators change the ratio of liquid and dense parts of sputum, stimulate the synthesis of lysozyme by the epithelium and the formation of surfactant in the lungs.

Proteolytic enzymes

These drugs break down protein and polypeptide molecules. They are capable of thinning even thick purulent sputum, acting in affected tissues without affecting healthy ones. Such drugs are often administered by inhalation, intratracheal and intrabronchial routes.

• trypsin, chymotrypsin, ribonuclease, dornase alpha.

Synthetic drugs

The drugs bromhexine, ambroxol (Ambrobene, Lazolvan), acetylcysteine ​​(ACC, Fluimucil), carbocysteine ​​and their analogues combine several properties and are widely used by specialists. Such drugs are optimal for the treatment of respiratory diseases and cough, especially in children. On the pharmaceutical market there is a large selection of release forms for different ages: syrups, solutions and drops, tablets and dragees.

Side effects of mucolytics

• Taking mucolytics can provoke allergic reactions, pulmonary hemorrhages, bronchospasm, and impair liver and kidney function.
• Use is limited to children under 3 years of age, pregnant and nursing mothers, and persons with liver and kidney diseases.
• Mucolytics, like expectorants, are undesirable to prescribe to bedridden patients due to the accumulation of liquid secretions and the effect of “flooding” the lungs.
• The clinical effect when taking expectorants and mucolytics is observed, as a rule, after 4-8 days. Before this, there may be an “imaginary deterioration” of the condition.

Ambrobene

Another popular drug for wet cough. A mucolytic with an expectorant effect contains the active substance ambroxol, which helps to thin and remove mucus from the lungs and stimulates expectoration. Within 30 minutes after taking Ambrobene it begins to act, and the positive effect lasts for 6-12 hours. It is very important to drink plenty of fluids during treatment with Ambrobene. This cough remedy is prescribed to adults and children over two years of age. The duration of treatment with the drug should not exceed 4-5 days.

Ambrobene

Merkle GmbH, Germany

Ambrobene is a mucolytic expectorant.
It is used for acute and chronic diseases of the respiratory tract, which are accompanied by impaired formation and discharge of sputum. from 85

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What to do if your cough bothers you

First of all, you need to sit or stand up and try to breathe in through your nose. If inhalation and exhalation through the nose is successful, then everything is fine for now. If you can’t take a breath, then you need to wake up someone close to you, try to scream or say something. If it works, then breathing is preserved - that’s not bad. If you can’t scream and breathe, you need to urgently call an ambulance.

If at night the cough interferes so much that it is impossible to sleep, you need to find out whether an ambulance and hospitalization are required.

While the ambulance is on the way, you need to:

• open the window to allow fresh cool air to enter;
• turn on hot water in the bathroom and breathe in the steam;
• calm down.

Plantain and coltsfoot syrup from Evalar

This drug is indicated for both wet and dry coughs. Effective and affordable. “Plantain and coltsfoot syrup” soothes coughs and has a good expectorant and cooling effect. Plantain and coltsfoot are excellent natural anti-inflammatory agents: they relieve irritation, disinfect, thin mucus, soothe and regenerate mucous membranes. To stimulate local immunity, the syrup is enriched with vitamin C. It also contains peppermint essential oil, which reduces the severity of cough, coats the mucous membrane of the throat, and cools it. There is no alcohol in Plantain and Coltsfoot Syrup, so taking it does not affect the speed of reactions. The drug has a pleasant taste.

Plantain and coltsfoot syrup

Evalar, Russia

Plantain and coltsfoot syrup from Evalar helps to liquefy and remove mucus.
Recommended for dry and wet cough. from 85

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Expectorants

This group of drugs stimulates the secretion of bronchial glands and the movement of the epithelium, increases the volume of sputum and slightly reduces its viscosity.

Direct action

Resorptive (direct) action drugs directly affect bronchial secretion. They are used in the form of tablets, solutions and mixtures.

• potassium iodide, sodium iodide, sodium bicarbonate, ammonium chloride.

Reflex action

Reflex (indirect) action drugs irritate the stomach receptors, causing a reflex increase in gland secretion and stimulating muscle contraction when coughing. Used in the form of infusions, powder, tablets, dry extract, collections, etc.

• thermopsis herb (Codesan), terpinhydrate (Coldrex), licorice root (Doctor MOM), marshmallow (Mukaltin), guaifenesin (Tussin), ammonia-anise drops and others.

Herbal remedies

Essential oils of medicinal plants have expectorant, anti-inflammatory and weak antiseptic effects.

• thyme herb (Bronchicum), eucalyptus leaf (Pectussin), ivy leaves (Gedelix), licorice (Glyceram), oregano, coltsfoot, elecampane and other plants in various combinations.

A prerequisite for the development of the therapeutic effect of any expectorant medications is regular drinking of water to prevent dehydration.

Side effects and contraindications

The use of some drugs is limited in pediatrics, pregnancy and lactation, carbohydrate metabolism disorders, as well as in the acute period of certain diseases. A complete list of contraindications and restrictions is indicated in the instructions for the drug.

• Stomach. When taken orally, they irritate the gastrointestinal mucosa and increase the secretion of gastric juice, therefore they are not used for gastritis and peptic ulcers.
• Allergy. Plant extracts often cause allergic reactions and are contraindicated in bronchial asthma.
• Vomit. Reflex-action drugs strengthen not only the cough reflex, but also the gag reflex. Large doses cause nausea and vomiting. Young children, as well as those with central nervous system damage, should not use them, as respiratory arrest may occur.
• For children. Medicines from these groups significantly increase the volume of secretions. But small children are not able to fully expectorate sputum themselves. This can lead to congestion in the bronchi and re-spread of infection.

Lazolvan

The active ingredient of this mucolytic expectorant for wet coughs is ambroxol hydrochloride. "Lazolvan" is prescribed for acute and chronic bronchitis, pneumonia, obstructive pulmonary disease, asthma, bronchiectasis. The product helps well with non-productive cough - both in complex therapy and as a single drug. Without consulting a doctor, Lazolvan should not be taken for longer than 4-5 days. Lazolvan tablets are indicated for adults and children over 12 years of age.

Lazolvan

Boehringer Ingelheim, Germany

Lazolvan stimulates the serous cells of the glands of the bronchial mucosa, increases the content of mucous secretions and the release of surfactants (surfactant) in the alveoli and bronchi;
normalizes the disturbed ratio of serous and mucous components of sputum. By activating hydrolytic enzymes and enhancing the release of lysosomes from Clara cells, it reduces the viscosity of sputum. Increases the motor activity of the cilia of the ciliated epithelium, increases the mucociliary transport of sputum. After oral administration, the effect occurs within 30 minutes and lasts for 6–12 hours from 138

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Why does a cough appear?

A cough can start due to any object or substance entering the respiratory tract: food fragments, perfume vapors or aerosols. Sometimes it is caused by allergies, and sometimes by stress.

Most often, a cough is provoked by viruses or bacteria and their waste products. In this case, the cough is called infectious, and its manifestations will differ depending on the pathogen:

Manifestations of an infectious cough:

• Coronavirus infection. The cough is most often dry and debilitating; in addition, there are other symptoms: shortness of breath, weakness, fever, headache.
• Pneumonia. Symptoms depend on the type of infection, but often the disease begins with coughing, which increases and turns into a constant wet cough. The amount of sputum increases, chest pain, fever, and weakness may appear. There is a general deterioration in the condition.
• Bronchitis. The cough is wet and becomes easier after clearing the throat. When breathing deeply, sounds are sometimes heard in the chest - they are caused by the fact that phlegm accumulates in the bronchi.
• Whooping cough. The cough with this disease is debilitating, paroxysmal, prolonged, and interferes with sleep. It is difficult to find a position to relieve the condition. Constant coughing causes pain in the intercostal muscles, and hemorrhage may occur in the eye. Over time, the frequency of attacks decreases, but this condition sometimes lasts for several months.

A cough can be a sign not only of an infectious disease, but also of other conditions and diseases.

The most common ones are:

• Allergies and asthma. In most cases, coughing attacks occur after contact with an irritant in the air.
• Chronic obstructive pulmonary disease (COPD) is a lung disease characterized by chronic restriction of air flow in the airways. The main symptoms of COPD are cough with phlegm and shortness of breath.
• Heartburn or gastroesophageal reflux disease (GERD). The movement of acidic stomach contents up the esophagus causes irritation of the mucous membrane of the throat and vocal cords, which contributes to coughing and tickling.
• Nervous breakdown. In a stressful situation, especially in children, nervous coughing is possible as a variant of a nervous disorder such as a tic.
• Foreign body or tumor.
• Smoking.
• Tuberculosis.

Traditional methods of treating wet cough

In addition to medications for wet coughs, there are proven folk methods that help thin and remove mucus. Here are some of them.

1. Milk with honey.
   You need to heat a glass of milk, add a couple of teaspoons of honey and a pinch of soda. This drink perfectly thins and removes phlegm. Another recipe is milk with butter. This recipe is suitable if you have an irritated throat (the drink eliminates soreness and soothes the mucous membranes).
2. Milk with banana.
   Add banana puree and a couple of teaspoons of cocoa to a glass of heated milk. Children will definitely appreciate this cough remedy. You need to drink the drink before going to bed.
3. Black radish.
   Radish contains an essential oil with a bactericidal effect, plus black radish is an excellent stimulant for mucus discharge. To treat a cough, take 1 teaspoon of radish juice five times a day. To “extract” the juice of a black radish, you need to cut it into two parts, remove some of the pulp, and put honey in the resulting holes. If you don't have honey, you can simply grate the radish and add a little sugar.
4. Honey compress.
   To relieve a cough, you can rub liquid honey on your chest, put parchment paper on top, and then cover yourself with a warm blanket. After half an hour, wipe off the honey with a damp cloth and wrap yourself up.
5. Chocolate for cough.
   Another recipe that kids will love. Melt 100 g of butter, add 100 g of chocolate and 2 tbsp. l. cocoa. Warm everything over low heat or in a water bath until the ingredients are well mixed. Cool and you can spread this chocolate spread on bread or cookies for your child. It’s great if the baby agrees to drink it with warm milk.