Cough medicines: pharmacological groups and their action, applicability, overview of representatives. Antitussive drugs for dry cough Antitussive syrup

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

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

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

There are many causes of cough in children:

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

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

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

Cough treatment is indicated only in cases where it disturbs the well-being and condition of the patient. In this case, you should always start by eliminating its cause.

The need for the treatment of the actual cough, that is, the appointment of the so-called antitussive therapy, arises mainly when the child has an unproductive, dry, obsessive cough. Its peculiarity is that it does not lead to the evacuation of secretions accumulated in the respiratory tract and / or does not release the receptors of the mucous membrane of the respiratory tract from irritating effects, for example, during irritative, infectious or allergic inflammation. It should be emphasized once again that in children, especially young children, an unproductive cough is more often due to increased viscosity of bronchial secretions, a violation of the "sliding" of sputum along the bronchial tree, insufficient activity of the ciliated epithelium of the bronchi and contraction of bronchioles. Therefore, the purpose of prescribing antitussive therapy in such cases is to thin the sputum, reduce its adhesiveness and thereby increase the effectiveness of coughing.

Thus, the effectiveness of antitussive therapy is essentially to increase the cough, provided that it is transferred from dry, unproductive to wet, productive. This ultimately leads to his disappearance.

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

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

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

Among them are:

• actually antitussive drugs (central and peripheral action);
• drugs with an indirect antitussive effect (bronchodilator, anti-inflammatory, antiallergic, decongestant, and others);
• combination drugs.

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

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

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

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

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

The group of antitussive non-narcotic drugs of central action is also indicated for cough associated with irritation of the mucous membranes of the upper (epiglottic) respiratory tract due to infectious or irritative inflammation. In these cases, the result of their appointment is usually enhanced when combined with peripheral drugs with an enveloping effect. Broncholitin can serve as a partial example of such a combined effect. But its use is justified only in the absence of pronounced changes in the mucosa of the lower parts of the bronchial tree, since the ephedrine included in it “dries out” the bronchial mucosa, increases the viscosity of the bronchial secretion and aggravates the violation of mucociliary transport, and, accordingly, increases the unproductiveness of cough in the presence of bronchitis and pneumonia. In addition, ephedrine has a stimulating effect on the central nervous system, disturbs the child's sleep and contributes to an increase in unproductive cough and shortness of breath.

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

One of the effective afferent antitussive drugs of peripheral action is moisturizing the mucous membranes. This is primarily the use of aerosols and steam inhalations, which reduce mucosal irritation and reduce the viscosity of bronchial secretions. Water vapor inhalation alone or with the addition of medications (sodium chloride or benzoate, sodium bicarbonate, ammonium chloride, plant extracts such as eucalyptus) is the simplest, most affordable and common method of moisturizing. Along with this, a plentiful drink can be used (including medicinal teas, when efferent and afferent mechanisms of action are combined), and in severe cases (in a hospital setting), intravenous fluid infusions.

Enveloping agents also refer to peripheral afferent antitussives. These drugs are mainly used for coughs that occur when the mucous membrane of the upper supraglottic sections of the respiratory tract is irritated. Their action is based on the creation of a protective layer for the mucous membrane of the nasopharynx and oropharynx. Usually they are oral lozenges or syrups and teas containing plant extracts (eucalyptus, acacia, licorice, wild cherries, etc.), glycerin, honey and other components. Local anesthetics (benzocaine, cyclain, tetracaine) are also afferent agents, but are used only in a hospital according to indications, in particular for afferent inhibition of the cough reflex during bronchoscopy or bronchography.

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

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

Plant extracts are included in syrups, drops and cough tablets, are components of breast fees.

EXPECTORANT DRUGS OF PLANT ORIGIN

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

Dosage forms:

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

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

The most effective antitussive drugs with efferent peripheral action are mucolytics. They well dilute the bronchial secret by changing the structure of the mucus. These include proteolytic enzymes (deoxyribonuclease), acetylcysteine ​​(ACC, carbocysteine, N-acetylcysteine ​​(fluimucil), bromhexine (bisolvan), ambroxol (ambrohexal, lasolvan), dornase (pulmozyme), etc. sputum, they practically do not increase its volume.The liquefying effect of proteolytic enzymes is based on breaking the peptide bonds of bronchial secretion protein molecules.Acetylcysteine, carbocysteine ​​and N-acetylcysteine, bromhexine and ambroxol disrupt the integrity of the disulfide bonds of acid mucopolysaccharides of the sputum gel, thereby diluting it.Bromhexine and Ambroxol also has the ability to stimulate the production of endogenous pulmonary surfactant (antatelectatic factor), which ensures the stability of alveolar cells during respiration, protects them from external adverse factors, improves the “sliding” of bronchopulmonary secretion along the epithelium of the bronchial mucosa. Its gliding facilitates the release of sputum from the respiratory tract.

MAIN INDICATIONS FOR THE CHOICE OF ANTICOUGH DRUGS IN CHILDREN

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

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

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

Currently, the drug guaifenesin is widely used. It is included in such products as coldrex broncho, robitussin - cough mixture, tussin (a combination drug that includes caramel, glycerin, citric acid, sodium benzoate, corn syrup along with guaifenesin) and a number of other widely advertised over-the-counter antitussives. The dose of guaifenesin is usually 100 to 200 mg taken every 4 hours. Guaifenesin may be used in children over 3 years of age. In its action, guaifenesin occupies an intermediate position between expectorant and mucolytic drugs. Unlike the expectorants described above, the action of guaifenesin is based on a decrease in surface tension and adhesion of sputum to the bronchial mucosa and a decrease in its viscosity due to the depolymerization of acid mucopolysaccharides of mucus. But the ability to increase the secretion of mucus (albeit less viscous) brings guaifenesin closer to expectorants. Side effects of guaifenesin are not noted, but there are no reliable data on its effectiveness.

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

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

I would like to focus on the use combined cough medicines. This group of drugs, usually over-the-counter or prescribed by doctors, contains two or more ingredients. A number of combined drugs include a centrally acting antitussive, antihistamine, expectorant and decongestant (broncholithin, stoptussin, sinecod, hexapneumine, lorain). Often they also include a bronchodilator (solutan, trisolvin) and / or an antipyretic component, antibacterial agents (hexapneumine, lorain). Such drugs relieve cough with bronchospasm, manifestations of a respiratory viral (eg, rhinitis) or bacterial infection, but they should also be prescribed according to the appropriate indications (see table). Often such drugs are not indicated or even contraindicated in young children, especially in the first months of life.

In addition, combined preparations, in particular those prescribed by doctors, may combine drugs that are opposite in their action, for example, antihistamines and expectorants (Zvyagintseva powder and its variants). Many prescriptions contain suboptimal or low concentrations of drugs, which reduces their effectiveness. But, of course, there are quite justified combinations of drugs.

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

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

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

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

Literature

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

Cough(tussis) - This is a reflex act aimed at cleansing the respiratory tract from sputum or foreign particles..

Considering that cough is one of the manifestations, often the only one, of any disease or pathological condition attempts to eliminate this symptom without explaining its cause are certainly erroneous. When establishing the nature of a cough, it is first necessary to carry out etiotropic or pathogenetic treatment of the underlying disease. In parallel, symptomatic cough therapy can also be carried out, which is either antitussive, that is, preventing, controlling and suppressing cough, or expectorant (pro-cough), that is, providing greater cough efficiency.

General principles of cough treatment:
cough treatment should begin with the elimination of its cause
it is necessary to determine whether the cough is dry or wet
individual approach to cough therapy, taking into account the diagnosis, clinical manifestations of diseases, the individual characteristics of the patient and the properties of prescribed drugs

Antitussive therapy is indicated when coughing does not clear the airways. At the same time, we can talk about specific antitussive therapy, which is essentially etiotropic or pathogenetic (for example, quitting smoking, eliminating the causes of postnasal drip). Nonspecific antitussive therapy is rather symptomatic, and it is given a limited place due to the high probability of establishing the cause of cough and prescribing targeted treatment.

The decision to prescribe antitussive drugs should be justified by the presence of a painful cough that causes significant physical and psychological discomfort in the patient, depriving him of sleep.. The choice of antitussive drug should be carried out individually, taking into account the mechanism of action, antitussive activity of the drug, the risk of side effects, the presence of concomitant pathology, and possible contraindications.

Causes of a cough

Acute cough:
aspiration - entry of foreign objects into the respiratory tract;
inhalation of irritants(house and library dust, chemical products, powders)
ARVI is the most common cause of acute cough, which is accompanied by nasal congestion and discharge, pain or a feeling of sore throat, and general malaise. After SARS cough can persist for several weeks
acute bronchitis - begins with fever and is manifested by cough with mucous sputum
whooping cough - a painful non-productive cough in children and some adults;
pneumonia - begins acutely with fever and is manifested by general weakness, malaise, headache
pleurisy - associated with pain in the side, which increases with deep breathing

chronic cough:
Lung cancer - agonizing cough, chest pain, hemoptysis, shortness of breath, weight loss
Chronical bronchitis- prolonged productive cough
bronchial asthma- unproductive cough with the release of a small amount of mucous viscous sputum
left ventricular failure that occurs against the background of coronary artery disease or heart defects - a cough is accompanied by the separation of mucous sputum, often with an admixture of blood. It is necessary to pay attention to the presence of other signs of heart failure: shortness of breath, edema, weakness
gastroesophageal reflux disease(GERD) - one of the symptoms is a cough without sputum. Often the patient feels pain and burning sensation behind the sternum or in the epigastric region, heartburn at night and in the morning
mental disorders- cough occurs in stressful situations (for example, when speaking in front of a large audience
taking certain medications- taking ACE inhibitors, blockers, cytostatics can provoke a cough. The cough usually disappears after the drugs are discontinued.

TREATMENT OF DRY COUGH

Antitussive drugs are used to treat dry cough.

Such drugs depress the cough center in the medulla oblongata or reduce the sensitivity of the respiratory mucosa to irritants:
drugs that depress the cough center- products containing codeine, dextromethorphan, paxeladin, tusuprex, butamirate
drugs that reduce the sensitivity of the mucous membrane of the respiratory tract to irritants- libexin

Centrally acting antitussives (narcotic)

Centrally acting antitussive drugs suppress the function of the cough center of the medulla oblongata. The best known drug of this group is codeine, a natural narcotic analgesic from the group of opiate receptor agonists.

Methylmorphine (codeine) Pronounced reduces the excitability of the cough center. It provides the duration of the blockade of the cough reflex for 4-6 hours. Currently, codeine is used infrequently and is used in short courses due to its ability to depress the respiratory center, which leads to a decrease in ventilation. May cause drowsiness, constipation. With prolonged use, it can cause addiction and drug dependence. Contraindicated during pregnancy and children under 2 years of age. It is not recommended to combine with alcohol, hypnotics, analgesics, psychotropics.

Dosage and administration Inside, adults with pain - 15-60 mg every 3-6 hours, with diarrhea - 30 mg 4 times a day, with cough - 10-20 mg 4 times a day; for children, these doses are respectively 0.5 mg/kg 4–6 times daily, 0.5 mg/kg 4 times daily, and 3–10 mg/kg 4–6 times daily. V / m is administered in the same doses as with enteral administration. The highest daily dose is 120 mg.

Dextromethorphan A synthetic analog of codeine, it is not inferior to it in antitussive activity. The ability to depress the respiratory center, cause constipation, addiction is much less than that of codeine. Contraindicated during pregnancy and children under 2 years of age. It can not be combined with alcohol, hypnotics, analgesics, psychotropic (pronounced depression of the central nervous system, respiration), amiodarone (increased toxicity).

Currently, new antitussives are more often used, free from these shortcomings (do not cause constipation, addiction and addiction, do not depress breathing, do not affect intestinal motility), the so-called non-narcotic antitussives. These include glaucine, which has a selective central action.

Centrally acting antitussives (non-narcotic)

They inhibit sensitive receptors and tension receptors of the mucous membrane of the respiratory tract and partially suppress the central link of the cough reflex without inhibiting the respiratory center. It should be noted that for oxeladine and butamirate, in addition to antitussive action, bronchodilator is characteristic. Butamirate also exhibits secretolytic and anti-inflammatory effects. A group of antitussive non-narcotic drugs of central action is also indicated for cough associated with irritation of the mucous membranes of the upper (epiglottic) respiratory tract, irritation of the mucous membranes of the nasopharynx and oropharynx, due to infectious or irritative inflammation.

Oxeladin (Tusuprex, Paxeladin) Synthetic antitussive agent, selectively acting on the cough center. When used, nausea, vomiting, drowsiness are rarely possible.

Dosage and administration inside. Adults - 1 caps. 2-3 times or 2-5 scoops per day, children (only syrup) - 1 scoop of syrup per 10 kg of body weight per day; children under the age of 4 years - 1-2, from 4 to 15 - 2-3 measuring spoons per day.

Butamirat An antitussive agent that selectively acts on the cough center. It has a moderately pronounced expectorant and anti-inflammatory effect, reduces airway resistance, improves respiratory function. Take before meals. In rare cases, the application may cause nausea, diarrhea, dizziness. Not recommended in the first trimester, during lactation. Children over 3 years old can be prescribed syrup, over 12 years old - tablets.

Dosage and administration Inside, the dose is determined depending on age.

Peripherally acting antitussives (non-narcotic)

Peripheral agents are also used to suppress cough. These include oral lozenges or syrups and teas containing plant extracts of eucalyptus, acacia, licorice, wild cherry, linden, etc., glycerin, honey, which have an enveloping effect and create a protective layer on the mucous membrane of the respiratory tract ( mostly upper sections).

Prenoxdiazine (Libexin) Synthetic antitussive drug of combined action. Slightly inhibits the cough center, without depressing respiration. It has a local anesthetic, direct antispasmodic effect, reduces the excitability of peripheral receptors, and prevents the development of bronchospasm. Tablets should be swallowed without chewing (otherwise, numbness, insensitivity of the oral mucosa is possible). During pregnancy should be administered with extreme caution.

Dosage and administration Inside, without chewing (to avoid numbness of the oral mucosa), 3-4 times a day: adults - usually 100 mg (in severe cases - 200 mg), children - depending on age and body weight, usually 25 -50 mg. In preparation for bronchoscopy: 1 hour before the study - 0.9-3.8 mg / kg, in combination with 0.5-1 mg of atropine.

TREATMENT OF WET COUGH

In the presence of viscous sputum, the patient can be recommended to drink plenty of fluids, including herbal remedies. Herbal remedies are used that have anti-inflammatory, enveloping, expectorant, bronchodilator effects, reduce irritation of the bronchial mucosa, and increase the cough threshold. In the absence of contraindications, for example, vasomotor rhinitis, inhalation of water vapor is also used, by itself or with the addition of sodium chloride or benzoate, sodium bicarbonate - soda, ammonium chloride, plant extracts. This helps to moisturize the mucosa, has a mild analgesic, anesthetic effect, reduces the reflex stimulation of the cough center, improves the rheological properties of the secret and relaxes the smooth muscles of the bronchi.
Along with this, drugs such as thermopsis, ipecac increase the vomiting and cough reflexes, so they should not be used in children of the first months of life and in patients with damage to the central nervous system: they can cause aspiration, asphyxia, atelectasis, or increase vomiting associated with with a cough.

Expectorants

The mechanism of action of expectorants is based on reducing the viscosity of mucus by increasing its volume and, as a result, removing bronchial secretions from the respiratory tract. Most of them actively increase the secretion of mucus due to reflex irritation of the glands of the bronchial mucosa. Iodides, ammonium chloride, sodium bicarbonate, essential oils have a direct secretory and secretolytic effect, stimulating proteolysis and hydrolysis of sputum.

Among the expectorants are:
reflex acting drugs- thermopsis, marshmallow, licorice, terpinhydrate, essential oils - when taken orally, they irritate the stomach receptors and reflexively increase the secretion of the salivary glands and mucous glands of the bronchi
resorptive drugs- sodium and potassium iodide, ammonium chloride, sodium bicarbonate - are absorbed in the gastrointestinal tract, excreted by the bronchial mucosa and increase bronchial secretion, thus thinning sputum and facilitating expectoration

Mucoregulatory agents

Carbocysteine ​​is only active when taken orally. Carbocysteine, unlike acetylcysteine, bromhexine and ambroxol, has a mucoregulatory effect, reducing the synthesis of neutral and increasing the production of acidic mucins. It also helps to increase the synthesis of IgA by epithelial cells and, by significantly reducing the number of goblet cells, especially in the terminal sections of the bronchioles, reduces mucus production, so carbocysteine ​​is not recommended to be combined with drugs that reduce the secretion of bronchial mucus, with poor sputum formation, as well as with a tendency to constipation. . Carbocysteine ​​restores the normal viscosity and elasticity of mucus, promoting its excretion, and also reduces sputum secretion. Clinical and pharmacological properties close to acetylcysteine. Liquefies sputum by breaking disulfide bonds in glycosaminoglycans. Inhibits local effects of inflammatory mediators. Promotes the penetration of antibiotics into the bronchial secretion.

Dosage and administration inside. Adults - 2 caps. or 15 ml (3 tsp) 5% syrup 3 times a day; after improvement - 1 caps. or 10 ml (2 teaspoons) 5% syrup 3 times a day. Children from 2 to 5 years old, 2.5–5 ml (1/2–1 teaspoon) of 2.5% syrup 4 times a day, from 5 to 12 years old - 10 ml of 2.5% syrup (2 tsp. spoons) 4 times a day.

Bromhexine reduces the viscosity of sputum, if it is not very pronounced. Currently, bromhexine is being replaced by the drug of its active metabolite, ambroxol (Ambrohexal). Ambroxol not only increases the level of sputum, but also contributes to its better excretion. Bromhexine is metabolized in the liver to the active substance ambroxol. Thus, ambroxol is the active metabolite of bromhexine. Fragment glycoproteins and glycosaminoglycans of bronchial secretion. They have a mucolytic (secretolytic) and expectorant effect. Provides a mild antitussive. Bromhexine and ambroxol have the ability to stimulate the production of endogenous pulmonary surfactant, and ambroxol, in addition, slows down its decay. The surfactant ensures the stability of alveolar cells during respiration, prevents the alveoli from collapsing, protects them from the effects of external adverse factors, and improves the “sliding” of bronchopulmonary secretion along the epithelium of the bronchial mucosa. Reducing the viscosity of mucus, improving its sliding significantly increase the fluidity of sputum and facilitate its release from the respiratory tract.

Dosage and administration Inside, inhalation, in / m, s / c, in / in slowly. Inside: adults and children over 14 years old - 8-16 mg 3-4 times a day; children under 14 years old - depending on age.

!!! one of the disadvantages of acetylcysteine, carbocysteine ​​and partly bromhexine is their ability to increase bronchospasm, so the use of these drugs in the acute period of bronchial asthma is not indicated

Mucolytic agents

Mucolytics normalize the secretion of bronchial secretions and thereby improve the excretion of mucus from the bronchi. Mucolytics can be used to treat diseases of the lower respiratory tract, both acute (tracheitis, bronchitis, pneumonia) and chronic (chronic bronchitis, bronchial asthma, cystic fibrosis). The appointment of mucolytic agents is also indicated for diseases of the ENT organs, accompanied by the release of mucous and mucopurulent secretions (rhinitis, sinusitis). Mucolytics are often the drug of choice in children during the first three years of life.

Actylcysteine ​​(ACC) is one of the most active mucolytic drugs. ACC breaks the bonds of sputum mucopolysaccharides, which helps to reduce the viscosity of mucus, thin it and facilitate excretion from the bronchial tract, without significantly increasing the volume of sputum. In addition, ACC increases the protection of cells from free radical oxidation, which is characteristic of the inflammatory response. ACC is a promising drug for the treatment of not only acute, but also chronic bronchopulmonary diseases, as well as for preventing the adverse effects of xenobiotics, industrial dust, smoking, including oncological morbidity in these groups of patients. The antioxidant effect helps to reduce inflammation in the bronchi, reduces the severity of the course of diseases and minimizes the frequency of exacerbations. To date, only preparations containing acetylcysteine ​​combine the properties of a mucolytic and an antioxidant.

Indications for the use of the drug are acute, recurrent and chronic diseases of the lower respiratory tract, accompanied by the formation of viscous sputum, without or in the presence of a purulent inflammatory process - acute and chronic bronchitis, pneumonia, bronchiectasis, cystic fibrosis, and other chronic diseases of the respiratory tract. ACC is available in several dosage forms: tablets, powders, solutions, injection ampoules. This allows you to choose the treatment individually for each patient.

Applied ACC in an average daily dose of 600 mg. After oral administration, the effect of the drug begins after 30-90 minutes. Usually, ACC is well tolerated; in rare cases, mild dyspeptic disorders are possible.

Additional medicines used to treat cough

For cough associated with irritation of the upper respiratory tract, the use of antitussives with local anesthetic activity. Lozenges containing diclonin are symptomatic therapy in the treatment of inflammatory processes in the pharynx (tonsillitis, pharyngitis) and larynx (laryngitis). The drugs reduce the feeling of soreness and irritation in the throat, sensitivity to various irritating factors (temperature, chemical), disrupting the development of the cough reflex. The drug eliminates dry paroxysmal, barking cough, chest pain associated with coughing.

If a cough occurs due to an allergic reaction, the appointment is indicated antihistamines(loratadine, terfenadine, cetirizine, fexofenadine) and mast cell membrane stabilizers (cromoglycate sodium, nedocromil sodium).

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Useful tips for coughing:
humidify the air; stop smoking or smoke less, and avoid areas that are heavily smoky
avoid sudden changes in temperature (for example, quickly leaving a warm room in the cold)
avoid chemical fumes (aerosols, dishwashing detergents, powders)
do inhalations and moisturize the nasal mucosa
cough - it helps to clear the bronchi

Folk remedies for cough:
Pour 1 lemon with water and boil over low heat for 10 minutes, after the lemon has cooled, cut it in half and squeeze juice from the lemon into a 200 gram glass, add 2 tablespoons of glycerin (for oral consumption), pour honey to the rim of the glass and that's it mix. Take 2 teaspoons of the mixture 3 times a day before meals and at night.
In equal parts, mix carrot or radish juice with milk, take 6 times a day, 1 tablespoon.
Mix 2 yolks, 2 tablespoons butter, 2 teaspoons honey and 1 teaspoon wheat flour, take up to 1 teaspoon many times a day.
Mix crushed walnuts in a mortar with honey in equal parts, dilute one teaspoon of the resulting mass in 100 ml of warm water and drink in small sips.
Pour 1 tablespoon of sage herb with 1 cup of boiling water, let it brew, strain, dilute the resulting broth with milk in a ratio of 1: 1, take 1/2 cup of the mixture warm, you can add honey or sugar.
200 ml of boiling water, pour 50 g of raisins, let it brew for 30 minutes, put onions and squeeze the juice out of it, drain the water from the raisins and add 3 tablespoons of the squeezed juice to it, drink in small sips at a time, best at night.
Cut seven pieces of radish into thin slices, sprinkle each slice with sugar and leave for 6 hours, take 1 tablespoon of radish juice every hour.
Pour 100 g of viburnum berries with 200 g of honey and cook over low heat for 5 minutes, then cool at room temperature and take 2 tablespoons of the mixture 5 times a day.
One tablespoon of red clover pour 200 ml of boiling water, cover, let it brew for 3-5 minutes, drink warm in small sips (expectorant).
Boil 500 g of peeled chopped onions, 50 g of honey, 400 g of sugar in 1 liter of water for 3 hours over low heat, after which the liquid must be cooled, drained into a bottle and corked, take 1 tablespoon 5 times a day with a strong cough.

Palliative care in the treatment of pathologies accompanied by unproductive is provided by antitussive drugs. They are recommended for children when reflex acts occur at regular intervals, which adversely affects the well-being of the baby.

They have a number of contraindications, non-observance of which is dangerous for the health of the child. The decision on the appointment is made exclusively by the doctor, guided by the age and physiology of the small patient, the etiology of the disease, which is associated with the appearance of an unpleasant symptom.

The modern pharmaceutical industry offers a wide range of products to suppress the activity of the cough center in the segment of the brain, to reduce the sensitivity of receptors in the respiratory mucosa. Available in a variety of formats: tablets, lozenges, powders, syrups, drops.

The basis for the division of antitussive drugs the medicinal composition(natural, combined, synthetic) and mechanism of action(peripheral, central, combined).

List of means of direct influence

Their appointment is not always an effective therapeutic measure. due to an increased risk of side effects. According to the method of interaction with the structural and functional basis of the organism, drugs of this group classified into opioid (narcotic) and non-opioid (non-narcotic).

In preparations close to drugs, the main substance is represented by morphine derivatives: codeine, ethylmorphine, dimemorphan. In pediatrics, they are used extremely rarely for particularly important indications (pertussis infection,), and only under medical supervision. They provoke such disorders as insufficient defecation, drug dependence, euphoria.

Nuance! The duration of the course is determined by the doctor on an individual basis, on average, 5-7 days are enough to achieve positive dynamics.

The most famous representatives:

The decision on the choice of cough medicine is made by the doctor after carrying out diagnostic measures.

1. Tablets "Codeine". They reduce the activity of the cough center, excite opiate nerve endings in peripheral tissues, and change the sensitivity of pain perception. Analgesic effect lasts up to 4 hours, antitussive effect up to 6 hours. Contraindications to the appointment are children under the age of one year, individual intolerance to constituent elements, toxic dyspepsia, diarrhea, bronchial asthma. Possible adverse reactions from the central nervous system, cardiovascular system, digestive tract. Significant disadvantage- development of tachyphylaxis (drug dependence), upon completion of therapy - withdrawal syndrome.
2. Suspension "Kodipront". Reduces the excitability of the cough center, has anti-allergic and slight sedative properties. Therapeutic result comes in half an hour, lasts up to 12 hours. Effective in the treatment of unproductive cough with allergies, colds, infectious inflammations of the respiratory mucosa. Causes a number of negative reactions, with an overdose, a deep syncope, arterial hypotension is possible. The list of contraindications includes children under 2 years of age..

Non-narcotic components include butamirate, glaucine, dextromethorphan, pentoxyverine, oxeladin. They do not destabilize the work of the respiratory center, they have a softening and local anesthetic effect.

Widespread in ENT practice received:

1. "". The drug has a diverse spectrum of action, exhibits anti-inflammatory, bronchodilator activity. Improves breathing quality and spirometry without reducing airway resistance. Suitable for treating children of different age groups: from 2 months, drops, syrup are prescribed from the age of three, dragees from 7 years. Adverse reactions are extremely rare.
2. Tablets "Tusuprex". They have mild expectorant and antitussive properties. Unlike codeine. do not depress the respiratory center, do not cause addiction. Assign to children older than a year with infectious and non-infectious cough of various etiologies. Adverse reactions are manifested by drowsiness, weakness, dyspeptic disorders.
3. Syrup "Glycodin". The versatility of the medicinal liquid provides a versatile composition. It increases the threshold of perception of the cough center receptors, reducing the frequency and intensity of reflex acts. Activates the secretory function of the mucosa, changes the fluidity of the bronchial secret, which facilitates its evacuation. It has antispasmodic and sedative effects. An overdose is dangerous with an allergic reaction, drowsiness, nausea. In pediatrics, they are used to treat children from a year.

For reference! The parallel use of antitussive drugs with mucolytics can provoke stagnation of sputum in the bronchi, which will negatively affect the health of the child.

Antitussive drugs are adjuvant therapy. They normalize the general condition of the patient, reduce the severity of symptoms, and speed up the healing process.

Peripherally acting drugs

They are more popular in pediatrics, because. the risk of side effects is minimal. Influencing the afferent or efferent component of the cough center, they do not affect the functions of the respiratory system and do not cause drug addiction. They reduce CNS stimulation, change the biological properties of sputum, eliminate bronchospastic syndrome.

The following antitussive drugs for children with dry cough have proven the drug efficacy and safety:

A herbal preparation with a versatile spectrum of actions simultaneously has an extensive list of contraindications

1. Tablets "Libeksin". According to the therapeutic effect, they are equated to "Codeine", but unlike the narcotic substance, they do not inhibit the respiratory processes. The main component, prenoxdiazine, blocks the afferent receptors of the cough reflex. They exhibit anti-inflammatory, bronchodilatory, anesthetic activity. Eliminate reflex acts in acute and chronic forms of colds, inflammation of the lungs, bronchi. The dosage is calculated taking into account the age and weight of the child.
2. syrups "Broncholitin", "Bronchocin", "Bronhoton". Herbal medicines based on glaucine with a similar mechanism of action. Suppress the cough reflex without disturbing the functions of the respiratory system. They cause bronchial dilation, increase the activity of mucociliary clearance, eliminate swelling of the mucous membranes. Less pronounced antiseptic, sedative and antispasmodic effect. Children are allowed to use from 3 years old, provided there are no contraindications(heart disease, thyroid problems, hypersensitivity to components).
3. Syrup "Levopront". The active substance - levodropropizine, reduces the sensitivity of the respiratory tract receptors. Used to soothe and mitigate unproductive cough in infectious and non-infectious forms of respiratory tract damage. Recommended for children over 2 years old. Use with caution in the treatment of patients with renal insufficiency, with impaired liver function, hypersensitivity to the constituent elements.

Advice! To enhance the palliative care of antitussive drugs, it is necessary to provide the child with two mandatory conditions: a plentiful drinking regimen and fresh cool air in the room.

When choosing medicines, give preference to domestic manufacturers. They are in no way inferior to foreign counterparts, but are several times cheaper.

Antitussive drugs for children up to a year

In the first year of a baby's life, it is advisable to limit the intake of any medication, which is associated with the risk of overdose.

Important! Infants and adults may develop a physiological cough. A protective and adaptive mechanism aimed at cleansing the respiratory tract from foreign substances, sputum residues. This is a natural reaction that does not require pharmacotherapy, reflex acts stop as soon as the stimulus is eliminated.

The list of approved pharmaceutical products for suppressing the cough reflex in newborns is limited. Most often, the following medications are included in the treatment regimen:

An effective antitussive agent has become widespread in pediatrics due to minimal side effects, the possibility of use from an early age

1. Drops "Sinekod". A non-narcotic drug of central action is not classified as an opium derivative. Improves the quality of breathing, additionally has an anti-inflammatory and bronchodilator effect. It has a pleasant taste, so it is well tolerated by young patients. In pediatrics, it is used to treat debilitating dry cough of various etiologies. in children aged 2 months and older.
2. Drops "Stoptussin". The drug of combined action increases the secretion of pathological secretion, reduces its viscosity, contributing to the active cleansing of the tracheobronchial tree. Neutralizes discomfort in the throat, reduces the frequency and intensity of cough attacks. Assign to children from 6 months with a dry irritating cough, incl. against the background of infectious and inflammatory pathologies of the upper and lower respiratory tract.
3. Syrup "Panatus". Antitussive agent of direct influence on the central nervous system. The main component - butamirate, does not apply to narcotic substances. It has expectorant, anti-inflammatory and bronchodilator properties. Sugar and lemon flavor improve taste. Suitable for children from 6 months.

To enhance the therapeutic effect, antitussive drugs often include auxiliary elements with antipyretic, antihistamine, antibacterial properties.

However, the wide variety of components complicates the choice of dosage and compatibility with other drugs, which imposes restrictions on the use of combined drugs in pediatrics.

Conclusion

Antitussive drugs are prescribed in extreme cases. The main task with a dry cough at the initial stage is to activate the natural protective reaction. To this end, it is necessary to wash the nose, offer more warm liquid, create a favorable indoor climate.

A systematic and intense cough can provoke the development of emphysema, hypertension in the pulmonary circulation and cause an increase in intrathoracic pressure. Medications that suppress the cough reflex help to get rid of frequent coughing.

Most popular cough medicines

The most popular non-narcotic cough medicines are the following types of medicines:

• Glaucine.
• Libeksin.
• Oxeladin (Tusuprex).
• Falimint.

Each of them has its own characteristics, which must be considered in the treatment of obsessive and intense cough.

Glaucine

Glaucine is a preparation of a group of alkaloids. When it is taken, the spasm of the muscles of the bronchi weakens, the nervous system calms down. Usually Glaucine is prescribed for acute bronchitis, pharyngitis, whooping cough. The medicine is produced both in the form of tablets and dragees, and in the form of a syrup.

Libeksin

Libexin is a synthetic cough suppressant. Its influence occurs both peripherally and centrally. When taking Libexin, the activity of the cough reflex is suppressed, spasms in the bronchi are eliminated, and pulmonary stress receptors are blocked. The antitussive effect of Libexin can be compared with the effect of Codeine, with the difference that the former is not addictive and does not depress the respiratory system. The effect of this drug lasts 3-4 hours. Libexin tablets are not chewed.

Oxeladin (Tusuprex)

This cough medicine is available in tablets, capsules (for adults only), and also as a syrup. The drug reduces the sensitivity of the cough center to the impulses supplied by the cough receptors, as a result, the attacks are blocked. The drug is effective for dry reflex spasm, acute bronchitis, tracheitis.

Falimint

Falimint is available in the form of a lozenge for resorption, it has pronounced antitussive and analgesic properties.

In addition to the above drugs, there are drugs that block coughing attacks that have a narcotic effect (Codeine, Kodipront, Demorphan, etc.).

For which cough is it appropriate to take stopping medicines

Medications that block involuntary movements of the diaphragm should be taken only in the absence of sputum, but if attacks are accompanied by abundant mucus, such drugs are categorically contraindicated, since, by retaining sputum in the lungs and bronchi, they can cause a relapse of the disease and lead to quite serious consequences.

- a reflex act aimed at cleansing the respiratory mucosa from various stimuli - physical, organic, chemical. Cough is a clinical sign of most respiratory pathologies. Its main goal is to expel all foreign bodies, microbes and sputum from the respiratory tract, thereby improving the patency of the airways.

Cough signals the existing trouble in the human body and gives the command to eliminate the causes that caused it.

Before you buy cough pills and start treatment, you need to determine its type, strength, duration, timbre, as well as the nature of sputum.

Airways

Cough happens:

1. Acute, subacute, chronic,
2. Strong, hysterical and weak in the form of a slight cough,
3. Constant, morning, night,
4. , sonorous, deep or hysterical.

A viscous secret from the lungs, bronchi and trachea, secreted during expectoration and containing saliva, nasal, sinus, and oral secretions. Sputum is serous, mucous, purulent, mixed with blood.

The most common causes of coughing are: inflammation of the bronchi and lungs, bronchial asthma, lung cancer, pathology of the heart and blood vessels, allergies.

Treatment of any type of cough is etiotropic. Only by eliminating the cause of the cough, you can get rid of it for a long time.

Preparations for the treatment of dry cough

Drugs intended for the treatment of dry cough suppress the cough center in the brain and block the coughing act at the level of the nerve endings of the tracheobronchial tree.

These medicines are forbidden to be used to eliminate a wet cough, since stagnation of the discharge in the bronchi is possible. They should be used as prescribed by a specialist after passing a comprehensive examination.

Centrally acting narcotic cough medicines

The drugs of this group have a narcotic effect on the body, are dispensed by prescription, have many side effects, used to treat very severe coughs, contraindicated in children under 2 years of age, inhibit the activity of the epithelium of the bronchial tree.

Codeine is an opioid that suppresses the cough center. It is a naturally occurring drug widely used in medicine as a cough medicine and pain reliever. Codeine is the main active ingredient in Codelac cough tablets and Cofex and Tussin plus syrups. The cough reflex is inhibited at the level of the central links, due to which the cough stops.

"Hydrocodone"- oral effective cough medicine with a pronounced analgesic effect.

Long-term use of these drugs can lead to the development of euphoria and addiction in the patient. They should be taken just before bedtime so that a painful cough does not interfere with sleep.

Non-narcotic antitussives of central action

Non-narcotic tablets and syrups suppress the cough center in the brain and weaken the signals coming from the inflamed bronchi to the cerebral cortex.

Peripheral cough medicines

They suppress the act of coughing at the level of receptors of the tracheobronchial tree, have analgesic and antispasmodic effects on the respiratory system, change the viscosity of the secret. Cough medicines are divided into enveloping and local anesthetics.

1. "Libeksin"- a cough remedy that suppresses the sensitivity of the nerve endings of the respiratory system and reduces the susceptibility of cough receptors to signs of inflammation. The drug reduces the activity of the respiratory center, while maintaining its functions in full.
2. "Bitiodin"- tablets for dry cough, not addictive and side effects. The antitussive effect is due to a greater extent to the influence on the receptors of the respiratory mucosa and to a lesser extent to the centers of the nervous system.
3. "Levopront"- a syrup that helps to reduce the intensity and frequency of coughing and has a bronchodilator effect. The drug has a peripheral effect on the tracheobronchial tree.

Medicines effective for wet cough

For the treatment of wet cough, patients are prescribed secretory and secretolytic tablets, potions and syrups.

Expectorants

They enhance the production of bronchial secretions, dilute sputum and contribute to its rapid removal from the body.

• "Mukaltin"- secretolytic and expectorant herbal remedy. Marshmallow, which is part of the drug, reflexively enhances the stimulation of the ciliated epithelium, the peristalsis of the respiratory bronchioles, the secretion of the bronchial glands, the thinning of mucus, and the release of sputum during coughing. "Mukaltin" moderately fights inflammation, envelops the mucous membrane and protects it from irritating substances, restores damaged tissues. The drug does not have a toxic effect. Similar effects are dyspepsia and allergies.
• "Doctor Mom"- a natural remedy that has a mild effect on the body and has a minimum of side effects. The medicine helps to quickly get rid of sputum. The syrup has a locally irritating, distracting, anti-inflammatory and expectorant effect. "Doctor Mom" ​​is often prescribed to patients with a dry cough, which quickly turns into a wet one.
• "Gedelix"- an effective expectorant, produced in the form of syrup. It contains substances that have mucolytic, bronchodilatory and antioxidant effects, destroy pathogenic microbes and fungi. The biologically active substances that make up its composition improve microcirculation, remove salts from the body, protect the liver and kidneys from the influence of external factors.

Mucolytics

Mucolytic drugs are designed to thin viscous and thick sputum, which makes it easier to discharge. Mucolytics restore the bronchial mucosa and elasticity of the lungs. They are usually prescribed together with expectorants to enhance the therapeutic effect of both groups of drugs.

1. Bromhexine- cough tablets that reduce the viscosity of sputum and contribute to its rapid removal. This is an effective mucolytic agent with a pronounced expectorant effect. Due to the depolarization of protein fibers, the consistency changes and the viscosity of sputum decreases. "Bromhexine" has a weak antitussive and pronounced secretolytic effect. The drug is able to stimulate the formation of surfactant and ensure the stability of alveolar cells during respiration.
2. Cough syrup "Ambrobene"- a mucolytic agent, under the influence of which the glands of the bronchi produce mucus, the motor activity of the cilia of the ciliated epithelium increases, the viscous sputum liquefies and comes out. The active ingredient in Ambrobene syrup is Ambroxol. It has an anti-inflammatory and expectorant effect, stimulates local immunity, enhances the penetration of certain antibiotics into the sputum and stimulates the production of surfactant, a substance that prevents the alveoli of the lungs from collapsing.
3. "ACC"- cough tablets, soluble in water. This dosage form is absorbed and acts much faster than others. The drug reduces the viscosity of mucus and facilitates the discharge of sputum by the influence of acetylcysteine ​​on its rheological properties. ACC is a non-toxic drug that can be used for a long time. It can be used prophylactically to reduce the frequency and severity of exacerbations in patients with chronic inflammatory respiratory diseases.

Mucolytic drugs act gently. The therapeutic effect after their application is achieved quickly. The negative consequences of taking mucolytics are intolerance to the components of the drugs and exacerbation of stomach diseases.

A cough that lasts several weeks and is accompanied by the formation of a purulent discharge and fever requires a visit to a specialist. Self-treatment in this case is unacceptable.

Combined antitussive drugs

Preparations of this group contain two or more therapeutic components that enhance the effect of each other.

Cough medicines suitable for children

For the treatment of cough in children, specialists usually prescribe mixtures and syrups. It is much easier for babies to take them than tablets.

Children under two years old are prescribed syrups "Lazolvan", "Linkas", "Prospan", "Bromhexin".

Children over two years old are prescribed Gerbion, ACC, Gedelix, Libeksin Muko. Cough syrups based on marshmallow or licorice are very effective, safe, natural. They can be purchased at any pharmacy, and they are inexpensive.

Modern pharmacy offers a huge selection of cough medicines, among which there is no universal one. Some drugs are effective against a dry, obsessive cough, while others eliminate a productive cough with sputum. The scheme of treatment of respiratory diseases differs in different categories of people. For children, the best remedy for a cough will be one, for the elderly - another. What is ideal for one person is absolutely unacceptable for others. This is due to the side effect of many cough medicines and depends on the state of the respiratory system and the degree of the body's immune defense.

In any case, only a doctor should prescribe treatment with antitussives, after a thorough diagnosis of the disease.

Video: cough medicine, “Doctor Komarovsky”