Mucolytic cough tablets. Expectorants and mucolytics: a review of drugs. What does mucolytic mean?

Expectorants and sputum-thinning agents are frequent components of treatment for bronchitis, pneumonia, and tuberculosis. Without their use, it is extremely difficult to clear the airways and ensure normal breathing. Such funds cannot be used arbitrarily, because they can cause side effects.

In what cases are thinning and expectorants used, and when are they prohibited?

In the bronchi of every healthy person, special mucus is produced. It makes impossible the negative impact of microorganisms, dust, allergens that enter with the air. In the normal state, the cilia of the bronchi independently push out the mucus with all the "unnecessary". If an inflammatory or some pathological process begins in the respiratory tract, the mucus begins to change its viscosity. It becomes thick, sticks to the lung tissues, there are more microorganisms in it, they begin to multiply, which further complicates the situation. The bronchi can no longer cope with excretion on their own. It is in this situation that funds come to the rescue that provide liquefaction of sputum when coughing and contribute to its rapid removal.

Expectorants and thinners are often recommended for:

• bronchitis (both in acute and chronic form);
• pneumonia of viral and bacterial origin;
• COPD;
• bronchiectasis;
• tracheobronchitis;
• emphysema of lung tissues;
• laryngitis;
• tuberculosis;
• bronchial asthma;
• diseases accompanied by difficult sputum excretion.

Means of this type have certain contraindications. The latter directly depend on the active substance and the mechanism of action. So, for example, products based on Ambroxol cannot be used in case of serious disorders of the kidneys and liver, based on Acetylcysteine ​​- for bleeding in the lungs, bronchial asthma, based on plant extracts - for high acidity, gastrointestinal diseases, gastritis.

In fact, all expectorant and thinning agents are strictly prohibited when:

• pregnancy (especially in the first trimester);
• hypersensitivity to any of the components of the agent;
• in early childhood (up to 1 year);
• oncological diseases of the respiratory system.

Mucolytics and their action

Mucolytic drugs are called drugs that are designed to dilute the thick mucus in the lungs. Directly or indirectly, these drugs prevent the adhesion of fluid formed in the lungs, have a moderate anti-inflammatory effect.

All mucolytic agents can be divided into 3 large groups:

• drugs that affect the elasticity of the liquid and the viscosity itself;
• reduce the volume of mucus;
• accelerate elimination.

Unlike expectorants, sputum-thinning drugs do not cause an increase in sputum in the lungs. They are actually never recommended for dry cough, which often occurs with influenza and acute respiratory infections. You can take mucolytic drugs when the cough is at least a little wet.

There are 4 active ingredients on the basis of which mucolytic preparations are made:

1. Acetylcysteine. The main representatives are: ACC, Fluimucil, Vicks Active, ACC Long, Expectomed. Means of this group are most often carried out in the form of tablets or powder. Less commonly, in the form of solutions for the preparation and implementation of inhalation, as well as injections. They perfectly cope with the dilution of the liquid, have a moderate antioxidant effect, due to which they can fight some poisons.
2. Bromhexine. On its basis, such medicines are made: Nycomed, Bromhexine, Bronchosan. One of the oldest drugs of the mucolytic type. Once in the human body, it undergoes specific processing, due to which it turns into Ambroxol. The latter performs a therapeutic effect.
3. Carbocysteine. Sold under commercial names: Libeksin Muko, Bronhobos, Fluditek. According to their direct indications and contraindications, these tablets are very similar to Acetylcysteine. Appropriate for use in whooping cough, sinusitis, otitis media.
4. Ambroxol. It is the main component of such drugs as: Lazolvan, Flavamed, Ambrobene, Ambroxol, Ambrohexal. Today it is considered the most effective substance for cough control. It is a combined remedy, because it simultaneously dilutes and has an expectorant effect. Ambroxol is able to prevent sticking of mucus and enhances the action of many antibiotics. Given this, it is often recommended for pneumonia.

Expectorants and their uses

Expectorant drugs have their main task to remove sputum from the lungs. As a rule, before using them or in parallel with them, doctors recommend mucolytic drugs to thin the sputum in the bronchi, as well as inhalations, expectorant massages.

The drugs of this group, in accordance with the mechanism of their action, can be conditionally divided into 2 main groups:

• reflex action - affect the gastric mucosa and activate the vomiting center of the brain, as a result of which the production of mucus is significantly accelerated, so the lungs are forced to get rid of it reflexively;
• direct action - can affect the bronchi themselves.

Means of both groups are taken orally and begin to act after successful assimilation by the digestive system. Medicines of reflex action are performed, as a rule, on the basis of plant extracts. Means of direct action can have both natural and chemical composition.

Many drugs of this type have simultaneously expectorant, thinning, antimicrobial and anti-inflammatory effects. The most prominent representatives of expectorants with a reflex action are:

• medications based on Althea (Alteika syrup, Mukaltin) - especially often used for bronchitis, emphysema; not recommended for children under 3 years of age, in addition, with ulcerative diseases of the gastrointestinal tract;
• thermopsis drugs (Termopsol, Codelac broncho) - have a bright mucolytic and expectorant effect;
• products based on plantain extract (for example: Stoptussin syrup, Gerbion Coldrex broncho) - can be used for various types of cough, including dry; distinguished by their soft action and safety;
• made from thyme (thyme) (Bronhikum C, Tussamag, Pectusin) - can be used to treat children from 6 months.

The composition of direct-acting preparations often includes components such as essential oils, ammonium chloride, potassium iodides. The main drug in this group can be called Amtersol.

Expectorant and liquefying herbal remedies

Some herbal remedies, plant extracts also help to effectively dilute mucus and remove it from the human respiratory system:

• option number 1 - oregano and pieces of coltsfoot;
• option number 2 - licorice, plantain, coltsfoot leaves;
• option number 3 - anise extracts, pine buds, sage extracts;
• option number 4 - elements of common chamomile, licorice, calendula herb, violet flowers, wild rosemary,

Additionally, you can use - wild rosemary grass. Performs a reflex action on the bronchi, the central nervous system. Able to reduce microbes in the upper lobes of the body. It can be used both for gargling the throat and mouth, and for oral administration.

Features of the use of thinning and expectorant drugs

Thinners and mucolytics today are available in a wide variety of pharmaceutical forms, including tablets, capsules, injections, herbal infusions, decoctions, teas, syrups, and the like.

Important rules that in no case should be neglected when starting treatment with cough remedies are:

• use as a volumetric amount of liquid (for example, warm teas, fruit drinks, boiled or mineral water) - they contribute to a more rapid liquefaction of mucus;
• a categorical rejection of antitussive drugs - if they are combined, you can count on very serious consequences, including pneumonia, necrosis of lung tissues and even death.

Treatment with mucolytics and expectorants will not be effective if the conditions of stay are not optimal for the patient. Be sure to ventilate the room and provide moist air.

When there is no improvement within 2 days from the start of using the drugs prescribed by the doctor, it is urgent to retake the tests and replace the drugs or their dosage. It is worth remembering that all expectorants and mucolytics are equally safe, sometimes they cause side effects. Among the most frequent are:

• discomfort in the stomach;
• diarrhea
• migraine;
• skin rashes;
• lowering blood pressure;
• increased acidity;
• pulmonary bleeding;
• dizziness.

Most drugs of these groups (especially in the form of tablets) can cause an overdose. Noticing any of the negative reactions, you need to urgently contact a specialist and stop taking the selected drug.

With well-chosen medicines and their use provided for by the instructions, the patient does not experience negative reactions that could interfere with driving or important technical processes.

Although some expectorant medicines are made on the basis of alcohol, their combination with alcoholic beverages is not desirable, as the toxic effects on the liver and kidneys increase.

Given the above, you should not refuse the advice of a doctor about the use of mucolytic or expectorant drugs when there is a difficult cough. A large number of pharmaceutical forms and active ingredients enable the specialist to choose the most convenient and effective option.

Expectorants are prescribed for the treatment of coughs that occur with the formation of viscous mucus in the bronchi. Preparations with expectorant properties are intended to facilitate the separation and excretion of sputum in adults and children from an early age.

Expectorants are classified according to their mechanism of action as:

• secretomotor - stimulating expectoration;
  • reflex;
  • resorptive;
• mucolytic.

The group of expectorants with mucolytic action is the most widely represented. These drugs change the parameters of sputum - they affect its viscosity, adhesive properties, and significantly thin the mucus.

The expectorant effect of secretomotor agents is associated with bronchial stimulation, increased activity of ciliated epithelial cells, aimed at mechanical expulsion of accumulated mucus.

Secretomotor means

The task of secretomotor expectorants is to increase the peristaltic contractions of the bronchioles, aimed at expelling sputum from the lower respiratory system into the upper respiratory tract.

The drugs have a moderate thinning effect on sputum, which also helps to accelerate the process of bronchial cleansing.

reflex action drugs

Reflex preparations include terpinhydrate, lycorine, plant extracts of marshmallow, thermopsis, ipecuana, licorice, elecampane, plantain leaves.

The action of these drugs is to irritate the receptors that are located in the gastric mucosa. Excitation of gastric receptors is transmitted through parasympathetic nerves to the bronchial mucosa.

These changes stimulate the activity of glands that secrete mucus in the bronchi, increase the mobility of the ciliated epithelium lining the respiratory tract.

As a result:

• sputum liquefies;
• facilitates its removal.

When coughing with sputum, expectorants containing marshmallow root are used. The extract of this medicinal plant is part of the tablets,.

Cough medicine, in addition to marshmallow root, includes licorice extract, anise seeds. Expectorants with licorice root are especially widely represented and used to treat children with a wet cough.

Licorice as an expectorant component is included in Doctor Mom syrups.

Expectorant effect differ preparations with thyme extract, these include syrups, Thyme, Bronchicum, Tussamag, Bronchipret.

All of these funds are distinguished by an expectorant effect, are approved for use in the treatment of children with a wet cough, taking into account compliance with the dosage. A contraindication to use may be the age limit specified in the instructions for use.

In case of an overdose, vomiting may occur, which is why the funds of this group should be used with extreme caution for the treatment of young children, the elderly, and bedridden patients.

Resorptive drugs

Resorption through the respiratory system is the property of the respiratory mucosa to absorb volatile substances. Eucalyptus essential oil, terpene, thymol oils have such a resorptive effect.

Expectorant properties show essential oils of anise, wild rosemary, pine, oregano, violet. These substances not only thin the sputum, but also contribute to its removal from the bronchi.

They need to be used in small doses. At high concentrations, these herbal preparations have the opposite effect - they reduce the formation of mucus.

Sodium iodides, potassium iodides, ammonium chloride have a resorptive effect. The activity of drugs is manifested after ingestion, since drugs are partially excreted through the lungs.

Expectorant action is manifested in the liquefaction of sputum and stimulation of the mucous glands of the bronchi.

Mucolytics

Mucolytic expectorants include:

• acetylcysteine ​​- Mucosolvin,;
• carbocisteine ​​- Bronchocode, Mucodin;
• mucoregulators, surfactant stimulants - Ambroxol, Bromhexine;
• surfactants - Curosurf, Exosurf are inhaled by premature newborns;
• proteolytic enzymes - from those known in practice, pulmozyme is used for cystic fibrosis.

Acetylcysteine

The mechanism of action of the active substance is to break the disulfide bridges in the large molecules of mucopolysaccharides that make up sputum. The process contributes to the liquefaction of sputum, reducing its ability to stick to the walls of the bronchi.

Effective expectorants for cough with sputum for adults and children are medicines in the form of syrup, granules for preparing a solution, effervescent tablets based on acetylcysteine ​​ACC. The activity of the drug increases with an increase in daily fluid intake, which is associated with increased sputum formation.

Bromhexine

The mucolytic drug Bromhexine and its analogues Ambroxol, Lazolvan have the ability to increase the formation of surfactant in the pulmonary alveoli. Surfactant is produced by special cells of the lungs, it consists mainly of fatty substances.

The functions of the surfactant are:

• in the regulation of the tension of the surface film at the border of the alveoli with air;
• regulation of the viscosity of bronchopulmonary secretion;
• ensuring the exchange of oxygen and carbon dioxide.

Bromhexine is prescribed as an expectorant mucolytic agent for adults, children from 3 years of age, pulmonary tuberculosis,. Bromhexine tablets are perhaps the cheapest and most effective cough expectorants available to any consumer.

Ambroxol

A drug similar in properties to Bromhexine is Ambroxol. Expectorants based on ambroxol have mucolytic properties, stimulate the production of surfactant.

The preparations are especially widely used as an expectorant for the treatment of children. Pharmacies offer a wide selection of medicines - liquid medicines in the form of syrups, suspensions for a child of any age.

The list of names of expectorant cough mixtures includes drugs:

• Ambrohexal;
• Ambroxol;

On the basis of Ambroxol, expectorants are produced in tablets, cough capsules for children and adults:

• Bronchoksol, Bronchorus (Russia);
• Ambrobene (Israel);
• Lazolvan, Flavomed (Germany);
• Ambrosan, Medox (Czech Republic);
• Ambroxol Richter (Hungary).

Carbocysteine

Drugs based on the mucolytic expectorant carbocysteine ​​exhibit activity similar in mechanism to that of acetylcysteine. Prescribe medicine for bronchitis, asthma.

Potions with carbocysteine:

• Fluifort;
• Libeksin Muko;
• Fluditec;
• Bronchobos.

Means containing mucolytic carbocysteine ​​include Bronchokod, Mukodin, Mukosol, Fluditec, Fluvik. Fluditec has a good expectorant and thinning effect for dry cough with sputum that is difficult to separate.

Fluditec syrup is available in two forms:

• 2% content of carbocysteine ​​- allowed for children from 2 years old;
• 5% concentration of carbocysteine ​​- recommended for adolescents over 15 years old.

In order not to harm the child, it is necessary to pay attention to the concentration of the drug, which was purchased at the pharmacy.

Combined funds

The best cough medicines for any age include combination preparations that have a complex composition, acting as expectorants, mucolytics, bronchodilators:

• tablets, syrup;
• syrups Dzhoset, Kashnol.

Joset syrup belongs to good cough remedies with sputum in adults; this medicine contains expectorant components guaifenesin and bromhexine.

The drug also contains the antispasmodic ingredient salbutamol, and can be used in the treatment of serious diseases such as COPD, emphysema, and tuberculosis.

An analogue of the drug Joset is Cashnol syrup - another combined expectorant, which is also effective for coughing with sputum. This medicine can also be used for children, following exactly the instructions for use.

Mucolytics are drugs that help to cope with a dry cough, the action of which is aimed at thinning the thick sputum secreted by the respiratory organs. The list of drugs in this group is quite large and each of them has different mechanisms of action, so the doctor should prescribe drugs based on the cause and severity of the disease.

Methods of use

Mucolytic drugs are available in the form of syrups, tablets, solutions, capsules and granules. The choice of medicine and its form is determined by the age of the patient and the severity of the disease.

• Granules and effervescent tablets based on acetylcysteine ​​dissolve in water and are taken within half an hour after meals.
• Tablets with ambroxol are washed down with a large amount of water, syrup with the same component is consumed with meals.
• Capsules containing carbocysteine ​​are swallowed whole, immediately after a meal.
• Bromgeskin in the form of tablets and syrup is taken 3 times a day and washed down with plenty of water.

Mucolytics are administered orally and by inhalation.

Difference from thinners

Medicines for the treatment of coughs are divided into three groups: mucolytics, antitussives and expectorants. Preparations of different groups differ in their effects, and therefore are not combined and are used in different situations.

Mucolytic drugs are used to treat coughs with thick, sticky sputum that result from bronchitis, tuberculosis, and other illnesses. They remove the nutrient medium for the formed mucus, thin the secretions and prevent them from sticking to the walls of the respiratory tract. Medicines in this group help to eliminate the cause of coughing.

Antitussive drugs, unlike mucolytic drugs, help with dry and unproductive cough, which can be caused by tobacco smoke, dust, rhinitis with sputum flowing into the bronchi, a reaction to inhaled oxygen, or after taking certain medications.

With the help of expectorants, the work of the ciliated epithelium, which is responsible for the amount of bronchial secretion secreted, is restored, and sputum discharge from the respiratory tract is stimulated. Medicines of this group, unlike the previous two, are used as auxiliary in the complex of antimicrobial therapy. They do not eliminate the cause of the cough, but they alleviate the patient's condition.

Indications

Mucolytic drugs are prescribed for the treatment of:

• acute and chronic bronchitis;
• bronchial asthma;
• pulmonary tuberculosis;
• smoker's cough;
• acute and chronic pneumonia.

Medicines effectively cope with a dry cough, turning it into a wet and productive one. Throughout the course of treatment, tablets and capsules are recommended to drink plenty of water, weak tea, fruit drink or compote.

Application restrictions

• It is not recommended to combine mucolytic drugs with antitussives, as they have the exact opposite effect.
• Mucolytics are not suitable for the treatment of wet cough, as they further increase sputum production.
• If allergic reactions or individual intolerance to the components appear, the prescribed drugs are canceled or replaced by others.
• Medicines are not used to treat drug addicted people.

Side effects

• Bronchospasms.
• Allergic reactions.
• Hemoptysis as a result of damage to the mucous membrane of the respiratory tract.
• The emergence of dependence on drugs containing codeine.
• indigestion and so on.

Classification

Mucolytics are divided into types according to the effect they have:

• affecting the viscosity of the secretion;
• contributing to the release of sputum;
• reducing the volume of sputum in the respiratory system.

They are also divided according to the way they act on direct (destroying polymeric mucous bonds) and indirect. The latter include drugs that change the biochemical composition of sputum, increase activity in the bronchial glands, affect hydration, and stimulate the gag reflex.

According to the composition of medicines are of plant origin and synthetic.

vegetable origin

These traditionally include plant extracts, dry mixtures, oils, herbal preparations. Mucolytics of this group have fewer side effects than drugs of artificial origin. They have anti-inflammatory properties, reduce swelling of the mucous membrane and facilitate sputum discharge. Each component of the drug purposefully affects the respiratory tract, for example, thyme relieves tickling and hoarseness, and ivy leaf extract has an expectorant effect.

Bronchicum S (Tussamag)

The active substance is an extract of the thyme herb. Available in the form of syrup, lozenges, elixir.

It has an expectorant effect, relieves swelling of the bronchial mucosa, reduces inflammation.

Side effects: allergic reactions, nausea, gastritis, dyspepsia.

Contraindicated in chronic heart failure, severe violations of the liver and kidneys, hypersensitivity to thyme. Bronchicum is not used to treat children under 6 years of age and to treat patients with alcohol dependence. Not used during pregnancy and lactation.

Linkas

The active ingredients are dry extracts of vascular adhatoda leaves, licorice roots, fruits and roots of long pepper, fragrant violet flowers, medicinal hyssop leaves, roots and rhizomes of alpinia galanga, marshmallow flowers, true jujube fruits, leaves and flowers of flower osma. Available in the form of syrup, lozenges, balm, granules for dissolving in hot water.

The drug increases the productivity of cough, has an expectorant and mucolytic effect.

Children from 6 months to 3 years old are prescribed 0.5 teaspoon 3 times a day, children from 3 to 8 years old - 1 teaspoon 3 times a day, children under 18 years old - 1 teaspoon 4 times a day. The dosage for adults is 2 teaspoons 3-4 times a day. The course of treatment lasts 5-7 days.

Contraindicated in children under 6 months and persons with hypersensitivity to the components of the drug. It is not recommended to take during pregnancy and lactation.

Mukaltin (Mukaltin tablets, Mukaltin-Lekt, Alteyka)

The active ingredient is marshmallow medicinal herb extract, available in tablets.

It is prescribed for the treatment of laryngitis, tracheitis or bronchitis individually, depending on the characteristics of the disease and age.

Side effects: allergic reactions.

Contraindicated in people with hypersensitivity to marshmallow.

Prospan (Gerbion, Gedelix, Prospan SASH)

The active ingredient is ivy leaf extract. Available in the form of drops and syrup.

The drug is effective in acute and chronic inflammation of the respiratory tract, accompanied by a cough with sputum difficult to separate.

The dosage of syrup for infants under 1 year is 2.5 milliliters 2 times a day, for children aged 1 to 6 years - 2.5 milliliters 3 times a day, for adolescents and schoolchildren - 5 milliliters 3 times a day. day. Adults are prescribed 5-7.5 milliliters of syrup 3 times a day. The duration of treatment depends on the severity of the disease.

Side effects: allergic reactions, a laxative effect is possible.

Contraindicated in fructose intolerance, sucrase deficiency, hypersensitivity to the components.

Sinupret

Active ingredients - gentian root, primrose flowers, sorrel herb, elder flowers, verbena herb. Produced in the form of dragees, drops for oral administration.

The drug has a mild effect and is easily tolerated. Thanks to plant components, the drug promotes the rapid removal of sputum from the sinuses and upper respiratory tract.

Adults are prescribed a dosage of 2 tablets 3 times a day, school-age children - 1 tablet 3 times a day. The course of treatment lasts from 7 to 14 hours. During pregnancy, the medicine is used only as directed by a doctor.

Side effects: allergic reactions, digestive disorders.

Contraindicated in children under 6 years of age, with hypersensitivity to the components of the drug, deficiency of lactase, sucrase and fructose intolerance.

Licorice Root Syrup (Licorice Syrup)

The active substance is licorice roots.

The drug is intended for the treatment of diseases of the upper respiratory tract. It has an expectorant effect, also acts as an anti-inflammatory, immunostimulating, regenerating and antiviral drug.

The medicine is taken 1 tablespoon 3-5 times a day.

Side effects: increased blood pressure, the appearance of edema.

Contraindicated in chronic hepatitis, cirrhosis of the liver, severe renal failure, diabetes mellitus, cardiac arrhythmias, pregnancy and lactation, sensitivity to licorice.

Synthetic

The components of these drugs are obtained by synthesizing, with their help, sputum discharge is enhanced and facilitated. They also have an antitoxic effect and regenerate bronchial sector cells.

ACC (Fluimucil, Mukonex, Acetylcysteine ​​sedicone)

The active substance is acetylcysteine. Available in the form of syrup, effervescent tablets, granules for dissolution, solution for injection.

Indicated for diseases of the respiratory system, accompanied by thick, difficult to separate sputum.

The daily dose for the treatment of adults and children from 14 years of age is 400-600 milligrams.

Side effects: allergic reactions, lowering blood pressure, tinnitus, nausea.

Contraindicated in peptic ulcer, hemoptysis, during pregnancy and lactation, children under 14 years of age.

Bromhexine (Bromhexine-Akrikhin, Bromhexine MS, Solvin, Bromhexine-Egis)

The active substance is bromhexine. Available in the form of tablets, syrup and solution.

The remedy is effective for tracheobronchitis, chronic bronchitis, bronchial asthma and chronic pneumonia.

Adults and children over 10 years old are prescribed 8 milligrams 3-4 times a day, children under 2 years old - 3 milligrams 3 times a day, children from 2 to 6 years old - 4 milligrams 3 times a day and from 6 to 10 years - 6-8 milligrams 3 times a day. During pregnancy, the medicine is used only as directed by a doctor.

Side effects: headache, dizziness, sweating, skin rash.

Contraindicated in case of hypersensitivity to Bromhexine.

Carbocisteine ​​(Flyuditek, Libeksin Muko, Bronhobos, Fluifort, Mukosol)

The active substance is carbocysteine. Available in the form of capsules and syrup.

It helps to reduce the formation of mucus and changes its biochemical composition. The drug activates the production of enzymes in the cells of the bronchial mucosa, and also helps to restore the mucosa itself after bronchitis.

Adults take 2 capsules 3 times a day, children under 2 years old take 0.5 teaspoon of syrup 4 times a day, children under 12 years old - 2 teaspoons 3 times a day. The course of treatment lasts 8-10 days. It is prescribed with caution during pregnancy; during treatment during lactation, breastfeeding should be stopped.

Side effects: nausea, diarrhea, gastrointestinal bleeding, headache, skin rash.

Contraindicated in hypersensitivity, active peptic ulcer, acute cystitis, children under 2 years of age, in the 1st trimester of pregnancy.

Lazolvan (Ambroxol, Ambrobene, Flavamed, Bronchorus)

The active substance is ambroxol. Available in the form of tablets, syrup and injection.

The drug is effective in acute and chronic diseases of the respiratory system with dry unproductive cough, smoker's cough.

The drug is taken 1 tablet 3 times a day. It is prescribed with caution in the 2nd and 3rd trimester of pregnancy.

Side effects: nausea, rash, anaphylactic reactions.

Contraindicated in the first trimester of pregnancy, during lactation and in children under 18 years of age.

Trypsin crystalline

The active substance is trypsin.

It has a thinning effect on viscous sputum secreted by the respiratory organs. The solution is administered intramuscularly or interprevally using aerosols and sprays.

Adults are prescribed 0.005-0.01 grams 1-2 times a day, a child - 0.0025 grams 1 time per day. After inhalation, rinse your mouth with warm water and rinse your nose. During pregnancy, it is used only as directed by a doctor.

Side effects: allergic reactions, fever, pain at the injection site.

Contraindicated in heart failure, hypersensitivity, dystrophy and cirrhosis of the kidneys, pancreatitis, hemorrhagic diathesis.

For kids

Children's preparations for dry cough are prescribed with extreme caution. For example, drugs containing codeine are prohibited for the treatment of children under 2.5 years of age. For small patients, soft preparations made on the basis of herbs are suitable.

Chest collection helps with coughing, as well as various inhalations, especially with soda. They actively moisturize and soften the child's airways, making coughing easier. The most suitable form of medicine for a child is syrup. Pleasant in taste and texture, it does not cause hostility in the child.

During pregnancy

Medicines for the treatment of cough during pregnancy should be prescribed only by a doctor. The safest are Bronchicum drops and elixir, licorice syrup, Bromhexine, Ambroxol and Carbocysteine.

The course of treatment will be more effective if you follow some rules. For example, drink more warm liquids (tea, milk or compote), do breathing exercises, do inhalations as directed by a doctor, avoid breathing cold air and hypothermia if possible.

What does mucolytic mean?

Almost every one of us has had a cold, bronchitis or respiratory infections accompanied by coughing and phlegm production. Mucolytic drugs have a secretolytic effect and help thin sputum, speed up its release and make breathing easier. They are prescribed when thick mucus is formed during diseases. These diseases include: pneumonia, bronchitis, rhinitis, sinusitis, sinusitis, laryngitis, ear inflammation. A feature of mucolytic agents is to improve the process of sputum discharge without increasing its volume.

Classification of mucolytic agents

Mucolytic drugs are divided into three main groups:

• affecting the viscosity of mucus;
• activating the release of sputum;
• reducing the amount of mucus.

Drugs that affect bronchial secretion can be direct and indirect action. Drugs that destroy polymeric mucous bonds act directly.

Indirect drugs include:

• changing the biochemical composition of mucus;
• changing the adhesion of the gel layer;
• affecting hydration;
• balms and volatiles;
• drugs that stimulate the gag reflex;
• changing activity in the bronchial glands.

The mechanism of action of mucolytic agents

The effect of mucolytic drugs is aimed at facilitating the removal of sputum from the respiratory tract. In the process, the serous cells of the mucosa on the bronchial membrane are stimulated, in which the disturbed ratio of the mucous and serous component is restored and the hydrolase is activated. The action of drugs is also aimed at breaking the disulfide bonds of sputum and inhibiting the formation of mucus.

Mucolytic drugs

Mucolytic drugs are used to treat a dry cough to turn it into a wet one. They are also used to treat inflammation of the nose. For sinusitis, mainly Fludex and Mucodin are used. They contain carbocysteine, which helps to remove mucus and restore breathing. At the same time, it helps to fight sinusitis and rhinitis.

Mucolytic agents of plant origin

The use of plants as a medicine came to us from ancient times. This is due to the fact that they have significant advantages over synthetic drugs. First of all, these are minimal side effects. Traditionally, plant extracts, dry mixtures, oils, herbal preparations are used. They have anti-inflammatory properties, reduce swelling of the mucous membrane and greatly facilitate sputum discharge. Phytonocytes, found in many herbs, help fight bacteria and viruses. They have a pleasant taste that is liked by children and adults. In some cases, allergic reactions may occur. It is important to carefully monitor the reaction of the body.

Thyme-based preparations, in addition to the main action, reduce perspiration and hoarseness of the voice. Such a drug is Bronchicum. It is sold in the form of syrup, lozenges and elixir.

The content of ivy leaf extract in preparations has an expectorant effect and reduces spasms in the bronchi. Sage has a bactericidal property and treats not only cough, but also pharyngitis and laryngitis. Althea root dilutes sputum and creates conditions for its easy discharge. Medicines based on a combination of thyme extract, psyllium are used to treat tracheitis and bronchitis when it is difficult to cough. These medicines include Linkas, which also includes violet and hyssop.

Expectorants and mucolytics

Expectorants are reflex and resorptive action. The former contain saponins and alkaloids (infusions of thermopsis, marshmallow and istoda). When taken, they irritate the receptors of the stomach, and this leads to excitation of the vagus nerve in the brain. Further, the secretion of mucus in the bronchi increases and the bronchial muscles contract. Resorptive drugs (, thyme, anise fruits), being absorbed into the gastrointestinal tract, are excreted in the form of mucus and thin the sputum. Preparations containing iodine contribute to the breakdown of sputum proteins. Mucolytic action leads to the fact that sputum becomes viscous and well departs. At the same time, the secretory function of the bronchial glands is normalized. The effect occurs within thirty minutes and lasts up to ten hours.

List of mucolytic agents

Mucolytics come in several dosage forms and provide a variety of delivery methods. This can be oral, endobronchial or inhalation. This allows the use of mucolytic agents as a means of complex therapy in the treatment of acute and chronic stages of respiratory disease. This is also shown for the treatment of ENT organs with the release of a purulent secret. These drugs are suitable even for the treatment of infants.

Mucolytics for children

For the treatment of diseases in children, preparations based on marshmallow are used. They are used for pneumonia, obstructive bronchitis, pulmonary enphysema. These medicines include: Mukaltin, Alteika syrup, marshmallow roots in the form of grass.

Thermopsis preparations have a pronounced expectorant property. They reduce the viscosity of sputum and stimulate the secretory function of the bronchi. These include:, Codelac Broncho with thyme, Stoptussin phyto syrup,

O.V. Zaitseva, Professor, Head of the Department of Pediatrics, Moscow State University of Medicine and Dentistry, Roszdrav, Dr. med. Sciences

It is known that inflammatory diseases of the respiratory tract are characterized by a change in the rheological properties of sputum, hyperproduction of viscous secretion and a decrease in mucociliary transport (clearance). This is especially pronounced in young children.

Therefore, the main goal of therapy in such cases is to thin the sputum, reduce its adhesiveness and thereby increase the effectiveness of coughing.

Medications that improve sputum separation can be divided into several groups:

• means of stimulating expectoration;
• mucolytic (or secretolytic) drugs;
• combined preparations (contain two or more components).

DRUGS THAT STIMULATE Expectoration

This group includes herbal preparations (thermopsis, marshmallow, licorice, etc.) and preparations of resorptive action (sodium bicarbonate, iodides, etc.). They contribute to an increase in the volume of bronchial secretions. Means that stimulate expectoration (mainly herbal remedies) are often used in the treatment of cough in children. However, this is not always justified. Firstly, the effect of these drugs is short-lived, so it is necessary to take small doses every 2-3 hours. Secondly, an increase in a single dose causes nausea and, in some cases, vomiting. Thirdly, drugs in this group can significantly increase the volume of bronchial secretions that young children are not able to cough up on their own, which leads to a significant violation of the drainage function of the lungs and reinfection.

MUCOLYTIC (OR SECRETOLYTIC) DRUGS

In the vast majority of cases, this group of drugs is optimal in the treatment of respiratory diseases in children. Mucolytic drugs (bromhexine, ambroxol, acetylcysteine, carbocysteine, etc.) affect the gel phase of bronchial secretions and effectively thin sputum without significantly increasing its amount. Some of the drugs in this group have several dosage forms that provide various methods of drug delivery (oral, inhalation, endobronchial), which is extremely important in the complex therapy of respiratory diseases in children, both acute (tracheitis, bronchitis, pneumonia) and chronic ( chronic bronchitis, bronchial asthma, congenital and hereditary bronchopulmonary diseases, including cystic fibrosis). Also, the appointment of mucolytics is indicated for diseases of the upper respiratory tract, accompanied by the release of mucous and mucopurulent secretions (rhinitis, sinusitis). Mucolytics are most often the drugs of choice in children in the first 3 years of life. At the same time, the mechanism of action of individual representatives of this group is different.

Acetylcysteine(ACC, N-AC-ratiopharm, Fluimucil) is one of the most active mucolytic drugs. Its mechanism of action is based on the effect of breaking the disulfide bonds of sputum acid mucopolysaccharides. This leads to depolarization of mucoproteins, helps to reduce the viscosity of mucus, thin it and facilitate excretion from the bronchial tract, without significantly increasing the volume of sputum. Restoration of normal parameters of mucociliary clearance helps to reduce inflammation in the bronchial mucosa. The mucolytic effect of acetylcysteine ​​is pronounced and fast. It is extremely important that the drug also contributes to the liquefaction of pus and thereby increases its evacuation from the respiratory tract.

The high efficiency of acetylcysteine ​​is due to its unique triple action: mucolytic, antioxidant and antitoxic. The antioxidant effect is associated with the presence of a nucleophilic thiol SH-group in acetylcysteine, which easily gives up hydrogen, neutralizing oxidative radicals. The drug promotes the synthesis of glutathione, the main antioxidant system of the body, which increases the protection of cells from the damaging effects of free radical oxidation, which is characteristic of an intense inflammatory reaction.

Acetylcysteine ​​has a pronounced non-specific antitoxic activity - the drug is effective in poisoning with various organic and inorganic compounds. So, acetylcysteine ​​is the main antidote for paracetamol overdose.

There are literature data on the immunomodulatory W. Droge] and antimutagenic properties of acetylcysteine, as well as the results of still few experiments indicating its antitumor activity [M.N. Ostroumova et al.]. In this regard, it has been suggested that acetylcysteine ​​seems to be the most promising in the treatment of not only acute and chronic bronchopulmonary diseases, but also to prevent the adverse effects of xenobiotics, industrial dust, and smoking. It is noted that the properties of acetylcysteine ​​are potentially important, associated with its ability to influence several metabolic processes, including glucose utilization, lipid peroxidation and stimulate phagocytosis.

Also, acetylcysteine ​​is prescribed during intratracheal anesthesia in order to prevent complications from the respiratory tract.

Acetylcysteine ​​is effective when administered orally, parenterally, with endobronchial and combined administration.

In many years of clinical practice, both in adults and in children, acetylcysteine ​​\u200b\u200b-ACC has proven itself well. The high safety of ACC is associated with its composition - the drug is an amino acid derivative. However, acetylcysteine ​​is recommended to be used with caution in patients with bronchial asthma, tk. some authors sometimes noted an increase in bronchospasm in adult asthmatics. According to the approved instructions, acetylcysteine ​​should be used with caution in peptic ulcer disease (there are no absolute contraindications).

ACC can be used in children from 2 years of age. ACC is produced in granules and effervescent tablets for the preparation of a drink, incl. hot, in dosages of 100, 200 and 600 mg, applied 2-3 times a day. Doses depend on the age of the patient. Usually, children from 2 to 5 years old are recommended 100 mg of the drug per reception, over 5 years old - 200 mg each, always after meals. ACC 600 (Long) is prescribed 1 time per day, but only for children over 12 years old. The duration of the course depends on the nature and course of the disease and ranges from 3 to 14 days for acute bronchitis and tracheobronchitis, and 2-3 weeks for chronic diseases. If necessary, courses of treatment can be repeated. Injectable forms of ACC can be used for intravenous, intramuscular, inhalation and endobronchial administration.

Carbocysteine(Bronkatar, Mukodin, Mukopront) has not only a mucolytic effect, but also restores the normal activity of secretory cells. There is evidence of an increase in the level of secretory IgA against the background of taking carbocysteine. The drug is available for oral administration (capsules, syrup).

Bromhexine is a derivative of the vizine alkaloid and has a mucolytic, mucokinetic and expectorant effect. Almost all researchers note a lower pharmacological effect of bromhexine compared to the new generation drug, which is an active metabolite of bromhexine - ambroxol. However, the relatively low cost of bromhexine, the absence of side effects, and the convenience of packaging explain the fairly widespread use of the drug. Bromhexine is used for acute and chronic bronchitis of various etiologies, acute pneumonia, chronic broncho-obstructive diseases. Children from 3 to 5 years of age are shown 4 mg 3 times a day, from 6 to 12 years 8 mg 3 times a day, adolescents - 12 mg 3 times a day.

Ambroxol(Ambrogexal, Ambrobene, Lazolvan) belongs to the new generation of mucolytic drugs, is a metabolite of bromhexine and gives a more pronounced expectorant effect. In pediatric practice, it is preferable to use ambroxol preparations that have several dosage forms: tablets, syrup, solutions for inhalation, for oral administration, for injection and endobronchial administration.

Ambroxol affects the synthesis of bronchial secretions secreted by the cells of the bronchial mucosa. The secret is liquefied by the breakdown of acid mucopolysaccharides and deoxyribonucleic acids, while secretion is improved.

An important feature of Ambroxol is its ability to increase the content of surfactant in the lungs, blocking the breakdown and enhancing the synthesis and secretion of surfactant in type 2 alveolar pneumocytes. There are indications of stimulation of surfactant synthesis in the fetus if ambroxol is taken by the mother.

Ambroxol does not provoke bronchial obstruction. Moreover, K. Weissman et al. proved a statistically significant improvement in respiratory function in patients with bronchial obstruction and a decrease in hypoxemia while taking ambroxol. The combination of ambroxol with antibiotics certainly has an advantage over the use of a single antibiotic. Ambroxol helps to increase the concentration of the antibiotic in the alveoli and bronchial mucosa, which improves the course of the disease in bacterial infections of the lungs.

Ambroxol is used for acute and chronic respiratory diseases, including bronchial asthma, bronchiectasis, respiratory distress syndrome in newborns. You can use the drug in children of any age, even in premature babies.

Thus, in the complex therapy of respiratory diseases in children, mucolytic drugs are the most commonly used, but their choice should be strictly individual and take into account the mechanism of the pharmacological action of the drug, the nature of the pathological process, the premorbid background and the age of the child.