Expectorants and sputum thinners are common components of treatment for bronchitis, pneumonia, and tuberculosis. Without their use, it is extremely difficult to clear the airways and ensure normal breathing. Such drugs cannot be used without permission, because they can cause side effects.

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

In everyone's bronchi healthy person special mucus is produced. It makes it impossible for the negative effects of microorganisms, dust, and allergens that enter with the air. In a normal state, the cilia of the bronchi independently push out mucus with all the “unnecessary” things. If an inflammatory or some pathological process begins in the respiratory tract, the mucus begins to change its viscosity. It becomes thick and sticks to lung tissue, 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 products that dilute sputum when coughing and promote its rapid elimination come to the rescue.

Expectorant and thinning medications are often recommended for:

• bronchitis (both acute and chronic);
• pneumonia of viral and bacterial origin;
• COPD;
• bronchiectasis;
• tracheobronchitis;
• emphysema of pulmonary tissue;
• laryngitis;
• tuberculosis;
• bronchial asthma;
• diseases accompanied by difficulty removing sputum.

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

In fact, all expectorants and thinners are strictly prohibited when:

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

Mucolytics and their action

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

All mucolytic agents can be divided into 3 large groups:

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

Unlike expectorants, phlegm thinners do not cause more mucus 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.

We can name 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. Products in this group are most often made in the form of tablets or powder. Less commonly in the form of solutions for preparing and performing inhalations, as well as injections. They cope well with thinning liquids and have a moderate antioxidant effect, thanks to which they can fight some poisons.
2. Bromhexine. The following drugs are made on its basis: Nycomed, Bromhexine, Bronchosan. One of the oldest mucolytic-type drugs. Once in the human body, it undergoes a specific treatment, thanks to which it turns into Ambroxol. The latter performs a therapeutic effect.
3. Carbocysteine. Sold under commercial names: Libexin Muco, Bronchobos, Fluditec. In terms of their direct indications and contraindications, these tablets are very similar to Acetylcysteine. Suitable for use for 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 fighting cough. It is a combined remedy, because it simultaneously liquefies and has an expectorant effect. Ambroxol is able to prevent mucus from sticking and enhances the effect of many antibiotics. Given this, it is often recommended for pneumonia.

Expectorant medications and their use

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

Drugs in this group, according to their mechanism of action, can be 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 reflexively get rid of it;
• direct action - can affect the bronchi themselves.

Drugs of both groups are taken orally and begin to act after successful absorption digestive system. Medicines with reflex action are usually based on plant extracts. Direct action agents can have both natural and chemical composition.

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

• medicines based on Althea (Alteika syrup, Mucaltin) - especially often used for bronchitis, emphysema; not recommended for children under 3 years of age, in addition, for gastrointestinal ulcers;
• thermopsis preparations (Thermopsol, Codelac broncho) - are distinguished by their strong mucolytic and expectorant effects;
• products based on plantain extract (for example: Stoptussin syrup, Gerbion Coldrex broncho) - can be used for various types cough, including dry cough; are distinguished by their mild action and safety;
• made from thyme (Bronchicum S, Tussamag, Pectusin) - can be used to treat children from 6 months.

Direct-acting drugs often include components such as essential oils, ammonium chloride, potassium iodides. The main drug in this group can be called Amtersol.

Expectorant and thinning herbal remedies

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

• option No. 1 - oregano and coltsfoot particles;
• option No. 2 - licorice, plantain, coltsfoot leaves;
• option No. 3 - anise extracts, pine buds, sage extracts;
• option No. 4 - elements of common chamomile, licorice, calendula herb, violet flowers, wild rosemary,

Additionally, you can use wild rosemary herb. Performs a reflex effect on the bronchi itself, the central nervous system. Capable of reducing microbes in the upper lobes of the organ. Can be used as a gargle and oral cavity, and for oral administration.

Features of the use of thinning and expectorant drugs

Thinning agents and mucolytics today can come in a wide variety of pharmaceutical forms, in particular sold in tablets, capsules, injection solutions, herbal bulk infusion kits, decoctions, teas, syrups, etc.

Important rules that should never be neglected when starting treatment with cough suppressants are:

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

There won't be effective treatment mucolytics and expectorants, if optimal conditions for the patient are not provided. Be sure to ventilate the room and provide moist air.

When no improvement is observed within 2 days of starting to use the medications prescribed by the doctor, you urgently need to retake the tests and change the medications or their dosage. It is worth remembering that all expectorants and mucolytics are equally safe; sometimes they cause side effects. Among the most common are:

• stomach discomfort;
• diarrhea;
• migraine;
• skin rashes;
• decreased blood pressure;
• increased acidity;
• pulmonary hemorrhage;
• dizziness.

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

With successfully selected medications and their use as prescribed in the instructions, the patient does not experience negative reactions that could interfere with management vehicles or important technical processes.

Although some expectorants are alcohol-based, combining them with alcoholic drinks not advisable as it intensifies toxic effects on the liver and kidneys.

Considering the above, you should not refuse your doctor’s advice regarding the use of mucolytic or expectorant drugs when you have a difficult cough. A large number of pharmaceutical forms and active ingredients enable a specialist to choose the most convenient and effective option.

Almost all colds and inflammatory diseases of a bacterial or viral nature are accompanied. Depending on the nature of the pathology and physiological state lungs and bronchi, the cough may occur with sputum (wet) or not be accompanied by discharge ().

Modern pharmaceutical companies offer a variety of remedies to help cope with coughs of various etiologies and prevent its unpleasant consequences.

What are expectorants and mucolytics used for?

considered the most dangerous for the body. A sharp contraction of the bronchi without secretion of the product leads to various pathological conditions. In the absence of sputum production, the cough reflex causes a lot of suffering. Moisturizing the respiratory mucosa is vital for the body, since this secretion helps internal organs protect yourself from negative action pathogenic microorganisms and hazardous factors of the external and internal environment.

With a large amount of sputum discharge, it can also be life-threatening, since the bronchi produce more mucus than is necessary for physiological norm, leads to clogging respiratory tract and serious difficulty breathing in the future. Accumulating in the bronchi, sputum can gradually thicken and harden, accumulating harmful substances and provoking the risk of developing a more serious condition for the patient.

It is in the mechanism of action on the lungs and bronchi that the main difference between expectorants and mucolytic drugs lies.

Expectorants promote active secretion of sputum. They act on the cough center of the brain and help the bronchi contract more intensely, removing phlegm out.

Mucolytic agents are used in cases where, during the course of an illness, too much sputum is released and at the same time it has an extremely dangerous, viscous and thick consistency. Mucolytics are needed to break down the molecular bonds inside the sputum, making it more liquid and accessible to natural elimination from the body.

After the mucus becomes easily separated and its passage through the respiratory tract does not cause difficulties, doctors recommend either switching from mucolytics to expectorants, or immediately prescribing a combination drug that can have several therapeutic effects on respiratory system person.

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Types of expectorants

Expectorants are also called “secretomotor”, since they are the ones that can start the process of mucus secretion and ease the internal condition of the human respiratory organs.

Depending on the mechanism of action of expectorant drugs, experts divide such drugs into two groups:

1. reflex drugs;
2. medicines direct action.

Reflex-action drugs actively affect the receptors responsible for the secretion of secreted sputum. This occurs due to preliminary irritation of the stomach receptors and an active effect on the cough center medulla oblongata. This mechanism of action helps to enhance the severity of the cough reflex and accelerate the synthesis of liquid bronchial secretions.

To drugs of reflex action include the following medicines:

Please note

Capable of causing large amounts side effects And allergic reactions Therefore, pharmaceutical products containing sodium benzoate are used with caution, under the mandatory supervision of a physician.

• Essential oils : terpene and eucalyptus. The most well-known preparations containing a large number of such oils are Eucabal, Doctor Mom, as well as cough herbs with a high percentage of essential oil raw materials. These active substances have an expectorant and anti-inflammatory effect, acting both on the receptors responsible for the production of mucus and directly on the epithelium lining the surface of the respiratory organs.

Direct acting expectorants contribute to strengthening the direct liquid component of sputum, significantly facilitating its separation. The main side effect of these active substances is an increased separation of snot and lacrimation, since the drug can affect the viscosity of any physiological fluids of the body. Such drugs are considered classic or even outdated, and therefore are used quite rarely: sodium and potassium iodides, ammonia, anise essential oil.

The exceptions are oregano and wild rosemary, which are part of popular antitussive preparations, and are also contained in combined cough medicines: Doctor Mom, Bronchofit, etc.

Types of mucolytic agents

Mucolytic agents are classified mainly by their composition, since their mechanism of action is very similar: diluting the composition of sputum, changing its composition to something more easily separated from the surface of the bronchi and lungs, and gradually removing excess secretions from the body.

Among mucolytics, experts especially highlight the following drugs:

To achieve the fastest effect, medical specialists recommend using mucolytic agents as inhalations, in special dosage forms ah for direct inhalation. This will significantly facilitate absorption processes and will not waste unnecessary time on the release of active metabolites directly in the body.

Despite the fact that almost all cough medications are available without a doctor’s prescription, before use it is advisable to consult with a specialist to select the most effective pharmacological agent in each specific clinical case.

If desired, use chemicals medicines can be combined with popular and herbal antitussives. However, you need to remember that herbs may also be incompatible with the active pharmacological components of the medication you are taking. Before use, you need to carefully read the instructions not only to become familiar with the mechanism of action and side effects, but also to find out exactly how to take it this medicine and what additional therapeutic measures it combines well with.

Catad_tema Colds and ARVI - articles

Mucolytic drugs in the daily practice of a doctor

O.V. Zaitseva, Professor, Head of the Department of Pediatrics, State Educational Institution of Higher Professional Education "Moscow State Medical and Dental University" of Roszdrav, dr med. sciences

It is known that for inflammatory diseases The respiratory tract is characterized by changes in the rheological properties of sputum, hyperproduction of viscous secretions 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 liquefy sputum, reduce its adhesiveness and thereby increase the effectiveness of cough.

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

• expectorant stimulants;
• mucolytic (or secretolytic) drugs;
• combination drugs (contain two or more components).

EXPECTORATION DRUGS

This group includes drugs plant origin(thermopsis, marshmallow, licorice, etc.) and resorptive drugs (sodium bicarbonate, iodides, etc.). They help increase the volume of bronchial secretions. Medicines that stimulate expectoration (mainly herbal medicines) 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, increasing a single dose causes nausea and in some cases vomiting. Thirdly, drugs in this group can significantly increase the volume of bronchial secretions, which young children are not able to cough up on their own, which leads to a significant disruption 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 for the treatment of respiratory diseases in children. Mucolytic drugs (bromhexine, ambroxol, acetylcysteine, carbocysteine, etc.) act on the gel phase of bronchial secretions and effectively dilute sputum without significantly increasing its quantity. Some of the drugs in this group have several dosage forms that provide different methods of drug delivery (oral, inhalation, endobronchial), which is extremely important in the complex treatment 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 use of mucolytics is indicated for diseases of the ENT organs, accompanied by the release of mucous and mucopurulent secretions (rhinitis, sinusitis). Mucolytics are most often the drugs of choice in children during 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. The mechanism of its action is based on the effect of breaking the disulfide bonds of acidic mucopolysaccharides of sputum. This leads to depolarization of mucoproteins, helps to reduce the viscosity of mucus, dilutes it and facilitates removal from the bronchial tract, without significantly increasing the volume of sputum. Restoring normal parameters of mucociliary clearance helps reduce inflammation in the bronchial mucosa. The mucolytic effect of acetylcysteine ​​is pronounced and rapid. It is extremely important that the drug also helps to liquefy pus and thereby increases its evacuation from the respiratory tract.

The high effectiveness 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 donates hydrogen, neutralizing oxidative radicals. The drug promotes the synthesis of glutathione, the body's main antioxidant system, which increases cell protection from the damaging effects of free radical oxidation, which is characteristic of an intense inflammatory reaction.

Acetylcysteine ​​has pronounced nonspecific antitoxic activity - the drug is effective against poisoning with various organic and inorganic compounds. Thus, acetylcysteine ​​is the main antidote for an overdose of paracetamol.

There are literary 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 for preventing the adverse effects of xenobiotics, industrial dust, and smoking. It is noted that potentially important properties of acetylcysteine ​​are associated with its ability to influence several metabolic processes, including glucose utilization, lipid peroxidation and stimulate phagocytosis.

Acetylcysteine ​​is also prescribed during intratracheal anesthesia to prevent complications from the respiratory tract.

Acetylcysteine ​​appears to be effective when taken orally, parenterally, endobronchially, or combined.

In many years of clinical practice, acetylcysteine ​​- ACC - has proven itself well in both adults and children. 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, because some authors have sometimes noted increased bronchospasm in adult asthmatics. According to the approved instructions, acetylcysteine ​​should be used with caution when peptic ulcer(there are no absolute contraindications).

ACC can be used in children from 2 years of age. ACC is available in granules and effervescent tablets for preparing drinks, 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 it is recommended for children from 2 to 5 years old to take 100 mg of the drug per dose, for children over 5 years old - 200 mg, always after meals. ACC 600 (Long) is prescribed once a day, but only for children over 12 years of age. 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, for chronic diseases– 2-3 weeks. If necessary, courses of treatment can be repeated. Injection forms of ACC can be used for intravenous, intramuscular, inhalation and endobronchial administration.

Carbocisteine(Broncatar, Mucodin, Mucopront) 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 when taking carbocisteine. The drug is available for oral administration (capsules, syrup).

Bromhexine is a derivative of the alkaloid visine and has mucolytic, mucokinetic and expectorant effects. Almost all researchers note a lower pharmacological effect bromhexine compared with a new generation drug, which is an active metabolite of bromhexine – ambroxol. However, the relatively low cost of bromine-hexine, 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 different etiologies, acute pneumonia, chronic broncho-obstructive diseases. Children from 3 to 5 years old are prescribed 4 mg 3 times a day, from 6 to 12 years old 8 mg 3 times a day, adolescents - 12 mg 3 times a day.

Ambroxol(Ambrogexal, Ambrobene, Lasolvan) 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 secretion is liquefied by the breakdown of acidic mucopolysaccharides and deoxyribonucleic acids, while the secretion of 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 indicators of external respiratory function in patients with broncho-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 when bacterial infections lungs.

Ambroxol is used for acute and chronic diseases respiratory organs, including bronchial asthma, bronchiectasis, respiratory distress syndrome in newborns. The drug can be used in children of any age, even premature infants.

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

6. M-cholinomimetic drugs.

7. N-cholinomimetic drugs. The use of nicotine mimetics to combat smoking.

8. M-anticholinergic drugs.

9. Ganglion blocking agents.

11. Adrenergic agonists.

14. Means for general anesthesia. Definition. Determinants of depth, rate of development and recovery from anesthesia. Requirements for an ideal narcotic drug.

15. Means for inhalation anesthesia.

16. Means for non-inhalation anesthesia.

17. Ethyl alcohol. Acute and chronic poisoning. Treatment.

18. Sedative-hypnotics. Acute poisoning and measures of assistance.

19. General ideas about the problem of pain and pain relief. Drugs used for neuropathic pain syndromes.

20. Narcotic analgesics. Acute and chronic poisoning. Principles and remedies.

21. Non-narcotic analgesics and antipyretics.

22. Antiepileptic drugs.

23. Drugs effective for status epilepticus and other convulsive syndromes.

24. Antiparkinsonian drugs and drugs for the treatment of spasticity.

32. Means for preventing and relieving bronchospasm.

33. Expectorants and mucolytics.

34. Antitussives.

35. Drugs used for pulmonary edema.

36. Drugs used for heart failure (general characteristics) Non-glycoside cardiotonic drugs.

37. Cardiac glycosides. Intoxication with cardiac glycosides. Help measures.

38. Antiarrhythmic drugs.

39. Antianginal drugs.

40. Basic principles of drug therapy for myocardial infarction.

41. Antihypertensive sympathoplegic and vasorelaxants.

I. Drugs affecting appetite

II. Remedies for decreased gastric secretion

I. Sulfonylurea derivatives

70. Antimicrobial agents. General characteristics. Basic terms and concepts in the field of chemotherapy of infections.

71. Antiseptics and disinfectants. General characteristics. Their difference from chemotherapeutic agents.

72. Antiseptics – metal compounds, halogen-containing substances. Oxidizing agents. Dyes.

73. Antiseptics of the aliphatic, aromatic and nitrofuran series. Detergents. Acids and alkalis. Polyguanidines.

74. Basic principles of chemotherapy. Principles of classification of antibiotics.

75. Penicillins.

76. Cephalosporins.

77. Carbapenems and monobactams

78. Macrolides and azalides.

79. Tetracyclines and amphenicols.

80. Aminoglycosides.

81. Antibiotics of the lincosamide group. Fusidic acid. Oxazolidinones.

82. Antibiotics, glycopeptides and polypeptides.

83. Side effects of antibiotics.

84. Combined antibiotic therapy. Rational combinations.

85. Sulfonamide drugs.

86. Derivatives of nitrofuran, hydroxyquinoline, quinolone, fluoroquinolone, nitroimidazole.

87. Anti-tuberculosis drugs.

88. Antispirochetal and antiviral agents.

89. Antimalarial and antiamoebic drugs.

90. Medicines used for giardiasis, trichomoniasis, toxoplasmosis, leishmaniasis, pneumocystosis.

91. Antifungal agents.

I. Drugs used in the treatment of diseases caused by pathogenic fungi

II. Drugs used in the treatment of diseases caused by opportunistic fungi (for example, candidiasis)

92. Anthelmintics.

93. Anti-blastoma drugs.

94. Remedies used for scabies and pediculosis.

33. Expectorants and mucolytics.

Classification of expectorants. This group of substances is designed to facilitate the separation of mucus (phlegm) produced by the bronchial glands. There are two types of expectorants: 1) reflex action (ipecac preparations and thermopsis preparations); 2) direct action.

Reflex expectorants.

This group of substances is designed to facilitate the separation of mucus (phlegm) produced by the bronchial glands. There are two types of expectorants: 1) reflex action (ipecac preparations and thermopsis preparations); 2) direct action.

Ipecac preparations and thermopsis preparations (infusions, extracts) act reflexively. The alkaloids they contain (and in thermopsis, saponins) when administered orally cause irritation of the stomach receptors. At the same time, the secretion of the bronchial glands reflexively increases, the activity of the ciliated epithelium increases, and contractions of the bronchial muscles intensify. Sputum becomes more abundant, less viscous, and coughing makes it easier to cough up. IN high doses These drugs reflexively induce vomiting.

Direct action expectorants.

Direct-acting expectorants include drugs that have a direct effect on the glands of the bronchial mucosa and enhance their secretion, for example, potassium iodide, as well as secretion-thinning agents (mucolytic agents) - preparations of proteolytic enzymes: crystalline trypsin, crystalline chymotrypsin, deoxyribonuclease. Recombinant α-DNAase preparations are marketed under the name Pulmozyme. Used as a mucolytic for cystic fibrosis. Administered by inhalation.

The active mucolytic drug is acetylcysteine ​​(ACC, broncholysin, mucosolvin). The effect is due to the presence of free sulfhydride groups in the molecule, which break the disulfide bonds of proteoglycans, which causes depolymerization and a decrease in sputum viscosity. ACC is used inhalationally, sometimes parenterally. There are long-acting drugs for oral administration - ACC-long.

Effective mucolytic and expectorant agents are ambroxol (ambrohexal) and bromhexine. The mucolytic effect of drugs is the depolymerization of mucoproteins and mucopolysaccharides of sputum, which leads to its liquefaction. It is also believed that the pharmacotherapeutic effect of both drugs is associated with stimulation of the production of endogenous surfactant (surfactant) formed in alveolar cells. At the same time, the secretion of the bronchial glands is normalized, rheological properties sputum, its viscosity decreases, and the release of sputum from the bronchi is facilitated. The effect develops after 30 minutes and lasts 10-12 hours. Injected internally. Side effects - nausea, vomiting, allergic reactions.

Sodium bicarbonate also thins mucus and possibly slightly increases bronchial secretion. Potassium iodide and sodium bicarbonate are prescribed orally and by inhalation (in an aerosol), solutions of crystalline trypsin, crystalline chymotrypsin, deoxyribonuclease - by inhalation (in an aerosol).

Expectorants also include preparations of marshmallow root, istod root, licorice root, teping hydrate, sodium benzoate.

Thermopsis preparations, potassium iodide, acetylcysteine, dornase alpha.

THERMOPSIS LANCEOLATA GRASS (Herba Thermopsidis lanceolata).

Synonym: Mouse grass.

Collected at the very beginning of flowering before the formation of fruits and dried grass of the wild perennial plant thermopsis lanceolata (Ther mopsis lanceolata R. Br.), fam. legumes (Leguminosae).

Thermopsis is common in the Volga region, Siberia, Kazakhstan and other places. Contains alkaloids (cytisine, methylcytisine, pachycarpine, anagyrine, thermopsin, thermopsidine), saponins, essential oil and other substances.

Alkaloids should be at least 1.5%.

Used in the form of infusions, powder, tablets, dry extract, which replace ipecac preparations as expectorants.

Cough tablets (Tabulettae contra tussim). Contains O. O1 g of thermopsis grass in fine powder, 0.25 g of sodium bicarbonate.

Dry thermopsis extract (Extractum Thermopsidis siccum). A mixture of dry thermopsis extract and milk sugar.

POTASSIUM IODIDE LKalii iodidum um).

Synonyms: Potassium iodide, Kalium iodatum.

Potassium iodide is well absorbed from the digestive tract and is excreted primarily by the kidneys.

Used as an iodine preparation for hyperthyroidism, endemic goiter, for preparation for operations for severe forms of thyrotoxicosis; for inflammatory diseases of the respiratory tract, bronchial asthma; for eye diseases (cataracts, clouding of the cornea and vitreous body, hemorrhages in the membranes of the eye); as well as for fungal infections of the conjunctiva and cornea.

An important property of potassium iodide is its ability to prevent the accumulation of radioactive iodine in thyroid gland and ensure its protection from radiation.

Potassium iodide is taken orally in the form of tablets, solutions and mixtures. To avoid irritation of the gastrointestinal tract, drink it with milk, jelly or sweet tea.

Solutions of potassium iodide are not injected into a vein due to the inhibitory effect of potassium ions on the heart (see Sodium iodide).

As an adjuvant, potassium iodide is prescribed to patients with syphilis (mainly in the tertiary period). The drug helps to resolve infiltrates and reduce pain.

Relatively large doses are prescribed for actinomycosis of the lungs.

In ophthalmic practice, potassium iodide eye drops in the form of a 3% solution are used as a “absorbable” agent.

If there is a threat of radioactive iodine entering the body, to protect the thyroid gland from radiation, it is prescribed to adults and children over 2. The tablet is crushed and given with a small amount of jelly or sweet tea.

The drug is taken daily until the threat of radioactive iodine entering the body disappears.

To protect the thyroid gland from the effects of radiopharmaceuticals labeled with radioactive iodine used during scanning, potassium iodide is given at a dose of 0.125 g once a day for 5 to 10 days.

When using potassium iodide, symptoms of iodism are possible: runny nose, urticaria, Quincke's edema, etc., and when taken orally, unpleasant sensations in the epigastric region.

The drug is contraindicated for pulmonary tuberculosis, nephritis, nephrosis, furunculosis, acne, pyoderma, hemorrhagic diathesis, urticaria, hypersensitivity to iodine, pregnancy, except in cases of threat of radioactive isotopes of iodine entering the body. In these cases, potassium perchlorate (0.75 g) is prescribed simultaneously with potassium iodide (0.125 g).

ACETYLCYSTEINE (Acetylcysteinum). N-Acetyl-L-cysteine.

Synonyms: Broncholysin, Mucosolvin, Acetein, Acetylcysteine, Airbron, Broncholysin, Fluimucetin, Fluimucil, Inspir, Mucisol, Mucofilin, Mucolyticum, Mucomyst, Mucosolvin, Racomex, etc.

It is a derivative of the amino acid cysteine ​​(see), from which acetyl cysteine ​​differs in that one hydrogen of the amino group is replaced by an acetic acid residue.

Acetylcysteine ​​is an effective mucolytic (secretolytic) drug.

By thinning mucus and increasing its volume, acetylcysteine ​​facilitates its secretion; promotes expectoration and also reduces inflammation.

The effect of the drug is due to the ability of its free sulfhydryl groups to break the disulfide bonds of acidic mucopolysaccharides in sputum, which leads to depolarization of mucoproteins and a decrease in mucus viscosity. The drug also liquefies pus.

Used for respiratory diseases accompanied by increased viscosity of sputum with the addition of a purulent infection (acute and chronic bronchitis, pneumonia, bronchiectasis, cystic fibrosis, etc.). Prescribed prophylactically to prevent complications during operations on respiratory organs, as well as after endotracheal anesthesia. It is also recommended during bronchoscopy for washing the bronchial tree.

The drug is effective for infectious-allergic bronchial asthma complicated by bacterial, especially purulent, bronchitis or suppurative bronchiectasis. However, in these cases, caution should be exercised due to the possibility of increased bronchiolospasm. As a prophylactic measure, it is advisable to simultaneously take bronchodilators."

The duration of treatment depends on the nature and course of the disease; usually the course of treatment lasts 1 - 2 weeks; for tracheobronchitis - 3 - 4 days, for cystic fibrosis - 7 - 10 days.

If necessary, administer the drug intravenously.

Acetylcysteine ​​is administered to children mainly intramuscularly.

The drug is usually well tolerated. In some cases, a nauseating note is possible (associated mainly with the specific smell of the drug). Caution should be observed in persons prone to bronchiolospasm (when bronchiolospasm occurs, bronchodilators are prescribed).

Acetylcysteine ​​should be used with caution if you are prone to pulmonary bleeding, liver disease, kidney disease, or adrenal dysfunction.

With long-term use, the functions of the liver, kidneys and adrenal glands should be monitored, and blood enzyme parameters should be checked.

Contraindications: individual hypersensitivity, bronchial asthma without thickening of sputum.

When working with the drug, you should use glass vessels, avoiding contact with metals and rubber (the formation of sulfides with a characteristic odor is possible).

Mixing solutions of acetylcysteine ​​with solutions of antibiotics and proteolytic enzymes is undesirable in order to avoid inactivation of the drug.

If necessary, bronchodilators can be added.

In patients with acute and chronic bronchopulmonary diseases, bronchial secretions produced by mucus-forming elements of the respiratory tract (bronchial glands, goblet cells) are characterized by high viscosity and adhesiveness. In addition to inhibiting mucociliary transport, it can cause bronchial obstruction due to excessive accumulation of mucus in the bronchial lumen.

In the treatment of bronchopulmonary diseases accompanied by a cough with sputum difficult to separate, drugs that stimulate expectoration and are generally called secretomotor drugs are usually used. Bronchosecretolytic drugs (mucolytics) are also widely used in clinical practice. It has been shown that the rheological properties of sputum (viscosity, elasticity, adhesiveness) determine the possibility of its free separation (expectation).

Therefore, mucolytics are especially useful for diseases of the respiratory system, conditions accompanied by the formation of viscous, difficult to separate sputum of a mucous or mucopurulent nature.
The accumulation of sputum in the respiratory tract is one of the causes of bronchial obstruction and contributes to the development of an infectious-inflammatory process in the lungs (more about mucolytics).

Expectorants- drugs that facilitate the release of mucus from the respiratory tract mainly by reducing its viscosity.

There are expectorants of reflex and direct action. The group of reflex actions includes drugs of a number medicinal plants thermopsis herbs, licorice root, istod root, rhizomes with elecampane roots, marshmallow root, thyme herb, rhizomes with cyanosis roots.

The expectorant effect of drugs in this group is due to the fact that when taken orally, the active ingredients they contain (mainly alkaloids and saponins) irritate the receptors of the stomach and, as a result, reflexively increase the secretion of the bronchial glands, which is accompanied by a decrease in the viscosity of sputum. In addition, reflex expectorants stimulate peristaltic contractions of the bronchi and increase the activity of the cilia of the ciliated epithelium of their mucous membrane, i.e. increase the so-called mucociliary clearance of bronchial secretions, thereby promoting sputum production.

The group of direct action expectorants includes drugs that have a direct stimulating effect on the bronchial glands, and drugs that thin sputum due to a direct effect on its physical and chemical properties.

Some iodine preparations, essential oils and preparations containing them, ammonium chloride, sodium benzoate have a direct stimulating effect on the secretion of the bronchial glands (more about expectorants).