Effective expectorants for bronchitis for children and adults

Why are expectorants prescribed for bronchitis? Because when the bronchi become inflamed, a cough appears – the main symptom of this disease, indicating the activation of the mucociliary system, which clears the respiratory tract of pathogenic agents.

The respiratory system's defense system works by producing mucin gel by goblet cells of the mucous membrane and submucous glands - a viscous adhesive mucous secretion containing glycoproteins, carbohydrates, sulfates, immunoglobulins. During inflammation, the synthesis of thick mucus increases - to neutralize viruses or bacteria that have entered the membranes of the respiratory organs. Thanks to the protective reflex, that is, coughing, mucus should be removed from the bronchi, and expectorants for bronchitis help with this.

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Indications bronchitis expectorants

The main indications for the use of expectorants for bronchitis are acute and chronic forms of this disease, obstructive bronchitis, tracheobronchitis, bronchopneumonia and other respiratory and bronchopulmonary diseases with a cough in which viscous sputum is difficult to cough up.

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Release form

These products come in various forms: tablets, capsules, dragees, mixtures (solutions for oral administration), syrups, drops, and herbal infusions.

Names of expectorants

The pharmaceutical market of expectorants offers a variety of

Mucoactive drugs, which by their mechanism of action are divided into mucolytics (thinning mucus) and mucokinetics (facilitating its removal when coughing). It should be noted that all expectorants will initially cause some increase in coughing, but their main goal is to facilitate the elimination of excess mucus from the respiratory system.

According to doctors, choosing the best expectorant for bronchitis is difficult, because each organism reacts differently to drug treatment. And those who prefer herbal preparations should remember that such remedies can also have side effects.

Here are some names of expectorants, grouped depending on the form of release (other trade names of drugs produced by different manufacturers, but identical in composition and all characteristics, are given in brackets).

Expectorant tablets for bronchitis: Bromhexine (Bromhexine chloride, Brombenzonium, Brodizol, Bisolvon, Mukovin, Mugocil, etc.); Ambroxol (Ambrohexal, Ambrosan, Ambrobene, Bronchopront, Lazolvan, Medox, Mucosan); Acetylcysteine (Acestin, Acestad, Mukomist, Mistabren, Fluimucil); Mucaltin.

Expectorants in capsule form: Carbocisteine (Mukodin, Mukopront).

Granulated products (for the preparation of a solution taken orally) and in the form of effervescent water-soluble tablets: ACC (Acestad), Bronchocod, Mucosol, Fluifort, etc.

Expectorant mixtures for bronchitis: Potassium iodide, Pertussin, Pectoral elixir, Ambroxol, Ascoril, Gerbion, etc.

Expectorant syrups for bronchitis: Althea, Ambroxol (Bronchoval, Lazolvan, Remebrox), Fluditec (Broncatar, Mucosol), Ascoril, etc.

Expectorants in the form of drops: ammonia-anise drops, Bronchosan (Bromhexine, Bronhotil, Flegamine), Gedelix (Gederin, Prospan).

Expectorants for chronic bronchitis, as well as expectorants for obstructive bronchitis (that is, when the mucous membranes of the bronchi swell and block their lumens) include almost all of the listed drugs, as well as combination drugs with guaifenesin, for example, Ascoril or Sudafed syrups. Also see - Treatment of obstructive bronchitis

Expectorant herbal teas for bronchitis - pharmacy chest teas - consist of medicinal plants. For example, chest tea #1 includes coltsfoot and oregano leaves (motherwort), and chest tea #2 includes coltsfoot leaves, plantain, and licorice root.

If the herbal mixtures are released in filter bags (that is, the plant material is ground to a finely dispersed state), then expectorant teas for bronchitis can be brewed from them directly in a cup.

Expectorant herbs for bronchitis have a proven therapeutic effect: coltsfoot, oregano, marshmallow, licorice, lanceolate thermopsis, plantain, thyme, sweet clover, blue cornflower, angelica, primrose, wild pansy, and mullein.

The main folk expectorants for bronchitis are the listed medicinal plants, from which decoctions or infusions are prepared (often with the addition of honey). Tea with fennel seeds and ginger, a decoction of pine buds, black radish juice with honey, etc. help well. More information in the material - Obstructive bronchitis: treatment with folk remedies

Read about cough treatment for allergic (asthmatic) bronchitis – Allergic bronchitis

Pharmacodynamics

Expectorant tablets for bronchitis Bromhexine and Ambroxol belong to the group of mucolytic agents based on nitrogen-containing derivatives of benzylamine (1-phenylethylamine), and ambroxol is a metabolite of bromhexine, which has a similar pharmacological effect. Both substances increase the lysosomal activity of enzymes of goblet epithelial cells of the bronchial mucosa, as a result of which the hydrolysis of glycoproteins of mucous secretion increases, and it, losing viscosity, is more easily excreted by coughing.

Acetylcysteine (N-acetyl-L-cysteine) and all drugs containing it also act by thinning mucus due to depolymerization of glycoprotein molecules. And the pharmacodynamics of Carbocysteine (L-cysteine-S-carboxymethyl) is based on inhibition of the activity of mucus-forming cells and an increase in the water content of mucus (which facilitates its expectoration), as well as on stimulation of the villi of the bronchial epithelial tissue responsible for their cleansing.

Expectorant tablets for bronchitis Mucaltin are a dry extract of the root of the marshmallow and sodium bicarbonate. The root of the marshmallow contains potassium sorbate, glycosides, saponins, phytosteroids (β-sitosterol and lanosterol) and phenolic acids. In combination, these compounds activate not only the secretory glands of the bronchial mucosa, but also the functions of the ciliated epithelium.

Expectorant mixtures for bronchitis include many agents. Potassium iodide (1-3% solution) is used, which helps break down mucous proteins and mucopolysaccharides of thick sputum. Pertussin and Pectoral Elixir are combined cough remedies. Petrussin contains liquid thyme extract and potassium bromide, and the active ingredients of Pectoral Elixir are licorice root (extract), anise oil and ammonia solution in water (ammonia). Both mixtures increase the production of mucous secretion and, at the same time, liquefy it, and reflexively activate the respiratory center.

Fluditec expectorant syrup contains carbocisteine, the mechanism of action of which was described above.

The pharmacologically active components of Ascoril syrup are bromhexine, beta-adrenergic agonist salbutamol and semi-synthetic analogue of glycerol ester of guaiacol – guaifenesin. The combined effect of these substances is to stimulate bronchial beta-adrenergic receptors (which dilates the bronchi), reduce viscosity (by breaking down sulfide bonds of high-molecular polysaccharides) and increase the activity of the ciliated epithelium of the bronchi.

The expectorant effect of ammonia-anise drops is provided by anise oil and ammonia solution, which reflexively stimulate breathing and increase mucin secretion. And the composition of Bronchosan drops - in addition to anise oil and bromhexine - contains essential oils of mint, oregano, fennel and eucalyptus.

Gedelix drops (Gederin, Prospan) are also of plant origin - based on an extract of ivy leaves, which contains a significant amount of saponins.

The pharmacodynamics of herbal preparations, as a rule, are not presented in the instructions, since there is insufficient information about the mechanism of action of their active substances. So we will limit ourselves to indicating the main active substances of medicinal plants that can have an expectorant effect.

Licorice root contains glycyrrhizic acid (which relieves inflammation and swelling no worse than glucocorticoids) and almost three dozen different isoflavones. Coltsfoot leaves also contain a sufficient set of flavonoid compounds, as well as glycosides, saponins and tannins. Among the compounds found in the essential oils of oregano and thyme - in addition to phenolic acids - there are anti-inflammatory anthocyanins and triterpene alcohols that help liquefy thick sputum. Thanks to steroid saponins and coumarins, the plants blue cyanosis and angelica (angelica) have the same effect.

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Pharmacokinetics

In most cases, manufacturers of expectorant tablets, mixtures, syrups, etc. do not provide information regarding their pharmacodynamics. Exceptions are Acetylcysteine, Carbocysteine and guaifenesin (as part of Ascoril or Bronchipret syrup).

Bioavailability of Acetylcysteine after taking drugs based on it does not exceed 10%, and the connection with plasma proteins reaches 50%; the half-life is about two hours. Biotransformation occurs in the liver with the formation of intermediate and final metabolites (sulfur compounds). Excretion is renal and intestinal.

Carbocysteine has similar bioavailability, and the highest concentration in blood plasma is observed on average 2.5 hours after taking drugs containing it. A small part of carbocysteine is transformed in the intestine, and the main amount is excreted unchanged - with urine.

Guaifenesin is well absorbed in the esophagus and stomach with the ability to penetrate with the bloodstream into all mucous membranes. This substance is metabolized in the liver, excreted from the body through the respiratory tract (with sputum) and kidneys (with urine).

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Dosing and administration

All of the above expectorants for bronchitis are intended for oral administration.

According to official instructions, Bromhexine tablets should be taken one tablet (8 mg) three times a day, for children under six years old - half this dose. And for younger children, Bromhexine syrup is recommended - three times a day, one teaspoon.

The dose of Ambroxol for adults is 60-90 mg per day, i.e. three times one tablet (after meals). For children, it is more convenient to use expectorant syrups containing this substance for bronchitis: Ambroxol, Ambroxol, Koldak Broncho, Rinikold Broncho, Lazolvan, etc.

The daily dose of Acetylcysteine is 600 mg (in three doses), for children under 14 years old – 400 mg. Tablets should be taken before meals and washed down with a sufficient amount of liquid.

It is recommended to take carbocisteine in capsules 500 mg three times a day; for children of a younger age group - a teaspoon of syrup or 15 ml of solution (prepared from granules).

Mucaltin should be taken one or two tablets (50-100 mg) two or three times during the day.

Potassium iodide is taken three times a day, 30 mg (that is, two tablespoons), and Pertussin - one tablespoon (children - one teaspoon or dessert spoon).

The standard dosage of Breast Elixir is 25-30 drops per dose (no more than four times a day). And syrups are usually taken 5-10-15 ml two or three times a day. If the product is intended for treating children, doctors prescribe a lower concentration of the product, and this should be taken into account in order to avoid overdose.

Bronchosan drops are taken 20 drops three times a day; ammonia-anise - 10, the dosage for children according to age is one drop per year. And Gedelix in the form of drops is recommended to be taken 15-20 drops twice during the day.

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Use bronchitis expectorants during pregnancy

Expectorants Bromhexine and Ambroxol (in all dosage forms), Fluditec syrup, Bronchosan drops are contraindicated in the first three months of pregnancy.

Acetylcysteine and Carbocysteine, as well as Ascoril syrup, may be prescribed by a doctor at a later stage, but only in case of extreme necessity.

Breast elixir, ammonia-anise drops, Gedelix drops (Gederin, Prospan) are contraindicated for pregnant and lactating women.

In addition, during pregnancy, expectorant herbs for bronchitis such as licorice, oregano, and primrose should not be used.

Contraindications

Expectorants for bronchitis containing Bromhexine or Ambroxol are contraindicated in gastric ulcer. In addition to exacerbation of gastric ulcer and duodenal ulcer, contraindications for Acetylcysteine and Carbocysteine include serious liver and kidney pathologies (chronic glomerulonephritis).

If you have pulmonary tuberculosis, nephritis, acne, or purulent skin inflammations, you should not take Potassium Iodide mixture.

The breast elixir is not used to treat children under 12 years of age, and the 5% Fluditec syrup is not used to treat children under 15 years of age. In addition, all contraindications of Carbocisteine, which is contained in this syrup, apply to Fludotec.

Contraindications to the use of Ascoril syrup (and all products containing salbutamol and guaifenesin) include high blood pressure and intraocular pressure, abnormal heart rhythms, myocarditis, and exacerbation of stomach ulcers.

Bronchosan drops are contraindicated for patients with gastric ulcer and duodenal ulcer, renal and/or hepatic insufficiency, as well as for children under three years of age. Gedelix drops are not prescribed to children under two years of age and to patients with bronchial asthma.

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Side effects bronchitis expectorants

The most common side effects of the expectorants listed in this review are as follows.

Nausea and vomiting can be caused by Bromhexine, Ambroxol, Carbocisteine (and Fluditec syrup), Bronchosan drops and Gedelix.

Urticaria as a side effect has been noted for Bromhexine, Acetylcysteine and Carbocysteine, Breast Elixir, as well as Bronchosan and Gedelix drops.

Increased bronchospasm is possible with the use of Bromhexine, Acetylcysteine or Pectoral Elixir, and a decrease in blood pressure and headaches - with Acetylcysteine, Pectoral Elixir and Ascoril drops.

In addition, the use of Bromhexine can lead to Quincke's edema; Acetylcysteine - to heart rate disturbance, pain in the pit of the stomach, inflammation of the mucous membrane in the mouth; potassium iodide - to difficulty in nasal breathing, rhinitis, increased lacrimation and discomfort in the stomach; Breast elixir - to the appearance of edema; Ascoril syrup - to tremors and convulsions, insomnia and increased nervousness. After Gedelix drops, the stomach may hurt.

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Overdose

Overdose of any of the above expectorants leads to nausea and vomiting, diarrhea and abdominal pain are possible. It is recommended to wash out the stomach and take an enterosorbent.

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Interactions with other drugs

Bromhexine and Amboxol can be prescribed together with antibacterial therapy, but Acetylcysteine (and all products containing it) are not combined with antibiotics.

Carbocisteine and Pectoral Elixir should not be used simultaneously with antibiotics and fungicidal drugs (due to increased effect).

Also, Carbocisteine and corticosteroids - when used simultaneously - potentiate each other's action, and atropine preparations reduce its therapeutic effect.

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Storage conditions

Normal storage conditions (room temperature not exceeding +25°C and a place protected from light) are recommended in the instructions for most of the presented medicines. Only Pertussin, ammonia-anise drops and Carbocisteine should be stored in a cooler place.

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Shelf life

Each drug's packaging contains information about its shelf life, in most cases it is two to three years. But it should be borne in mind that opening a bottle of syrup, mixture or drops reduces its shelf life by half or more (and such information should be either in the instructions or on the packaging).

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