Effective expectorants for bronchitis for children and adults

Why are expectorants prescribed for bronchitis? Because with inflammation of the bronchi appears cough - the main symptom of this disease, indicating the activation of the mucociliary system, which cleans the respiratory tract from pathogenic agents.

The protective system of the respiratory system works by the production of goblet cells of the mucous membrane and submucosal glands of mucin gel - a viscous adhesive mucus secretion containing glycoproteins, carbohydrates, sulfates, immunoglobulins. When inflammation increases the synthesis of thick mucus - to neutralize viruses or bacteria that hit the shells of respiratory organs. Thanks to a protective reflex, that is, a cough, mucus should be excreted from the bronchi, and help in this expectorant for bronchitis.

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Indications of the expectorants for bronchitis

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

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Release form

The form of release of these drugs is different: tablets, capsules, dragees, potions (solutions for oral administration), syrups, drops, as well as collections of medicinal plants.

Names of expectorants

The pharmaceutical market of ejectors - expectorants - offers many  

Mukoactive drugs that are divided into mucolytics (liquefying mucus) and mukokinetics (facilitating its excretion upon coughing) according to the mechanism of action. It should be noted that all expectorants initially will cause some increase in cough, but their main goal is to facilitate the elimination of excess mucus from the respiratory system.

According to doctors, to choose the best expectorant for bronchitis is difficult, because for drug treatment each organism reacts differently. And those who prefer herbal preparations, it should be remembered that such drugs can also give side effects.

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

Expectorant tablets with bronchitis: Bromhexine (Bromhexin chloride, Brombenzonium, Brodizol, Bisolvon, Mukovin, Mugocil, etc.); Ambroxol (Ambrohexal, Ambrosan, Ambrobene, Bronhopron, Lazolvan, Medox, Mukozan); Acetylcysteine (Acestin, Acestad, Mukomist, Mistabren, Fluimutsil); Mukaltin.

Expectorants in capsular form: Carbocysteine (Mukodin, Mukoprint).

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

Expectorants for bronchitis: Potassium iodide, Pertussin, Thoracic elixir, Ambroxol, Ascoril, Herbion, etc.

Expectorant syrups with bronchitis: Althea, Ambrohexal (Bronhoval, Lazolvan, Remebroks), Fljuditik (Bronkatar, Mukosol), Ascoril, etc.

Expectorants in the form of drops: ammonia-anise drops, Bronchosan (Bromhexin, Bronchotil, Flegamin), Gedelix (Hederin, Prospan).

Expectorant for chronic bronchitis, as well as expectorants for obstructive bronchitis (that is, when the bronchial mucous membranes swell and block their lumens) include virtually all of the listed products, as well as combined preparations with guaifenesin, such as Ascoril syrups or Sudafed. Also see -  Treatment of obstructive bronchitis

Expectorant charges for bronchitis - pharmacies Thoracic collections - consist of medicinal plants. For example, Breast Collection No. 1 includes the leaves of the mother-and-stepmother and the oregano (Matinka), and in the Breast Collection No. 2 - the leaves of the mother-and-stepmother, plantain, and the licorice root of naked (liquorice).

If the collections are produced in filter bags (that is, vegetable raw materials are ground to a fine state), then one can make expectorant teas in bronchitis right in the cup.

A proven therapeutic effect is provided by expectorating herbs in bronchitis: mother-and-stepmother, oregano, marshmallow, licorice, thermopsis lanceolinate, plantain, thyme, sweet clover, blue sinew, angelica, spring primrose (primula forest), violet trichrome, mullein large .

The main folk expectorants for bronchitis are the listed medicinal plants from which they prepare decoctions or infusions (often with the addition of honey). Good tea helps with fennel seeds and ginger, a decoction of pine buds, black radish juice with honey, etc. More information in the material -  Obstructive bronchitis: treatment with alternative means

On the treatment of cough for allergic (asthmatic) bronchitis read -  Allergic bronchitis

Pharmacodynamics

Expectorant tablets with bronchitis Bromhexine and Ambroxol belong to the group of mucolytic agents based on nitrogen-containing derivatives of benzylamine (1-phenylmethylamine), moreover, ambroxol is a metabolite of bromhexine, which has a similar pharmacological effect. Both substances increase the lysosomal activity of the enzymes of the goblet epitheliocytes of the bronchial mucosa, as a result of which hydrolysis of glycoproteins of the secretion of the secretion increases, and it, losing its viscosity, is easier to excrete when coughing.

Acetylcysteine (N-acetyl-L-cysteine) and all preparations containing it also act by diluting sputum due to the depolymerization of glycoprotein molecules. And the pharmacodynamics of carbocysteine (L-cysteine-S-carboxymethyl) is based on the inhibition of the activity of mucus-forming cells and the increase in the mucus content of water (which facilitates its coughing), as well as the stimulation of the villi of the epithelial tissue of the bronchi responsible for their purification.

Expectorant tablets with Muciltin bronchitis are a dry extract of the althea drug root and sodium bicarbonate. The root of the althaea contains potassium sorbate, glycosides, saponins, phytosteroids (β-sitosterol and lanosterol) and phenol carboxylic acids. In a complex, these compounds activate not only the secretory glands of the bronchial mucosa, but also the function of the ciliated epithelium.

Expectorants for bronchitis include a variety of drugs. Potassium iodide (1-3% solution) is used that promotes the cleavage of mucous proteins and mucopolysaccharides of thick sputum. Pertussin and the Thoracic Elixir are a combination of cough suppressants. Petrussin contains a liquid extract of thyme (thyme) and potassium bromide, and the active ingredients of the Thoracic elixir are the licorice root (extract), anise oil and ammonia in water (ammonia). Both medicines increase the production of mucous secretions and, at the same time, dilute it, and also reflexively activate the respiratory center.

Expectorant syrup Fluidite contains carbocysteine, the mechanism of action of which has been described above.

Pharmacologically active components of the Ascoril syrup are bromhexine, beta-adrenomimetic salbutamol and a semi-synthetic analogue of the glyceryl ester of guayaacol-guaifenesin. The cumulative effect of these substances is to stimulate bronchial beta-adrenoreceptors (which dilates the bronchi), reduce viscosity (by breaking down the sulfide bonds of high molecular weight 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 respiration and enhance mucin secretion. And in the composition of Bronchosan drops - besides anise oil and bromhexine - essential oils of mint, oregano, fennel and eucalyptus are contained.

Drops Gedelix (Hederin, Prospan) is also of plant origin - based on the extract of ivy leaves, containing significant amounts of saponins.

Pharmacodynamics of phytopreparations, as a rule, is not presented in the instructions, since information on the mechanism of action of their active substances is not enough. So, we will limit ourselves to indicating the main active substances of medicinal plants capable of exerting an eksponentant effect.

In the root of licorice is glycyrrhizic acid (which removes inflammation and swelling not worse than glucocorticoids) and nearly three dozen different isoflavones. In the leaves of mother-and-stepmother, too, a sufficient set of flavone compounds, as well as glycosides, saponins and tannins. Among the compounds found in the essential oil of oregano and thyme - in addition to phenol carboxylic acids - there are anti-inflammatory anthocyanins and triterpene alcohols that promote liquefaction of thick sputum. Thanks to the steroid saponins and coumarins, the same effect is exerted by the plants blue and angelica (angelica).

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Pharmacokinetics

In most cases, manufacturers of expectorant tablets, potions, syrups, etc. Do not give information on their pharmacodynamics. Exceptions - Acetylcysteine, Carbocysteine and guaifenesin (as part of Ascoril syrup or Bronchipret).

Bioavailability of acetylcysteine after taking drugs on its basis does not exceed 10%, and the connection with plasma proteins reaches 50%; the half-life period 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 a similar bioavailability, and the highest concentration in blood plasma is observed on average 2.5 hours after taking medications with its content. A small part of carbocysteine is transformed in the intestine, and the main amount is excreted unchanged - with urine.

Guaifenesin is characterized by good absorption in the esophagus and stomach with the ability to penetrate the bloodstream into all mucous membranes. This substance is metabolized in the liver, it is excreted from the body through the respiratory tract (along with phlegm) and kidneys (with urine).

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Dosing and administration

All of these 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, children up to six years of age - one half of this dose. And for young children recommend syrup Bromhexine - three times a day for a teaspoon.

The dose of Ambroxol for adults is 60-90 mg per day, that is three times one tablet (after meals). For children it is more convenient to use this expectorant syrup with bronchitis: Ambrohexal, Ambroxol, Broncho Cold, Rinicold bronchus, Lazolvan, etc.

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

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

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

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

Standard dosage of the Thoracic Elixir is 25-30 drops per dose (no more than four times a day). And syrups usually take 5-10-15 ml two or three times a day. If the drug is intended for the treatment of children, doctors prescribe a lower concentration of the remedy, and this must be paid attention to avoid overdose.

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

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Use of the expectorants for bronchitis during pregnancy

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

Acetylcysteine and carbocysteine, as well as Ascoril syrup, can be prescribed by a doctor at a later date, but only in case of emergency.

Thoracic elixir, amniotic anise drops, drops of Gedelix (Gederin, Prospan) are contraindicated to pregnant and lactating women.

In addition, during pregnancy, you can not use such expectorant herbs in bronchitis, like licorice, oregano and spring primrose.

Contraindications

Expectorants for bronchitis, containing Bromhexin or Ambroxol are contraindicated in peptic ulcer disease. In addition to exacerbation of gastric ulcers and duodenal ulcers, contraindications of Acetylcysteine and Carbocysteine include serious pathologies of the liver and kidneys (chronic glomerulonephritis).

In the presence of pulmonary tuberculosis, nephritis, acne and skin purulent inflammation, potassium iodide should not be taken.

The thoracic elixir is not used in the treatment of children younger than 12 years, and 5% syrup Fluidite - under 15 years. In addition, all contraindications of Carbocysteine contained in this syrup are distributed to Floodotech.

Among the contraindications to the use of Ascoril syrup (and all agents with salbutamol and guaifenesin) are indicated increased arterial and intraocular pressure, cardiac rhythm disturbances, myocarditis, exacerbation of stomach ulcers.

Patients with peptic ulcer of the stomach and duodenum, kidney and / or liver deficiency, as well as children under the age of three are contraindicated with Bronchosan drops. A drop of Gedelix is not prescribed for children under two years old and suffering from bronchial asthma.

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Side effects of the expectorants for bronchitis

The most typical side effects of expectorants given in this review are as follows.

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

Urticaria as a side effect was noted in Bromhexin, Acetylcysteine and Carbocysteine, Thoracic Elixir, and also in drops of Bronchosan and Gedelix.

Increased spasm of bronchi is possible with Bromhexine, Acetylcysteine or Thoracic Elixir, and lowering blood pressure and headaches - Acetylcysteine, Thoracic Elixir and Ascoril Drops.

In addition, the use of Bromhexine may lead to the edema of Quincke; Acetylcysteine - to the violation of heart rate, pain in the pit of stomach, inflammation of the mucosa in the mouth; potassium iodide - to obstruction of nasal breathing, rhinitis, increased lacrimation and discomfort in the stomach; Thoracic elixir - to the appearance of edema; syrup Ascoril - to tremors and cramps, insomnia and increased nervousness. After Gédelix drops, the stomach may get sore.

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Overdose

An overdose of any of these expectorants leads to nausea and vomiting, diarrhea and abdominal pain are possible. It is recommended to wash the stomach and take enterosorbent.

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Interactions with other drugs

Bromgeksin and Amboksol can be prescribed together with antibacterial therapy, but Acetylcysteine (and all its containing agents) with antibiotics do not combine.

Simultaneously with antibiotics and fungicides, Carbocysteine and the Thoracic Elixir should not be used (due to increased exposure).

Also, carbocysteine and corticosteroids - with simultaneous application - potentiate the action of each other, and atropine drugs reduce its therapeutic effect.

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Storage conditions

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

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Shelf life

On the packaging of each drug there is an indication as to its shelf life, in most cases it is two to three years. But it must be borne in mind that opening a vial of syrup, potion or drops reduces its shelf life by half or more (and this information must be either in the instructions or on the package).

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