Effective expectorants for expectoration of phlegm

The main protective barrier preventing respiratory tract infection is the epithelium of their mucous membrane, covered with a constantly renewed mucous secretion, preventing the epithelium from drying out and acting as a filter. A healthy person produces about 0.1 liters of this mucus per day, it covers the epithelium from the nasal passages to the terminal bronchioles and traps exogenous ingredients (corpuscular particles and microbes) entering with inhaled air. Natural evacuation of foreign elements is carried out together with mucus. From five to ten percent of rhinobronchial mucous secretion consists of acidic and neutral glycoproteins (mucins), which provide its viscosity. In diseases of the respiratory system, the composition of the mucous secretion changes: the content of acidic water-soluble mucins decreases, and neutral water-repellent ones increases. The mucus becomes jelly-like, in addition, due to hyperplasia of the bronchial glands, its quantity increases, which is accompanied by a decrease in the concentration of constantly present protective ingredients (interferon, immunoglobulin A, lactoferrin, lysozyme). The natural filter partially loses its properties and begins to pass pathogenic microorganisms to the submucosal layer of the respiratory tract, which favors the creation of colonies of pathogens. Therefore, in inflammatory diseases of the respiratory tract, especially in the case of congestion and difficult coughing, expectorants are used - drugs that restore the activity of the ciliated epithelium, liquefy rhinobronchial secretion (phlegm) and improve its movement and removal with the help of coughing - a natural protective factor.

According to their medicinal pathogenesis, these drugs are divided into secretomotor drugs, which activate the process of coughing up and evacuating liquid secretions (mucociliary clearance), and secretolytic drugs, which increase the proportion of hydrophilic components in the secretion, i.e. making it more liquid, thereby facilitating the process of removal.

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Indications expectorants

Dry cough occurs most often as a reflex reaction to irritation of the rhinobronchial epithelium in response to smoke, strong odors, dust and other similar substances, as well as at the onset of inflammatory or allergic lesions of the respiratory tract as an attempt by the body to get rid of the irritant. Expectorants are usually not prescribed for dry cough, since at this stage they can aggravate the inflammatory process. In this case, drugs are indicated that qualitatively change the cough - from dry to wet, as well as medications that have a double effect - suppressing cough and facilitating expectoration.

Antitussive multicomponent drugs are usually prescribed for debilitating severe attacks of dry cough, causing sleep and appetite disorders. For example, the drug Sinekod has a direct effect on the cough center, calming attacks of acute dry cough of various etiologies. It is not a narcotic. Synonyms - Butamirate, Omnitus, Codelac Neo.

The herbal preparation Gerbion with plantain is intended to relieve attacks of dry cough. In addition to the antitussive effect, it has an expectorant, moderate bactericidal and inflammation-reducing effect on the respiratory tract.

In acute bronchitis and pneumonia, drugs that directly suppress cough are not recommended. They are prescribed when it is necessary to stop intense attacks in patients with whooping cough, smokers, in cases of surgical interventions and diagnostic procedures.

Unproductive cough, which often accompanies the initial stages of respiratory diseases, is transferred to the wet cough category with the help of inhalers, sprays, oral medications, air humidification and warming procedures, after which the intake of medications that stop coughing attacks is stopped and expectorants are prescribed.

In cases of easily separated liquid sputum, in order to quickly remove it from the body, secretomotor expectorants are indicated for wet cough. If the cough is productive, however, the mucous secretion has a thick, viscous and sticky consistency, drugs that thin it are used.

With all the variety of forms of bronchitis, the treatment regimen necessarily includes agents that stimulate and facilitate the work of the mucociliary transport system. They are necessary because during inflammation, hypersecretion of sputum occurs, its properties change - it becomes more viscous. Pathogenic microorganisms and pus accumulate in the branches of the bronchial tree, congestion and intoxication begin. Expectorants for bronchitis are prescribed to evacuate bronchial secretions, improve bronchial patency and relieve intoxication. They are used at the stage of productive cough, when the patient begins to cough up mucous secretions. Syrups Doctor Mom and Bronchicum facilitate its discharge. Inhalations with Lazolvan (Ambroxol) liquefy viscous secretions and simultaneously tone the smooth muscles of the bronchi, accelerating their evacuation. Carbocysteine can be prescribed orally.

Expectorants are indicated for pneumonia to restore normal ventilation. Cough suppressants are not used for acute pneumonia, and the doctor bases the prescription on the intensity of attacks, the characteristics of rhinobronchial mucus and expectoration, and the presence of chronic respiratory pathologies in the patient (special attention is paid to the presence of obstruction). In case of thick secretions that are difficult to remove and long coughing attacks (a quarter of an hour or more), inhalations of Ambroxol are indicated. The same drug, but in oral form, is prescribed for easily removed mucous secretions and short coughing attacks.

If, in case of a respiratory disease, the presence of pus in the secreted mucus is detected (purulent pneumonia, bronchitis, etc.), it is recommended to use medications with the active ingredient Acetylcysteine (the drug of the same name, ACC, Fluimucil).

Expectorants for asthma are used to improve drainage in the bronchial tree and restore normal evacuation of mucous secretions. The most effective for asthma is inhalation expectorant therapy: a two-percent solution of baking soda and Acetylcysteine preparations, which are prescribed in combination with bronchodilators. Among oral medications, asthmatics are most often prescribed Ambroxol (Lazolvan) and Bromhexine.

Expectorants are prescribed for smoking to eliminate thick mucus, inflammation of the respiratory tract and their swelling, since this bad habit leads to a disorder of the natural cleansing functions. Smokers often have a history of a whole bunch of chronic respiratory diseases and, depending on the existing disease, certain drugs are used, in particular, those that increase the secretion of mucus, make its structure more rarefied and enhance the functions of the ciliated epithelium.

Expectorants are rarely used for tracheitis. Firstly, this disease is characterized by a dry, sore cough at night and in the morning, and during the daytime – attacks at the moment of a sharp change in the breathing rhythm (screaming, crying, laughing, etc.). Secondly, with tracheitis, even mucus of a thick and viscous consistency is usually eliminated without difficulty. Therefore, complex drugs that have the ability to suppress coughing attacks with a moderate expectorant effect are more often used. For example, cough syrup based on medicinal plants Doctor Mom, which stops cough attacks and helps to convert dry cough into wet. In inflammatory diseases of the larynx, vocal cords, mucous membrane of the pharynx, which most often accompany tracheitis, the use of drugs with an analgesic and anti-inflammatory effect is indicated. In addition to the already mentioned Doctor Mom, which has all the listed properties, Gerbion with plantain, Sinekod or Stoptussin can be prescribed.

Tracheitis rarely occurs as an independent disease, much more often it is complicated by pharyngitis (inflammation of the mucous membrane of the pharynx), which is characterized by difficulty coughing up secretions, especially if the disease has become chronic. In this pathology, expectorants for pharyngitis are prescribed, often combined, with bactericidal and anti-inflammatory properties. Mucaltin, Acetylcysteine, Lazolvan and other medications are used, taking into account their properties and the patient's condition. The same as expectorants for laryngitis (inflammation of the mucous membrane of the larynx and vocal cords), which usually accompanies the so-called colds. Patients with excessive secretion of sputum are prescribed drugs that activate the coughing process, and with thick and poorly separated sputum - secretolytics.

When prescribing expectorants for colds, the doctor is usually guided not by which parts of the respiratory system are affected by inflammation, but by the nature of the cough, mucous secretions and the degree of disturbance of mucociliary clearance. The drug Erespal has a fairly wide spectrum of action - anti-inflammatory and preventing bronchial constriction, eliminating respiratory symptoms of various etiologies.

The principles of drug treatment that facilitates coughing do not differ significantly in acute respiratory diseases and in serious chronic diseases. Expectorants for lung cancer perform the same tasks - they facilitate and activate the evacuation of mucous secretions with a wet cough (Mukaltin, Prospan, Lazolvan). If the patient has a painful dry cough, direct-acting medications are prescribed to stop its attacks; the use of complex agents that additionally facilitate coughing is not excluded (Bronholitin, Stopussin).

Cough with secreted mucus is also one of the main symptoms of chronic obstructive pulmonary disease (COPD). Hypertrophic changes in the glands that produce mucus are specific for broncho-obstruction. Therefore, medications that have the ability to stimulate the production of sputum, affect its structure and activate the evacuation function are actively used in the treatment of this disease. Expectorants for COPD are designed to improve the drainage function and eliminate congestion in the bronchial tree. Quite often, patients with obstruction are prescribed Bromhexine, which normalizes the biochemical composition of sputum, facilitates coughing and has a slight antitussive effect. Currently, Ambroxol (Lazolvan) is more often used - an active metabolite of Bromhexine, superior to it in positive properties and preventing pulmonary atelectasis. And also – Ascoril, which contains three active components and has an expectorant, bronchodilator and secretolytic effect.

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Release form

Pharmaceutical products for the relief and elimination of cough are available in various forms: for local, oral and parenteral use. The same drug, for example, Lazolvan (Ambroxol) can be found in pharmacies in all possible forms. Oral forms are available in the form of tablets (capsules), syrup and sachets with powder or granules for making a solution. Expectorants in syrup are usually intended for children, but some adults who do not like to swallow tablets or capsules also prefer this form of release. Moreover, it is already completely ready for use. A solution prepared from powder (granules) or syrup is absorbed faster from the gastrointestinal tract and is less aggressive to the mucous membrane compared to capsules and tablets.

Ampoules for parenteral administration are also used as an expectorant for inhalation. Their contents are usually diluted in equal proportions with saline. Some drugs, such as Acetylcysteine, Bromhexine, can be purchased at the pharmacy as ready-made solutions for inhalation. Solutions of drugs are not used in steam inhalers, since it is undesirable to heat them, but are used as an expectorant for a nebulizer, in which the drug is sprayed without heating at room temperature.

If it is not possible to use expectorants in the form of inhalations or orally (infants, unconscious patients), injection solutions in ampoules are used.

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Expectorants and mucolytics, mucolytics and expectorants

Many names of cough-relieving drugs are familiar from childhood, we get information about new products from TV commercials, which present each advertised product as a panacea for cough, visually demonstrating how the bronchial tree is cleared of phlegm strewn with microbes. Let's consider in what cases the most well-known drugs are used today and what properties they have.

The list of expectorants is headed by ACC (Acetylcysteine). A typical mucolytic that changes the structure of sputum from thick to watery and thin, which significantly accelerates its removal and promotes natural sanitation of the respiratory tract. It is prescribed to patients with a wet cough with difficult expectoration, accompanying acute and chronic diseases of the respiratory system (bronchitis, asthma, pneumonia, bronchiectatic pulmonary disease, cystic fibrosis, inflammation of the trachea and vocal cords, sinusitis and otitis), including allergic genesis, complicated by bacterial infection and suppuration. Reduces the symptoms of intoxication and the activity of proinflammatory mediators, prevents relapses and complications. Patients with a likelihood of broncho-obstruction in combination with acetylcysteine are prescribed drugs that expand the lumen of the bronchi and prevent the development of their spasms. The most effective method is inhalation (through a nebulizer), but any form can be prescribed (the choice is up to the doctor). Drinking plenty of fluids potentiates the action of acetylcysteine.

Fluimucil is a complete synonym of the previous drug, used in the same way as Acetin, Broncholisin, Mukobene, and Mukomist inhalation solution.

Carbocisteine is another representative of the amino acid cysteine derivatives, it improves the rheology of bronchial secretions and has a moderate anti-inflammatory effect.

Mucaltin is an expectorant of plant origin (marshmallow root extract) that increases mucus secretion and mucociliary clearance, and also somewhat reduces the inflammatory process. Its use is inappropriate for inflammatory processes in the upper respiratory tract, and the drug has virtually no antitussive effect. It facilitates coughing and, by stimulating the bronchial glands, helps dry coughs become wet. The drug is available in solid tablet form for resorption under the tongue. Liquid oral forms with the same active ingredient can be purchased: Althea syrup and its children's version - Althea syrup.

Preparations based on thyme herb (thyme) have been known for quite a long time - syrups Pertussin, Bronchicum. This plant has quite pronounced bactericidal properties, has an antispasmodic and expectorant effect. The Pertussin syrup includes potassium bromide as the second active component, which soothes and softens cough.

Herbion syrup with ivy extract is an expectorant indicated for productive cough with difficulty in coughing up phlegm.

The syrup of the same name, containing extracts of primrose and thyme, stimulates the secretion of sputum and expands the bronchial lumen, reducing the risk of spasms. Levomenthol, contained in the composition of the drug, has an analgesic and antiseptic effect. Helps to get rid of a wet cough faster.

Herbal preparations Doctor Mom (syrup, lozenges, individual inhalation pencil) are used to facilitate coughing, stimulating the production of sputum, thinning its consistency and enhancing evacuation by activating the ciliated epithelium and expanding the lumen of the bronchioles, acting simultaneously as mucolytics and expectorants.

The most powerful herbal remedy that helps to cough up mucus is Thermopsis tablets. The herb Thermopsis lanceolata contains a whole complex of alkaloids that stimulate the respiratory center. The drug increases and activates the work of the bronchial glands and its evacuation by toning the smooth muscle tissue of the bronchioles.

Bromhexine is a drug that thins bronchial secretions and facilitates the process of coughing them up, and it also has the ability to soothe coughing fits. It is one of the components of the drug Ascoril, which contains another active component that has a similar effect - guaifenesin, as well as the vasodilator ingredient salbutamol. This drug is a potent expectorant prescribed only by a doctor for strict indications.

Lazolvan (synonym Ambroxol) is currently a worthy representative of phlegm thinning and expectorant agents. Its active ingredient is the active metabolite of Bromhexine. It has a similar effect, however, does not suppress the cough reflex and is qualitatively superior to its predecessor. It is used for wet cough with the formation of thick and sticky mucus that is difficult to separate.

The multicomponent drug Codelac Broncho has a pronounced ability to liquefy bronchial secretions and stimulate peristalsis of the bronchial muscles due to its ambroxol and thermopsis extract. Its other components, glycyrrhizinate and sodium bicarbonate, complement this effect and also reduce inflammation and allergic reactions.

The drug of direct resorptive action Potassium iodide has a mucolytic effect on the excretion of iodine taken orally by the bronchi; it is almost never prescribed nowadays, being considered ineffective.

Antitussives and expectorants are prescribed in cases where it is necessary to stimulate the secretion removal and relieve the patient's condition, suffocating from severe attacks, usually night cough, preventing a full rest. Bromhexine can be partly classified as such drugs, which to a greater extent stimulates expectoration, but at the same time has a weak antitussive ability, unlike Mucaltin, Thermopsis, cysteine derivatives and Lazolvan. The advisability of prescribing combined drugs that have two opposite effects at the same time (antitussive and expectorant) is generally questioned by many specialists, since it is unclear what effect such a combination will have on a specific patient. Medicines with codeine in combination with herbal substances that stimulate contractions of the bronchial muscles - ipecacuanha, thermopsis, licorice root - cause especially ambiguous attitudes.

Anti-inflammatory expectorants are more trusted by specialists, since the reduction of inflammation plays a significant role in reducing respiratory symptoms and leads to a gradual decrease in mucus secretion and, as a result, the disappearance of coughing attacks.

Erespal is not a direct expectorant. Its active substance (phenispiride hydrochloride) has antihistamine and bronchodilator (indirectly expectorant) properties, and also reduces the amount of produced proinflammatory mediators, thereby reducing respiratory symptoms, including cough. The antitussive effect of the drug is complemented by its ability to reduce the production of viscous sputum. All forms of this drug are used for various acute and chronic pathologies of ENT organs with pronounced respiratory symptoms - inflammation of the nose, ear, pharynx, larynx, trachea, bronchi, and can also be prescribed to relieve rhinobronchial symptoms in measles, acute respiratory viral infections, flu, whooping cough.

Herbion syrup with plantain extract is indicated for unproductive cough. It has anti-inflammatory, softening, growth and development of microorganisms prevention effects, and the presence of ascorbic acid in its composition helps to strengthen the immune barrier, prevent the development of complications and convert dry cough into wet.

It is used mainly for pathological processes in the upper respiratory tract, accompanied by a dry unproductive cough. It alleviates smokers' cough.

Sinekod has a central effect, suppressing cough, without affecting the respiratory center. It is used in cases of painful dry cough, exhausting the patient, preventing him from fully resting and eating. It also has the ability to expand the bronchi, indirectly facilitating coughing, and reduces the activity of inflammation mediators.

Etiotropic treatment of inflammatory diseases accompanied by cough (tracheitis, laryngitis, bronchitis, pneumonia) is usually carried out with antibiotics, since most of them are caused by bacteria or aggravated by an associated bacterial infection. These drugs also, in their own way, facilitate expectoration. Indirectly expectorants - antibiotics have an anti-edematous and anti-inflammatory effect, improve pulmonary ventilation and air permeability in the bronchial tree, and also - to some extent reduce the production of sputum. Most drugs belonging to the group of direct expectorants (Bromhexine, Lazolvan and others) promote more active penetration of antibacterial components into sputum. Considering their synergistic interaction, American pharmacists have released a complex drug - a combination of ambroxol and doxycycline (Ambrodox), but this drug is not registered in the post-Soviet territory.

Antihistamines prescribed for coughs of allergic origin also have an indirect expectorant effect, as they are able to expand the bronchi and reduce the production of sputum.

Modern expectorants have a fairly pronounced effect, herbal preparations, in addition to plant extracts, contain at least preservatives and stabilizers. Often, herbal extracts are combined with medications. Therefore, before stimulating coughing with potent drugs, you can first try to get rid of it with more harmless home remedies.

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Folk remedies for cough expectorants

Since cough is a symptom of the most widespread diseases, folk healers pay a lot of attention to getting rid of it. Such substances as honey and soda are the most famous cough fighters. Probably, there is not a single person among us who was not given warm milk with honey or soda to drink for cough in childhood. And indeed, this simple remedy had quite a pronounced expectorant effect.

Honey is present in many traditional medicine recipes that help get rid of cough. It has antiseptic properties, helps cope with inflammatory processes, and is a powerful natural energy drink. Many recipes use heated honey or add it to a hot drink. It should be remembered that honey cannot be heated to a temperature above 60℃, it becomes poison.

A sore throat and unproductive dry cough can be helped by this drink: add a teaspoon of honey to warm milk, stir well until completely dissolved. To soften the mucous membrane, you can add a little butter. This remedy can be consumed several times a day.

You can prepare an expectorant decoction based on a head of garlic or ten small onions per liter of milk. After boiling the garlic (onion), let the milk decoction cool, strain it and stir ten teaspoons of honey into it. Take a tablespoon often, six to eight times a day.

Quite effective is frequent drinking of linden, raspberry, chamomile tea with the addition of a teaspoon of honey, half a glass 30 minutes before meals.

You can mix 100 g of honey with the juice squeezed from a whole lemon. Eat a tablespoon of the mixture daily before bed with hot tea. An effective mixture is equal proportions (for example, half a glass) of honey with freshly squeezed white cabbage juice. Take a tablespoon before meals three to four times a day.

Soda is a substance that can easily compete with honey in popularity as a remedy. Warm milk with soda will literally transform a non-productive, exhausting cough into a wet one in a day, since soda promotes the production of mucous secretions, as well as increases their fluidity. Many recipes for preparing expectorants at home are based on milk with soda. So, the basic component is prepared in the following proportions: half a teaspoon of soda per glass of milk. To improve its expectorant properties, you can add to this mixture:

• a teaspoon of honey and/or butter;
• cocoa butter;
• 2-3 drops of propolis alcohol tincture;
• yolk of a raw chicken egg or five yolks of quail eggs, ground with a tablespoon of sugar;
• a pinch of salt;
• 3-4 drops of camphor oil.

The milk to which soda is added should not be too hot (about 40℃), at high temperatures it loses its properties.

Inhalation expectoration is very effective, some experts believe that this is the most acceptable form of using medicinal and folk remedies. With soda, they can be done in different ways - steam (the old-fashioned method) and with more modern devices, in particular, a nebulizer. The temperature of the inhaled steam should be about 40 ℃. A couple of drops of an alcohol solution of iodine or garlic are added to the soda solution (one teaspoon per liter of water) as follows: six cloves of garlic are poured with a liter of hot water, brought to a boil and boiled for five minutes over medium heat. Cool to the desired temperature and soda is added.

Cough, especially with a cold, flu, acute respiratory viral infection, is accompanied by a sore throat and pain. Regular gargling with a soda solution (a level teaspoon is taken per half a glass of water), performed three to four times a day, will soften the cough, transfer it to the wet category and facilitate expectoration.

Home physiotherapy with potato cakes placed on the chest below the thyroid gland and above the heart area will be a good addition to gargling or inhalation. The procedure is done before bedtime. Cake recipe: boil two medium-sized root vegetables in their skins, mash them with the sequential addition of vegetable oil, dry mustard, honey and a tablespoon of soda. Make a cake, wrap it in plastic wrap, and warm, putting a piece of natural fabric or gauze under it, place it on the chest, covering the patient with a blanket.

At home, you can use herbal expectorants. The following medicinal plants are considered especially effective in this capacity:

1. Thyme or thyme: the easiest way is to drink tea with this herb (brew several sprigs with boiling water and wait until the drink becomes rich and aromatic), you can sweeten it with honey. Thyme essential oil has a beneficial effect on the respiratory system, it can be used in steam inhalations. In addition to the coughing effect, thyme has antiseptic properties and improves the emotional state.
2. Licorice (licorice), or more precisely, the root of the plant is used, containing glycyrrhizin and its acid, which facilitates the evacuation of sputum, flavonoids, also contained in the root, - an antispasmodic effect. As an expectorant, an infusion is used, prepared as follows: a tablespoon of dried root of the plant of a small fraction is poured into an enamel or glass container, brewed with boiling water (200 ml) and simmered in a water bath for a little more than a quarter of an hour; let cool for 45 minutes, filter and top up to the original capacity with boiled water. The daily dose is three or four tablespoons, one per dose before meals. A new infusion is prepared every other day.
3. Plantain - as an expectorant, freshly squeezed juice from the plant is used, possibly with honey, or honey syrup from fresh leaves. To prepare the syrup, they are crushed and mixed with an equal volume of honey, in a closed container placed in a warm place for 3-4 hours. Then eat a teaspoon of syrup before each meal (the effect is noticeable after 24 hours). A decoction of plantain seeds also has expectorant properties (you can use both dry and fresh seeds) - for 200 ml of water, take a tablespoon of seeds and boil them over low heat for two minutes, insist, strain and take two tablespoons during the day before each meal. You can eat after 20 minutes.
4. Marshmallow - an infusion of the root of this plant is prepared very simply: dried roots of a small fraction in a volume equal to a tablespoon, pour cold boiled water for an hour, filter and take every two hours a tablespoon. It has enveloping properties, protects the mucous membrane from irritation, is a soft expectorant with a pronounced anti-inflammatory effect.
5. Coltsfoot - four teaspoons of crushed plant are brewed with 200 ml of boiling water, after half an hour it is filtered and this portion is consumed on the same day, divided into three to four doses. Saponins present in the plant restore the functions of the ciliated epithelium, mucus envelops and relieves irritation and inflammation, organic acids liquefy phlegm.
6. Ginger – it is enough to simply drink ginger tea a couple of times a day. You can add lemon and honey to it. Or you can add finely chopped ginger to a herbal infusion or decoction, to a breast collection – you will get an aromatic and pleasant drink with anti-inflammatory, bactericidal and expectorant effects.

The herbs listed above are included as components in herbal mixtures from pharmacies. They are produced in the form of a mixture of crushed plant components and in tea bags with a powdered herbal mixture.

The Bronchophyte collection, which includes plants with expectorant and anti-inflammatory properties (roots of marshmallow, licorice, elecampane and calamus, aerial parts of thyme and sage, inflorescences of black elderberry and linden, chamomile flowers, leaves of peppermint and nettle), is indicated for unproductive cough. Increases the production of sputum and improves the tone of the bronchial muscles, while simultaneously relieving inflammation, killing microbes and strengthening the immune system.

There are a great many cough mixtures in pharmacies and online stores. You need to pay attention to the composition and indications for use, since the ingredients of herbal mixtures under the same number, but from different manufacturers, may differ.

Breast collection No. 1, classic, presented in pharmacies, three-component - marshmallow root, oregano herb and coltsfoot leaf, activates the evacuation of sputum in case of unproductive cough. It is not recommended for use in case of dry cough.

Composition No. 2 contains two components with a pronounced expectorant effect (licorice root, coltsfoot), as well as plantain leaves. It softens the cough by enveloping the mucous membrane, reduces inflammation symptoms, liquefies bronchial secretions and activates mucociliary clearance.

Breast collection No. 3, the classic components of which are marshmallow and licorice roots, anise, pine buds and sage leaves, has the strongest expectorant effect and promotes rapid clearing of the respiratory tract from phlegm.

All three collections are used for productive cough with difficult expectoration. In addition, the herbs always have a bactericidal effect, reduce inflammation and promote cellular renewal of the respiratory tract epithelium.

For dry cough, it is advisable to use chest collection No. 4, which, although it contains components that stimulate expectoration (licorice root, violet, wild rosemary), however, its composition is dominated by anti-inflammatory, antiseptic and bronchodilatory properties of the same components, as well as calendula, chamomile, mint, which also soothe cough and soften the mucous membrane of the respiratory tract. This collection promotes the transition of dry cough to productive, and then facilitates expectoration.

The advantage of folk remedies over pharmaceuticals is obvious. Firstly, these are substances of natural origin, they can cause allergies, they have contraindications, but compared to cysteine derivatives or bromhexine, they are trivial. Secondly, almost all of them, to one degree or another, except for expectorants, have anti-inflammatory, bactericidal, symptom-relieving and regenerating properties, which are not at all unnecessary in case of inflammation of the respiratory tract. Thirdly, they all stimulate the secretion of sputum and are able to turn a dry cough into a wet one. There are no strict divisions by action in folk remedies. If we take into account that some specialists, in particular, Dr. Komarovsky, consider the effectiveness of expectorants to be unproven, and they themselves are drugs for calming the relatives of the patient, then the conclusions are in favor of folk medicine.

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Pharmacodynamics

Disturbances in the rate of mucus secretion removal from the respiratory tract are caused by an increase (decrease) in its production, changes in its rheological properties, dysfunction of the ciliated epithelium, and combined causes. Having determined what provoked the disorder of mucociliary clearance, it is easier to select an expectorant that is effective in a given clinical case.

According to the mechanism of action, reflex expectorants are distinguished - when they enter the stomach, they stimulate the gag reflex, affecting its center in the medulla oblongata. The consequence of which is increased salivation and sputum production, as well as its movement with the help of ciliated epithelium from small bronchioles to the bronchi and trachea. Basically, such a reflex reaction is provided by medicinal plants, preparations based on them - marshmallow, thermopsis, licorice, coltsfoot and others.

Expectorants with direct resorptive action, getting into the gastrointestinal tract, are absorbed, distributed in tissues, including the bronchi, being released there and irritating their mucous membrane. At the same time, the production of sputum increases, and its consistency becomes more rarefied. Such properties are possessed by iodide salts of potassium and sodium, ammonium chloride (ammonium hydroxide), baking soda and other salts.

A special category are new generation mucolytics, which regulate the secretion of sputum thanks to the proteolytic enzymes they contain, that is, enzymes involved in the breakdown of proteins.

Bromhexine and its active metabolite Ambroxol are pulmonary surfactant stimulants, activate the mucociliary transport system and have a mucokinetic effect (increase the production of glycoproteins). The combination of these actions leads to increased coughing and clearing the respiratory system of excess mucus. Bromhexine also has a slight ability to suppress the cough reflex.

Acetylcysteine (N-derivative) and Carbocysteine (L-derivative) of cysteine - a free sulfhydryl group present in the molecules of the drug, allows to break the bisulfide bonds of acidic glycosaminoglycans of bronchial secretions, which leads to the breakdown of mucoproteins into simpler molecules and has the effect of reducing the viscosity of sputum, activating the process of its evacuation.

The three-component drug Ascoril has a fairly strong expectorant effect, since it contains two mucolytics (Bromhexine and Guaifenesin) acting synergistically, and the β-adrenergic agonist salbutamol provides bronchodilation.

Erespal (fenispiride), not being a mucolytic, acts by blocking the production of inflammation mediators, histamine, which can lead to bronchial constriction and congestion, has a relaxing effect on smooth muscles, including bronchial, reduces the secretion of viscous sputum by blocking α1-adrenoreceptors. In various inflammatory processes in the respiratory system, acute and chronic, it has an indirect expectorant effect, helps reduce cough.

The active substance of the drug Sinekod has a central antitussive effect, inhibiting the activity of the part of the brain responsible for coughing. In addition, some bronchodilatory effect of the drug is noted, as well as inhibition of proinflammatory factors.

The action of multicomponent cough suppressants is determined by the effects of their ingredients. The action of oral forms is considered.

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Pharmacokinetics

After oral administration, Bromhexine is absorbed within half an hour by 99% and is completely bound to serum proteins. It has been established that it penetrates the brain, the fetus in pregnant women and into breast milk in nursing mothers. It is broken down in the liver to ambroxol, and is excreted slowly (T₁/₂=15 hours) due to slow reverse diffusion. Excretion of metabolic products occurs through the urinary organs. It can accumulate with prolonged and repeated administration.

Ambroxol taken orally is absorbed and distributed in tissues quickly. Its high density is determined in the lungs. The half-life is shorter than that of the predecessor (T₁/₂=10 hours).

Cysteine derivatives are absorbed quickly and almost completely, splitting occurs in the liver during the first pass. The maximum concentration is determined in the interval from one to three hours. In tissues, acetylcysteine and its splitting products are determined as a free substance, compounds with serum proteins, incorporated amino acids. The half-life from the bloodstream is approximately one hour and is proportional to the rate of splitting in the liver. In case of its dysfunction, this period of time can be extended to eight hours. It is excreted mainly by the kidneys, the remaining insignificant part - by the intestines.

The absorption, distribution and metabolism of Carbocisteine occur similarly. The highest concentration in plasma is determined after two hours, during which time the half-life of the drug occurs. The presence of Carbocisteine is determined for the longest time in the serum, liver parenchyma and in the cavity behind the eardrum (middle ear). It is eliminated by the kidneys unchanged.

The highest concentration of Erespal is found in the blood serum six hours after oral administration, the half-life is 12 hours. Excretion occurs through the kidneys.

The active substance of the drug Sinekod is characterized by rapid absorption and high affinity for serum proteins. The highest plasma concentration is detected after one and a half hours. It is hydrolyzed in the blood, does not accumulate, half-life occurs within six hours. Elimination occurs through the urinary tract in the form of metabolites and unchanged substance.

The pharmacokinetics of multicomponent and herbal preparations is not presented.

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Dosing and administration

Expectorants are used in several ways. Most often, oral medications are prescribed, the most convenient form of which are syrups and drops. Inhalation - for which special solutions for inhalation or injection solutions diluted with water 1:1 are used. In severe cases, expectorants are administered by injection. The dosage and duration of administration are prescribed by a doctor, based on the age and condition of the patient. Drinking plenty of fluids increases the effectiveness of expectorant therapy.

Standard dosages of Acetylcysteine are as follows: patients from the age of fourteen take 400 to 600 mg per day. From ten days to two years of age, they receive a single dose of 50 mg twice or three times during the day. From two to five years, a single dose is 100-150 mg, taken twice. From six to 13 full years, they take 150 to 200 mg twice a day. The medicine (effervescent tablet or sachet with powder) is poured into half a glass of water, juice or tea at room temperature and taken twice a day after meals.

Carbocisteine is prescribed to patients over 12 years of age in a single dose of 750 mg in three doses. When the therapeutic effect is achieved, the patient of this age group continues treatment with half the dose of the drug.

Syrup for children is dosed:

Children under five years of age take from half to a whole teaspoon (dosage 125 mg/5 ml) in four doses;

Children from five to 12 years of age are prescribed three doses of one teaspoon with a dosage of 250 mg/5 ml or two doses with a dosage of 125 mg/5 ml.

Marshmallow preparations are taken before meals:

Mucaltin tablets twice or three times a day at a dose of 50-100 mg per dose.

Althea syrup - for patients under six years of age, it is advisable to reduce its concentration by diluting it in a small container (≈20 ml) of boiled water at room temperature.

The dosage for infants is half a teaspoon once or twice a day; for one-year-old children, the same dosage can be given three times; 2-6 full years - a whole teaspoon of syrup is given four to six times; 7-13 full years - the same number of times, two teaspoons or one dessert spoon; 14 years and older, the same number of times, a tablespoon.

Gerbion syrup usually comes with a measuring spoon for dosing: at the age of 2-6 full years, a single dose is one measuring spoon three times during the day; 7-13 full years - from one to two measuring spoons the same number of times; 14 years and older - two portions three to four times during the day. The drug is taken during or after meals. It is recommended to drink plenty of water, wash and dry the measuring spoon each time after taking the drug.

Pertussin - for patients under six years of age, it is advisable to reduce its concentration by diluting it in a small container (≈20 ml) of boiled water at room temperature.

The frequency of administration is three times.

Dosage: for the age group from three to five years old - 2.5 ml (half a teaspoon); from six to eight years old - 5 ml (a whole teaspoon); 9-11 years old - 10 ml (a dessert spoon or two teaspoons); 12 years and older - 15 ml (a tablespoon).

Bronchicum C is prescribed to infants from six months to one year of age, twice a day, 2.5 ml (half a teaspoon); one-year-old children are given the same dose three times a day; from two to five years, 5 ml (a whole teaspoon) twice a day; 6-11 years - 5 ml (a whole teaspoon) three times a day; 12 years and older - 10 ml (a dessert spoon or two teaspoons) three times a day. The drug is taken after meals.

Thermopsis is taken one tablet three times a day for three to five days.

For children, the dosage is as follows: up to six months, a single dose is 10 mg of the active substance no more than twice a day; the same single dose is prescribed from six months to two years, increasing the frequency of administration to three times; from three to four years, a single dose is 15 mg; from five to seven - 20-25 mg; from eight to 14 years - 30 mg.

Oral forms of Bromhexine are prescribed without regard to food intake: for patients aged 2-5 years, the daily dose is 12 mg, divided into three doses; 6-9 years – 18-24 mg. Patients aged 10 years and older take one tablet (8 mg) every six to eight hours. The largest single dose allowed for adult patients is two tablets.

Inhalation: the solution is diluted with distilled water in equal proportions and heated to body temperature. Patients with bronchial asthma are prescribed a bronchodilator before inhalation.

The frequency of procedures is two per day. Dosage of one inhalation: up to two years of age - five drops of inhalation solution; 2-5 years - 10 drops; 6-9 years - 1 ml; 10-13 years - 2 ml; 14 years and older - 4 ml.

Parenteral administration is carried out under the supervision of a specialist.

Ambroxol tablets are prescribed to adult patients at one unit (30 mg) every eight to twelve hours, after meals, with water.

Ambroxol syrup (5 ml of syrup contains 15 mg of the active ingredient) is dosed as follows: up to two years of age, take 2.5 ml every 12 hours; from two to five years - the same dose is taken every eight hours; over five years of age - 5 ml every eight to twelve hours. Treatment can be started with a double dose (for two to three days).

In the first 2-3 days of treatment for adult patients (over five years old), the dose can be doubled. Children under five years of age can begin treatment by combining oral administration with inhalations (one or two per day, 2 ml each).

Ascoril is prescribed to children under six years of age three times a day, 5 ml each; from six to 12 years of age – three times a day, 5-10 ml each; over 12 years of age – three times a day, 10 ml each.

Erespal for patients over 14 years of age is prescribed at 80 mg (one tablet) every 12 hours or 45-90 ml of syrup, which is three to six tablespoons. The maximum permissible dose is 320 mg per day, divided into two or three doses.

Pediatric dosing:

Infants (body weight does not exceed 10 kg) are prescribed two doses of one or two teaspoons of syrup or 4 mg per kilogram of body weight (single dose);

After reaching 1 year (weight over 10 kg), a two-time intake of one or two tablespoons is prescribed.

Sinekod syrup is dosed:

• patients aged three to six years are prescribed a single dose of 5 ml every eight hours with meals;
• 6-11 years – 10 ml;
• 12-17 years – 15 ml.

Patients over 18 years of age are prescribed 15 ml of syrup four times a day. The drug is dosed using a measuring cup, which must be washed and dried after each portion of syrup taken.

Oral drops are prescribed to children from two months of age. The frequency of administration is four times a day. The dose for patients in the first year of life is 10 drops, 1-2 years - 15 drops, three full years and older - 25 drops.

Herbal chest infusions: pour 200 ml of boiling water over two tablespoons of the mixture, simmer in a water bath for a quarter of an hour, remove the container with the infusion from the water and leave at room temperature for 45 minutes. Strain, add boiled water to the original level. Take warm, half a glass three times a day after meals. The duration of treatment is on average two to three weeks.

A common question is: how many days can expectorants be taken? The duration of the course is determined by the doctor, taking into account the patient's condition. On average, the course of expectorants is from one to two weeks, the doctor can extend the intake. However, if expectorants do not help within three to five days, you should consult a doctor, the same applies to antitussives. During this time, the cough will not completely go away, but an improvement in the condition should be observed.

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Cough expectorant for adults

All drugs of this group are addressed to this category of patients. Restrictions may be in the presence of known intolerance to one or more components of specific drugs or herbal preparations, contraindications for concomitant diseases the patient has. Expectorants, especially medicinal ones, are recommended to be taken only as prescribed by a doctor, who will take into account the pathogenesis of the disease, the patient's condition and the nature of the cough.

Particular caution should be exercised when administering expectorant therapy to pregnant and lactating women. It is not recommended to take any medications during this period. The use of expectorants during pregnancy in the 1st trimester is contraindicated in the instructions for most drugs - ACC, Carbocisteine, Lazolvan (Ambroxol), Bromhexine, Sinekod, in the 2nd and 3rd trimesters - only for vital indications, although the embryotoxic effect of these drugs has not been identified.

The effect of Erespal on the human fetus has not been sufficiently studied, however, in experimental animals, babies were born with a "cleft palate". It is not recommended for women expecting a child.

The above medications are found in breast milk and are therefore not recommended for nursing mothers. If a woman needs to take any of them, breastfeeding will have to be stopped.

The following herbal preparations are not contraindicated for use during pregnancy: Gerbion with plantain, Mucaltin tablets and syrup; Pertussin is allowed in the second and third trimesters; Thermopsis is allowed only in the third. However, only if the expectant mother is not allergic to the components of the preparation, has no complications or threat of miscarriage, or severe early toxicosis (herbal expectorants increase the gag reflex). It is not recommended to use Gerbion syrups with ivy and primrose, Doctor Mom, Bronchicum during pregnancy. Pertussin is prohibited in the first trimester, and Thermopsis in the first and second trimesters.

During pregnancy, medicinal herbs are not contraindicated: plantain, marshmallow, thyme - in a short course and with caution. Licorice, coltsfoot are not recommended for pregnant women.

It would seem easier to choose an expectorant for a cough during lactation. There is no longer a threat of miscarriage and toxicosis, however, the effect of herbal preparations on infants has not been studied, so manufacturers often do not recommend using them. Therefore, first of all, you need to consult a doctor. Plantain definitely has no contraindications. Coltsfoot and wild rosemary, as well as preparations containing ethyl alcohol, are not recommended.

Herbalists recommend that pregnant and lactating women consume ginger, which has a pronounced antiseptic, anti-inflammatory effect and stimulates the immune system.

The safest expectorants during this period are soda, salt and honey (if there is no sensitization). And also – water! Humidifying the air and drinking plenty of fluids also helps to thin mucus and works no worse than medications.

However, any medication a pregnant woman takes should be discussed with her doctor, even the most natural and harmless one.

Expectorants for children

A child's cough can be caused by various reasons, most often it is a viral infection or as it is also called a cold. The inflammation is concentrated in the upper respiratory tract and is accompanied by a cough and runny nose.

In this case, the most optimal treatment for a child of any age is humidification of the air, rinsing (cleaning the nasal passages), chest massage and plenty of fluids. Babies are simply put to the breast more often. Usually, such measures are well justified and no other efforts are required.

If the cough does not go away but gets worse, consult a pediatrician who will examine the child, possibly prescribe the necessary diagnostic procedures and, after establishing a diagnosis, prescribe treatment. Expectorants are prescribed to children in case of unproductive wet cough with inflammation of the lower respiratory tract. You need to start with the safest means that have an expectorant effect. These are milk, soda, raspberry jam and honey, thermal procedures using paraffin or potato cakes are possible. However, even treatment with folk and seemingly safe means should not be started without consulting a pediatrician you trust.

Recently, the French, and then the Italians, have banned the prescription of expectorants and phlegm-thinning medications to children under two years of age at the legislative level. The ban applies to such active substances as cysteine derivatives, bromhexine hydrochloride, ambroxol hydrochloride, terpenoids and some others, which are often included in combination over-the-counter cough syrups. This ban is due to the emergence of many severe complications when using these drugs in young children. By the way, despite the widespread information about this, our pediatricians often recommend treating a child with ARVI with one of these drugs.

However, there are cases when prescribing expectorants to small children is justified. Herbal preparations without alcohol, flavorings and flavor additives in the form of a solution or syrup are preferable for children. The effectiveness of taking such drugs increases with plenty of fluids.

It is especially difficult to choose an expectorant for a child under one year old. Almost all herbal syrups with expectorant properties sold in pharmacies have an age limit of up to two years. You can treat a baby on your own without harm to him only with water - humidifying the air, rinsing (cleaning) the nose, drinking plenty of fluids (if you are already giving water to the child) will not harm him. A child who has not yet tried anything other than breast milk should be put to the breast more often. Massage with light patting movements on the back and feet of the child also helps to get rid of phlegm faster.

Older babies who have already tried complementary feeding or are on mixed (artificial) feeding can be offered warm milk with soda or honey (if the child is not allergic to it), raspberry jam diluted with warm water.

It is very important to ventilate the room where the child is well and do wet cleaning there more often.

Expectorants should not be given to infants without a doctor's consultation, even those of plant origin. Of the medicinal plants, at this age, traditional healers recommend brewing not herbal infusions, but one of the herbs: raspberry and fireweed leaves, thyme, chamomile flowers (from six months of age), plantain. Although herbs also have contraindications, their effect on the child's body has not been studied, so there are discrepancies in the recommendations.

Thermoposol tablets can be prescribed even to infants.

Bronchicum S syrup (with thyme and ethyl alcohol) is approved for use according to the instructions from the age of six months, Alteyka syrup has no age limit.

The drug Erespal, according to the instructions, can also be prescribed in infancy.

According to the manufacturer's instructions, Sinekod cough drops for oral use can be given to children from two months of age.

There is a children's syrup with prohibited Acetylcysteine, which, according to the instructions, can be taken from the age of ten days. The instructions for Ambroxol, Bromhexine also describe dosages for infants. Parents should discuss the appropriateness of using such drugs with their doctor, and there should be very good reasons for considering their use.

Expectorants for children over 2 years of age should also be prescribed by a doctor. At this age, the range of drugs is significantly expanded. It is allowed to use almost all medicinal herbs, except for poisonous ones (ledum). Syrups on a plant basis Gerbion, Doctor MOM, from licorice root, Mucaltin are no longer contraindicated. Serious mucolytics - ACC, Lazolvan (Ambroxol), Bromhexine are also already on the list of permitted drugs.

Children over three years of age have practically no restrictions on the use of expectorants and mucolytics. It is possible that in some cases this is necessary. Expectorants for children over 3 years of age should not be simply bought at the pharmacy, just because they are freely available. At this age, you can prepare herbal teas for your child, treat him with folk methods. And the use of pharmaceutical products must be agreed with a doctor.

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Contraindications

The main contraindication to the use of any expectorant is a known sensitization to its ingredients.

The period of pregnancy, especially the first three months, and lactation is undesirable for taking expectorants, only some drugs are allowed to be used with the proviso that there is no hypertonicity, threat of miscarriage, pathological nausea.

Children under two years of age should not be given medications that facilitate expectoration or thin mucus without good reason.

Bromhexine and Ambroxol have virtually no contraindications for diseases. General contraindications for other expectorants are peptic ulcer, pulmonary hemorrhage or hemoptysis, severe decompensated diseases of the cardiovascular system, liver and kidneys. Ascoril, in addition, is contraindicated in hyperthyroidism and glaucoma.

Medicines in the form of syrups are not intended for patients with congenital

Fructose intolerance, sucrose-isomaltose deficiency, glucose-galactose absorption disorders. Prescribed with caution in diabetes mellitus.

Medicinal herbs and herbal infusions also have contraindications, which should be familiarized with before using them. Thus, licorice is contraindicated for pregnant women and infants, hypertensive patients, heart patients and patients prone to bleeding. Plantain should not be used by patients with peptic ulcer disease, hyperacid gastritis, a tendency to thrombosis. Thyme is undesirable for people with vascular pathologies, hypothyroidism, liver and kidney dysfunction. Coltsfoot is contraindicated for pregnant and lactating women, children under two years of age, people with liver disease. Ginger also has contraindications: peptic ulcer disease, gastritis, cholelithiasis, hypertension, a tendency to bleeding. Marshmallow has virtually no contraindications.

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Side effects expectorants

Any synthetic, herbal or combination drug can cause a respiratory allergic reaction, skin rashes, angioedema.

The most common side effects caused by almost all expectorants are nausea, gagging, and vomiting.

Acetylcysteine, in addition, can provoke diarrhea, heartburn, stomatitis, in addition, it reduces blood pressure, tinnitus and headaches may appear, as well as tachycardia. Acetylcysteine can cause bronchial spasm.

Carbocisteine - stomach pain, gastrointestinal hemorrhages.

Ascoril can have a stimulating effect on the nervous system, causing tremors, muscle spasms, headaches, digestive disorders, relapses of peptic ulcers, abnormal liver function tests, hypotension (up to collapse), tachycardia, changes in urine color, and paradoxical bronchospasm.

The antitussive drug Sinekod occasionally causes nausea, diarrhea, hives and drowsiness.

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Overdose

Exceeding the recommended dose of drugs usually manifests itself in symptoms of side effects. In expectorants of any origin, overdose most often manifests itself in vomiting and vomiting attacks.

Besides:

Acetylcysteine is characterized by: digestive disorders; in infants, overdose is manifested by hypersecretion of sputum.

An overdose of Carbocisteine is manifested by pain in the epigastrium, nausea, and diarrhea.

If the dose of Pertussin is exceeded, symptoms of bromism may be observed - rash, runny nose, lacrimation, malaise, asthenic syndrome, gastroenterocolitis, uncoordinated movements and speech, slow pulse.

An overdose of Ascoril causes nervous excitement, tremors, muscle spasms, headaches, digestive disorders, relapses of peptic ulcers, abnormal liver function tests, hypotension (up to collapse), tachycardia, changes in urine color, and paradoxical bronchospasm.

Exceeding the recommended dose of Erespal and Sinekod is manifested by hypotensive symptoms: dizziness, nausea, drowsiness, and diarrhea. Erespal, in addition to these symptoms, can cause an excited state.

There is no specific antidote for expectorants. Therapy is symptomatic, aimed at removing intoxication and maintaining vital functions of the body.

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Interactions with other drugs

The combined use of expectorants and mucolytics with drugs that suppress the cough reflex and reduce sputum secretion should be avoided.

Besides this:

Acetylcysteine is not compatible with tetracycline antibiotics, except doxycycline. No incompatibility has been found with other antibacterial drugs, however, it is recommended to observe an interval of at least two hours between taking antibiotics and acetylcysteine. Enhances the vasodilatory effect of nitroglycerin.

Thermopsole reduces the absorption of absorbents, alkaloids of drugs with astringent properties. Preparations that have an enveloping effect reduce the absorption of active substances of Thermopsole.

Bromhexine can be prescribed in combination with antibiotics, bronchodilators, cardiac drugs and other medications.

Drug interactions between Erespal and Sinekod have not been described.

The storage conditions and expiration date of expectorants are indicated on the packaging. Solutions of powders, effervescent tablets, inhalations are prepared immediately before use. Decoctions and infusions of medicinal herbs must be used within 24 hours.

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Reviews

Pharmacies offer a lot of expectorants of natural and chemical origin. Both are available at different price levels. Imported herbal syrups are more expensive, however, the domestic pharmaceutical industry produces many herbal preparations containing the same components: marshmallow, thyme, licorice, plantain, the price of which is much lower. In terms of quality, they are not inferior to imported analogues. Judging by the reviews of forum members, inexpensive and effective natural expectorants Althea, Pertussin, breast collections, Bronchophyte have helped many. Both adults and children are successfully treated with them.

Medicines containing synthetic components should never be used without a doctor's prescription. Even if they are sold without a prescription. Doctors' reviews of them are very ambiguous, and for successful coughing it is necessary to follow a regime of abundant drinking and clean, cool, moist air. Without these conditions, the most modern expectorant medicine is not effective.