Effective expectorants for sputum production

The main protective barrier preventing the infection of the respiratory tract is the epithelium of their mucous membrane, covered with a constantly renewing mucous secret, preventing the epithelium from drying out and acting as a filter. A healthy person produces about 0.1L of this mucus per day, it covers the epithelium from the nasal passages to the terminal bronchioles and delays the exogenous ingredients (corpuscular particles and microbes) that enter the inhaled air. Together with the mucus is carried out and the natural evacuation of alien elements. Five to ten percent of the rhinobronchial mucosa secretion consists of acidic and neutral glycoproteins (mucins), which provide its viscosity. In diseases of the respiratory system, the composition of the mucous secretion varies: the content of acidic water-soluble mucins decreases, and the neutral water-repellent ones increases. The mucus becomes gel-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) in it. The natural filter partially loses its properties and begins to pass pathogens to the submucosal layer of the respiratory tract, which favors the creation of colonies of pathogens. Therefore, inflammatory diseases of the respiratory tract, especially in cases of stagnant phenomena and difficult coughing, use expectorants - drugs that restore the activity of the ciliated epithelium, dilute the rhinobrochial secretion (sputum) and improve its progress and excretion with the help of a cough - a natural protective factor.

According to the drug pathogenesis, these drugs are divided into secreto-motor drugs - the active coughing and evacuation process of liquid secretion (mucociliary clearance), and secretholytic - increasing the proportion of hydrophilic constituents in a secret, that is, making it more liquid, thereby facilitating the elimination process.

[1], [2], [3], [4], [5]

Indications of the expectorants

Dry cough occurs most often as a reflex reaction to irritation of the rhinobronchial epithelium in response to smoke, sharp smells, ingress of dust and other similar substances, and also at the onset of inflammatory or allergic respiratory tract infections as an attempt of the body to get rid of the irritant. Expectorants with a dry cough usually are not appointed, because at this stage they can aggravate the inflammatory process. In this case, the funds that qualitatively change the cough - from dry to wet, as well as medications that have a double effect - a depressing cough and relieves coughing are shown.

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

Herbal preparation Herbion with psyllium is intended for relief of attacks of dry cough. In addition to the antitussive, it has an expectorant, moderate bactericidal and inflammatory action that reduces inflammation.

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

An unproductive cough, often accompanying the initial stages of the respiratory system, with the help of inhalers, sprays, oral preparations, moistening the air and warming procedures, is transferred to the category of wet, then stop taking medications that stop coughing attacks and prescribe expectorants.

In cases of easily separated liquid sputum for the purpose of its prompt removal from the body, secretory motor expectorants are indicated with a wet cough. If the cough is productive, however, the slimy secret has a thick viscous and sticky consistency, diluting drugs are used.

With all the diversity of forms of bronchitis, the scheme of its treatment necessarily includes funds that stimulate and facilitate the work of the mucociliary transport system. They are necessary, because inflammation leads to hypersecretion of sputum, its properties change - it becomes more viscous. Pathogenic microorganisms, pus accumulate in the branches of the bronchial tree, stagnant phenomena and intoxication begin. For evacuation of bronchial secretions, improvement of bronchial patency and removal of intoxication, expectorants are prescribed for bronchitis. They are used in the stage of productive cough, when the patient begins to cough up the mucous secret. Doctor Mom and Bronhikum ease his departure of syrup. Lazolvanom (Ambroxol) inhalations dilute the viscous secret and simultaneously tone the smooth muscles of the bronchi, speeding up its evacuation. Orally, carbocysteine can be administered.

To restore normal ventilation of the lungs, expectorants are indicated for pneumonia. Medications that inhibit coughing are not used in acute pneumonia, and the doctor approves the appointment with the intensity of seizures, the characteristics of rhinobronchial mucus and coughing, the presence of chronic respiratory system pathologies in the patient (special attention is paid to the presence of obstruction). With hard to secrete dense secretions and prolonged coughing attacks (a quarter of an hour or more), inhalations of Ambroxol are indicated. The same drug, but in the oral form, is prescribed with mildly secretive mucous secretion and short coughing attacks.

If the presence of pus in the separated mucus (purulent pneumonia, bronchitis and others) is detected with respiratory illness, it is recommended to use medicines with the active ingredient Acetylcysteine (eponymous drug, ACS, Fluimutsil).

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

Expectorants for smoking are prescribed to eliminate thick sputum, inflammation of the respiratory tract and their edema, as this harmful habit leads to a disruption of the natural functions of purification. Smokers often have a history of a bunch of chronic respiratory diseases and, depending on the present disease, certain drugs are used, in particular, sputum secretion increasing, making its structure more sparse and enhancing the functions of the ciliated epithelium.

Expectorants for tracheitis are rarely used. First, this disease is characterized by dry sore cough in the night and morning hours, during the day - attacks at the time of a sharp change in the rhythm of breathing (screaming, crying, laughing, etc.). Secondly, with tracheitis, even mucus thick and viscous consistency, as a rule, is eliminated without difficulty. Therefore, complex medicines with the ability to suppress cough attacks with moderately expectorant effect are more often used. For example, a cough syrup based on medicinal plants Dr. Mom, stopping his attacks and promoting the transfer of dry cough to wet. With inflammatory diseases of the larynx, vocal cords, mucous pharynx, which are most often accompanied by tracheitis, the use of drugs with analgesic and anti-inflammatory effect is indicated. In addition to the already mentioned drug Dr. Mom, who possesses all of the above properties, Herbion with plantain, Sinekod or Stoptussin can be prescribed.

Tracheitis rarely occurs as an independent disease, it is much more often complicated by pharyngitis (inflammation of the mucous membrane of the pharynx), which is characterized by a difficult cough secretion, especially if the disease has become chronic. With this pathology, expectorants are prescribed for pharyngitis often combined, possessing bactericidal and anti-inflammatory properties. Used in this case, Mukaltin, Acetylcysteine, Lazolvan and other medications, consistent with their properties and the patient's condition. As well as expectorants for laryngitis (inflammation of the mucous membrane of the larynx and vocal cords), which are usually accompanied by so-called colds. Patients with excessive secretion of sputum are prescribed drugs that activate the coughing process, and with thick and poorly separated secretion.

By prescribing expectorants for colds, the doctor is usually guided not by which parts of the respiratory system are affected by inflammation, but by the character of coughing, mucous discharge and the degree of mucociliary clearance disorder. A fairly broad spectrum of action - anti-inflammatory and preventing constriction of the bronchi, eliminating the respiratory symptoms of a different etiology is the drug Erespal.

The principles of drug treatment, which facilitates cough, are not significantly different in acute respiratory diseases and in serious chronic diseases. Expectorants for lung cancer perform the same tasks - facilitate and activate the evacuation of the mucous secretion with a wet cough (Mukaltin, Prospan, Lazolvan). If the patient has a painful dry cough, direct-acting medications that stop his attacks are prescribed, the use of complex agents that further facilitate coughing (Broncholitin, Stoptussin) is not ruled out.

Cough with secreted secret is one of the main symptoms of chronic obstructive pulmonary disease (COPD). For bronhoobstruktsii specific are hypertrophic changes in glands that produce a mucous secret. Therefore, in the treatment of this disease, medicines that have the ability to stimulate the production of sputum, influence its structure and activate the evacuation function are actively used. Expectorants for COPD are designed to improve drainage function and eliminate stagnation in the bronchial tree. Quite often, patients with obstruction are prescribed Bromgexin, which normalizes the biochemical composition of the sputum, facilitates cough and has a slight antitussive effect. Currently, Ambroxol (Lazolvanum) is the most commonly used active metabolite of Bromhexine, which is superior in its positive properties and prevents lung atelectasis. And also - Ascoril, containing three active components and providing expectorant, bronchodilator and secretolitic action.

[6]

Release form

Pharmaceutical products for the relief and elimination of cough are available in a variety of forms: for topical, oral and parenteral use. The same drug, for example, Lazolvan (Ambroxol) can be found in the pharmacy network in all possible forms. Oral forms are available in the form of tablets (capsules), syrup and sachets of powder or granules for solution. Expectorants in syrup are usually addressed to 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 made from powder (granules) or syrup is absorbed faster from the gastrointestinal tract and is less aggressive to the mucosa 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, for example, Acetylcysteine, Bromhexine, can be purchased at the pharmacy in the form of ready-made solutions for inhalations. Medicinal solutions are not used in steam inhalers because they are undesirable to heat, 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 inside (infants, patients in the unconscious state) injectable solutions in ampoules are used.

[7], [8]

Diluting sputum and expectorants, mucolytics and expectorants

Many names of drugs that facilitate coughing are familiar from childhood, we learn about news from television advertising, which presents each advertised remedy as a panacea for coughing, visually demonstrating how the bronchial tree is cleared of sputum strewn with microbes. Let us consider in what cases the most well-known drugs are used and what properties they possess.

The list of expectorants is headed by  ATSTS (Acetylcysteine). A typical mucolytic that changes the structure of sputum from dense to watery and sparse, which greatly speeds up its excretion and promotes natural sanitation of the respiratory tract. It is prescribed for patients with a wet cough with difficulty in expectoration accompanying acute and chronic diseases of the respiratory system (bronchitis, asthma, pneumonia, bronchiectatic disease of the lungs, 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 the likelihood of bronchial 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 the nebulizer), however, any forms (choice of doctor) can be prescribed. Abundant drink potentiates the action of acetylcysteine.

Fluimucil  is a synonym of the previous preparation, it is used in the same way as Acetin, Bronholysin, Mukobene, Mukanist inhalation solution.

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

Mukaltin  is an expectorant of plant origin (root extract of althea), which enhances sputum secretion and mucociliary clearance, and also reduces the inflammatory process somewhat. In inflammatory processes in the upper respiratory tract, its use is impractical, and the drug has virtually no antitussive effect. It facilitates cough and, thanks to the stimulation of bronchial glands, helps dry cough to become wet. The drug is produced in a solid tablet form for resorption under the tongue. With the same active substance you can buy liquid oral form: Althea syrup and its children's version - syrup Alteika.

Known long ago, preparations based on herb thyme (thyme) - syrups of  Percussion, Bronchicum. This plant has quite pronounced bactericidal properties, has an antispasmodic and expectorant effect. In the syrup of Pertussin, the second active ingredient is potassium bromide, a soothing and softening cough.

Herbion syrup  with ivy extract is an expectorant, indicated with a productive cough with difficulty in coughing.

The eponymous syrup, containing extracts of primrose and thyme, stimulates sputum secretion and enlarges the bronchial lumen, reducing the risk of spasms. Levomenthol, contained in the drug, has analgesic and antiseptic effects. Helps to get rid of a damp cough faster.

Drugs  Mom  (syrup, troches, individual inhalation pencil) are used to facilitate coughing, stimulating the production of sputum, diluting its consistency and strengthening the evacuation by activating the ciliated epithelium and enlarging the lumen of bronchioles, acting simultaneously as mucolytics and expectorants.

The most potent agent of plant origin, which helps to cough up mucus - Thermopsol tablets  . Grass thermopsys lanceolate contains a whole complex of alkaloids that excite the respiratory center. The drug increases the activation of the bronchial glands and its evacuation by toning smooth muscle tissue bronchioles.

Bromhexine  belongs to drugs that dilute the bronchial secret and facilitate the process of its coughing, besides it has the ability to calm calms of coughing somewhat. It is one of the components of the drug  Ascoril, which contains another active component, which has a similar effect - guaifenesin, and also the vasodilator ingredient salbutamol. This drug-a strong expectorant is prescribed only by a doctor under strict indications.

Thinning phlegm and expectorants currently presently represents  Lazolvan  (synonymous with  Ambroxol ). Its active ingredient is the active metabolite Bromhexine. Has a similar effect, however, does not inhibit the cough reflex and qualitatively superior to its predecessor. It is used for wet coughing with the formation of thick and sticky poorly detachable mucus.

Multicomponent drug  Kodelak Broncho  has a pronounced ability to thin the bronchial secret and stimulate peristalsis of the bronchial muscles due to the included ambroxol and the extract of thermopsis. Other components of glycyrrhizinate and sodium hydrogen carbonate supplement this effect and also reduce inflammation and allergic manifestations.

The preparation of direct resorptive action  Potassium iodide  exerts a mucolytic effect when the bronchi are taken into the inside of iodine, it is hardly prescribed nowadays, considering it to be ineffective.

Antitussive and expectorants are prescribed in cases where it is necessary to stimulate the secretion and ease the patient's condition, suffocating from severe attacks, as a rule, a night cough that interferes fully with rest. Partially to such preparations it is possible to carry Bromgeksin which stimulates expectoration in a greater degree, but thus possesses also weak antitussive ability unlike Mukaltina, Termopsola, derivatives of cysteine and Lazolvana. The expediency of prescribing combined drugs that have at the same time two opposite effects (antitussive and expectorant), by many experts in general, is questioned, since it is not clear what effect this combination will have on a particular patient. Especially ambiguous attitude towards themselves is caused by medicines with codeine in combination with plant substances, which stimulate the contraction of the muscles of the bronchi - ipecacuano, thermopsis, licorice root.

Expectorant anti-inflammatory drugs cause more confidence in specialists, as reducing inflammation plays a significant role in reducing respiratory symptoms and leads to a gradual decrease in mucus secretion and, consequently, the disappearance of coughing attacks.

Erespal is  not a direct expectorant. Its active substance (fenispirida hydrochloride) has antihistaminic and bronchodilating properties (indirectly expectorant), and also reduces the number of proinflammatory mediators produced, thereby reducing respiratory symptoms, and coughing as well. The antitussive effect of the drug complements its ability to reduce the production of viscous sputum. All forms of this remedy are used for various acute and chronic pathologies of ENT organs with severe respiratory symptoms - inflammation of the nose, ear, pharynx, larynx, trachea, bronchi, and can be prescribed to alleviate rhinobronchial symptoms in measles, ARVI, influenza, whooping cough.

Syrup Herbion  with plantain extract is shown with an unproductive cough. It has anti-inflammatory, softening, preventing the growth and development of microorganisms, and the presence of ascorbic acid in it helps to strengthen the immune barrier, to prevent the development of complications and to translate dry cough into wet.

It is used mainly in pathological processes in the upper respiratory tract, accompanied by a dry non-productive cough. Helps cough smokers.

The sinecode  has a central effect, depressing the cough, without affecting the respiratory center. It is used in cases of excruciating dry cough, exhausting the patient, preventing him from fully resting and eating. Possesses, in addition, the ability to expand the bronchi, indirectly facilitating cough, and reduces the activity of inflammatory mediators.

Etiotropic treatment of inflammatory diseases accompanied by coughing (tracheitis, laryngitis, bronchitis, pneumonia) is usually performed with antibiotics, since most of them are caused by bacteria or aggravated by an attached bacterial infection. These drugs also, in their own way, facilitate coughing. Medically expectorants - antibiotics have anti-edematous and anti-inflammatory effects, 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 directly expectorants (Bromhexin, Lazolvan and others) contribute to a more active penetration into the sputum of antibacterial components. Given their synergistic interaction, American pharmacists released a complex drug - a combination of ambroxol and doxycycline (Ambrodox), but this tool is not registered in the post-Soviet territory.

Antihistamines prescribed for coughing of allergic origin also have an indirect expectorant effect, since they can expand the bronchi and reduce the production of sputum.

Modern expectorants have a fairly pronounced effect, preparations of plant origin, in addition to plant extracts, contain at least preservatives and stabilizers. Often, extracts of medicinal plants are combined with medicines. Therefore, before you can stimulate cough by strong drugs, you can first try to get rid of it more harmless home remedies.

[9], [10], [11]

Alternative expectorants for cough

Since cough is a symptom of the most widespread diseases, many recommendations are also given in the recommendations of alternative healers to get rid of it. Such substances as honey and soda are the most famous fighters with a cough. Probably, we will not find a single person among us who would not have been given a warm milk with honey or soda as a child from a cough. Indeed, this simple remedy had a completely expressed expectorant effect.

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

From the perspiration in the throat and the unproductive dry cough can help such a drink: in warm milk, add a teaspoon of honey, stir well until complete dissolution. To soften the mucosa, you can add a little butter to it. This remedy can be consumed several times a day.

You can prepare an expectorant broth at the rate of a liter of milk - a head of garlic or a dozen small bulbs. Boil the garlic (onion), give milk decoction to cool, strain and stir in it ten teaspoons of honey. Take a tablespoon often, six to eight times a day.

Effective drinking of lime, raspberry, chamomile tea with the addition of a teaspoon of honey in half a cup for 30 minutes before eating is quite effective.

You can mix 100 g of honey with juice, squeezed out from a whole lemon. Eat a tablespoon of the mixture every day before going to bed snack with hot tea. An effective mixture in equal proportions (for example, half a cup) of honey with freshly squeezed juice from white cabbage. It is taken on a tablespoon before meals three to four times a day.

Soda - this substance as a medicinal product by popularity can quite compete with honey. Warm milk with soda literally a day will translate an unproductive, exhausting cough into the wet, as soda contributes to the production of mucous secretions, and also, to increase its fluidity. Many recipes for preparing expectorants at home are based on milk with soda. So, the basic component is prepared in the proportions: a glass of milk - half a teaspoon of soda. In this mixture to improve its expectorant properties, you can add:

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

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

Inhalational expectoration is very effective, some experts believe that this is the most acceptable form of application of medicinal and alternative agents. With soda they can be done in different ways - steam (grandfather method) and with the help of more modern devices, in particular, a nebulizer. The temperature of the inhaled vapor should be from about 40 ℃. To a solution of soda (one teaspoon per liter of water), add a couple of drops of an alcohol solution of iodine or garlic as follows: six garlic slices are poured with a liter measure of hot water, brought to a boil and boiled for five minutes over medium heat. Cool to the desired temperature and add soda.

Cough, especially with colds, flu, ARVI, is accompanied by a tickle and sore throat. The usual rinsing of the throat with a solution of soda (half a cup of water take a teaspoon without top), performed three to four times a day, soften the cough, transfer it to the discharge wet and facilitate expectoration.

Home physiotherapy with potato cakes placed on the chest below the thyroid and above the heart zone will be a good addition to rinsings or inhalations. The procedure is done before bedtime. Cake recipe: cook two medium sized root vegetables in a uniform, make mashed potatoes with a sequential addition of vegetable oil, dried mustard, honey and a tablespoon of soda. To make a cake, wrap it with plastic wrap, and warm, laying a piece of natural cloth or gauze under it, put it on the chest, covering the patient with a blanket.

At home, you can use expectorants on herbs. In this capacity, medicinal plants are recognized as particularly effective:

1. Thyme or thyme: the easiest way is to drink tea with this herb (boil several sprigs and wait until the drink becomes saturated and fragrant), you can sweeten with honey. Essential oil of thyme 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), to be more precise, uses a plant root containing glycyrrhizin and its acid, which facilitates the evacuation of phlegm, flavonoids also contained in the root, an antispasmodic effect. As the expectorant is used infusion, prepared as follows: the dried root of the small fraction plant in the volume of a tablespoon is covered in enamel or glassware, brewed with boiling water (200ml) and tanned in a water bath for slightly more than a quarter of an hour; allow to cool for 45 minutes, decant and top up to the original capacity with boiled water. The daily dose - three or four tablespoons, one at a reception before meals. A new infusion is prepared every other day.
3. Plantain - as an expectorant used fresh squeezed juice from the plant, you can with honey, or syrup on honey from fresh leaves. To prepare the syrup, they are crushed and mixed with an equal volume of honey, in a sealed container placed in a warm place for 3-4 hours. Then they eat a teaspoon of syrup before each meal (the effect is noticeable in a day). Expectorant properties are possessed by decoction from the seeds of plantain (you can use both dry and fresh seeds) - take 200 ml of water for a tablespoon of seeds and boil them on a small fire for two minutes, insist, strain and take during the day two tablespoons before each food intake. There are 20 minutes later.
4. Althaeus - the infusion of the root of this plant is prepared very simply: the dried rootlets of a fine fraction in a volume equal to a tablespoon are poured with cold boiled water for an hour, filtered and taken every two hours on a tablespoon. It has enveloping properties, protects the mucosa from irritation, is a mild expectorant with a pronounced anti-inflammatory effect.
5. Mother-and-stepmother - four teaspoons of a crushed plant brew 200ml of boiling water, after half an hour filter and this portion is consumed on the same day, divided into three or four receptions. Saponins present in the plant restore the functions of the ciliated epithelium, mucus envelops and relieves irritation and inflammation, organic acids dilute sputum.
6. Ginger - just enough to drink a couple of times a day tea with ginger. You can add lemon and honey to it. And you can sliced finely ginger add to the herbal infusion or broth, to the breast collection - you will get a fragrant and pleasant drink that has an anti-inflammatory, bactericidal and expectorant effect.

The above herbs are included in the components in pharmacy herbal preparations. They are produced in the form of a mixture of ground vegetable components and sachets for brewing with powdered phyto-mixtures.

Collection Bronchophytes, including plants with expectorant and anti-inflammatory properties (roots of althaea, licorice, elecampane and aira, aboveground parts of thyme and sage, black and lime blossom buds, chamomile flowers, peppermint and nettle leaves), is shown with a low-yield cough. Increases the production of sputum and increases the tone of the bronchial muscles, in parallel removing inflammation, killing germs and strengthening immunity.

In the pharmacy network and online stores of fees from cough there is a great variety. It is necessary to pay attention to the composition and indications for use, since the ingredients of the herbal mixture under the same number, but different manufacturers, may differ.

Breast collection number 1, classical, represented in pharmacies, three-component - althaea root, oregano and leaf of mother-and-stepmother, activates sputum evacuation with low-yield cough. It is not recommended for use with dry cough.

Composition 2 contains two components with a pronounced coughing effect (licorice root, mother-and-stepmother), and also leaves of plantain. It softens the cough, enveloping the mucous membrane, reduces the symptoms of inflammation, dilutes the bronchial secretion and activates the mucociliary clearance.

Breast gathering number 3, the classical components of which are the roots of althea and licorice, anise, pine buds and sage leaves, has the most powerful expectorant effect and facilitates the rapid clearance of the respiratory tract from sputum.

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

In case of dry cough, it is advisable to use breast collection №4, which, although it contains components stimulating expectoration (licorice root, violet, Ledum), however, anti-inflammatory, antiseptic and bronchodilating properties of the same constituents prevail in its composition, as well as calendula, chamomile , mint, which also calms cough and softens the mucous membranes of the respiratory tract. This collection promotes the transition of dry cough to productive, and then - facilitates expectoration.

The advantage of alternative agents over pharmaceutical products is obvious. Firstly, they are substances of natural origin, they can cause allergies, they have contraindications, but in comparison with the derivatives of cysteine or bromhexine, crap. Secondly, almost all of them, to some extent, except for expectorant, have anti-inflammatory, bactericidal, softening symptoms and regenerating properties, which are not superfluous when the airway is inflamed. Thirdly, everyone stimulates sputum secretion and is able to translate dry cough into wet. Strict divisions on the effect of alternative means there. If we consider that some experts, in particular, Dr. Komarovsky, consider the effectiveness of expectorants not proven, and they themselves - drugs to calm the relatives of the patient, then the conclusions suggest in favor of alternative medicine.

[12], [13], [14], [15], [16]

Pharmacodynamics

Disorders of the rate of excretion of the mucous secretion from the respiratory tract are caused by an increase (decrease) in its production, changes in its rheological properties, dysfunction of the ciliated epithelium, combined causes. Having determined what triggered the disorder of mucociliary clearance, it is easier to choose an expectorant effective in this clinical case.

By the mechanism of action, reflex expectorants are isolated - they enter the stomach stimulating the vomiting reflex, affecting its center in the medulla oblongata. The consequence is an increase in salivation and production of sputum, as well as its progress with ciliated epithelium from the small bronchioles to the bronchi and trachea. In general, such a reflex reaction is provided by medicinal plants, preparations based on them - marshmallows, thermopsis, licorice, mother-and-stepmother and others.

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

The mucolytics of a new generation that regulate the secretion of sputum by the proteolytic, that is, participating in the cleavage of proteins, enzymes, stand apart.

Bromgexin and its active metabolite Ambroxol are stimulants of the pulmonary surfactant, activate the mucociliary transport system and exert a mukotoxin effect (increase the production of glycoproteins). The combination of these actions leads to an increase in the coughing and cleansing of the respiratory system from excess mucus. Bromhexine still has a slight ability to inhibit the cough reflex.

Acetylcysteine (N-derivative) and carbocysteine (L-derivative) cysteine, a free sulfhydryl group present in the drug molecules, ruptures the bisulfide bonds of acidic glycosaminoglycans of bronchial secretion, which leads to the cleavage of mucoproteins into simpler molecules and has the effect of reducing the viscosity of phlegm, activates the process of its evacuation.

The three-component drug Ascoril has a rather strong expectorant effect, because it contains two mucolytics (Bromhexin and Guaifenesin) synergistically, and β-adrenomimetic salbutamol performs bronchodilation.

Erespal (non-mucolytics) acts by blocking the production of inflammatory mediators, histamine, which can lead to bronchial constriction and stagnant phenomena, has a relaxing effect on smooth muscles, including bronchial muscles, reduces secretion of viscous sputum by blocking α1-adrenergic receptors . With various inflammatory processes in the respiratory system, acute and chronic, has an indirect expectorant effect, contributes to a reduction in cough.

The active substance of the Sinekod preparation has a central antitussive effect, inhibiting the activity of the person responsible for the coughing of the brain region. In addition, some bronchodilator effects of the drug have been noted, as well as inhibition of proinflammatory factors.

The effect of multicomponent agents that facilitate coughing is determined by the effects of their ingredients. The effect of oral forms is considered.

[17], [18]

Pharmacokinetics

After oral administration, Bromhexin is absorbed for half an hour by 99% and completely binds to serum proteins. Its penetration into the brain, the fetus's body in pregnant women and into breast milk from nursing mothers has been established. It is cleaved in the liver to ambroxol, it is excreted long (TH / ₂ = 15 hours) due to slow reverse diffusion. Excretion of metabolic products occurs through the urinary organs. Can accumulate with prolonged and repeated admission.

Ambroxol taken internally is absorbed and distributed in tissues rapidly. In the lungs, its high density is determined. The half-life is less than that of the predecessor (Т₁ / ₂ = 10 hours).

Derivatives of cysteine are absorbed quickly and almost completely, splitting occurs in the liver at the first passage. The maximum concentration is determined in the interval from one to three hours. In tissues, acetylcysteine and its cleavage products are defined as a free substance, compounds with serum proteins, and incorporated amino acids. Half-life from the bloodstream is approximately one hour and is proportional to the rate of cleavage in the liver. With its dysfunction, this time interval can extend up to eight hours. Excreted mainly by the kidneys, the remaining insignificant part - the intestine.

Absorption, distribution and metabolism of carbocysteine occurs similarly. The greatest concentration in the plasma is determined after two hours, during the same time, half-elimination of the drug occurs. The longest time the presence of Carbocysteine is determined in serum, liver parenchyma and in the cavity behind the eardrum (middle ear). Eliminated kidneys unchanged.

The greatest concentration of Erespal is found in the blood serum six hours after ingestion, the half-life is 12 hours. Excretion is carried out through the kidneys.

The active substance of the Sinekod preparation is characterized by rapid absorption and a greater affinity for serum proteins. The greatest plasma concentration is detected after an hour and a half. It hydrolyzes in the blood, does not accumulate, half-elimination occurs within six hours. Elimination occurs through the urinary tract in the form of metabolites and an unchanged substance.

The pharmacokinetics of multicomponent and herbal preparations are not presented.

[19], [20], [21]

Dosing and administration

Expectorants are used in several ways. Most often, oral medications are prescribed, the more convenient form of which are syrups and drops. Inhalation - for which use special solutions for inhalation or solutions for injection, diluted 1: 1 with water. In severe cases, expectorant drugs are injected. Dosage and duration of administration is prescribed by the doctor, based on data on the age and condition of the patient. Abundant drink improves the effectiveness of expectorant therapy.

The 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 receive a single dose of 50 mg twice or thrice throughout the day. From two to five years, a single dose is 100-150 mg, taken twice. From six to 13 full years, twice a day take from 150 to 200 mg. The medicine (effervescent tablet or sachet with powder) is poured into a half cup of water, juice or tea at room temperature and taken twice a day after meals.

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

Syrup for children's use is dosed:

Up to the age of five take from half to a teaspoonful (dosage 125 mg / 5ml) in four divided doses;

From five to 12-year-old age appoint three doses of one teaspoon with a dosage of 250 mg / 5 ml or two - with a dosage of 125 mg / 5 ml.

Preparations of althea are taken before meals:

Tablets  Mukaltin  twice or thrice a day at a dose of 50-100 mg per session.

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

Dosage to infants half a teaspoon once or twice a day; One-year-old children can be given the same dose three times; 2-6 full years - a whole teaspoon of syrup is given from four to six times; 7-13 full years - as many times as two teaspoonfuls or one dessert spoon; 14 years and older as many times a tablespoon.

Syrup Herbion, as a rule, has a measuring spoon for dosing: at the age of 2-6 full years, a single dose is one measuring spoon three times a day; 7-13 full years - from one to two measuring spoons as many times; 14 years and older - two servings from three to four times a day. Take the drug in the process of eating or after it. It is recommended to drink plenty of water, wash and dry the measuring spoon every time after taking the drug.

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

Multiplicity of administration three times.

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

Bronchicum C  is administered to infants from half a year until reaching the age of one year twice a day for 2.5 ml (half teaspoon); One-year-old children are given the same portion three times a day; from two to five years, 5 ml (whole teaspoon) twice a day; 6-11 years - 5 ml (whole teaspoon) three times a day; 12 years old and older - 10 ml (a dessert spoon or two teaspoonfuls) three times a day. The drug is taken after a meal.

Thermopsol  take one tablet three times a day for three to five days.

Children are dosed: up to six months, a single dose is 10 mg of active ingredient no more than twice a day; the same single dose is prescribed from six months to two years, increasing the frequency of intake up 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  Bromhexin  are prescribed, not focusing on food intake: for patients 2-5 years, the daily dose is 12 mg divided into three doses; 6-9 years - 18-24mg. Patients 10 years and older take one tablet (8 mg) every six to eight hours. The largest single dose, admissible 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 bronchodilator before inhalation.

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

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

Ambroxol  in tablets is given to adult patients by one unit (30 mg) every eight to twelve hours, after ingestion, with water.

Syrup Ambroxol (in 5 ml of syrup contains 15 mg of active ingredient) is dosed: up to a two-year age, 2.5 ml are taken 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. You can start treatment with a double dose (for two to three days).

In the first 2-3 days of treatment, adults (older than five years) patients can double their dose. Children under the age of five can begin treatment, combining oral intake with inhalations (one or two per day for 2ml).

Ascoril  until the age of six appoint three appointments per day for 5ml, from six to 12 years - three doses of 5-10ml; over 12 years - three times 10ml.

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

Pediatric dosing:

Infants (body weight does not exceed 10 kg) is given twice taking one or two teaspoons of syrup or 4 mg per one kilogram of body weight (single dose);

After reaching 1 year (weight more than 10 kg), a double intake of one or two tablespoons is prescribed.

Syrup sinekod dosages  :

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

Patients over 18 years of age are prescribed a fourfold intake of 15 ml of syrup. Dosiruetsya drug using a measuring cup, which must be washed and dried after each portion of the syrup.

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

Herbal breasts:  two tablespoons of the mixture are poured 200ml of boiling water, doused in a water bath for a quarter of an hour, take out the dishes with infusion of water and insist at room temperature for 45 minutes. Strain, add boiled water to the original level. Accept warm half a cup three times a day after meals. The duration of treatment is an average of two to three weeks.

It is often asked: 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 the average, the course of expectorant drugs is from a week to two, the doctor can extend the reception. However, if the expectorant is not helped within three to five days, you need to see a doctor, the same applies to antitussive drugs. During this time, the cough does not go away at all, but there should be an improvement in the condition.

[26], [27], [28], [29]

Expectorant against coughing adults

This category of patients is addressed to all drugs of this group. Limitations may be in the presence of a known intolerance of one or more components of specific drugs or herbal medicines, contraindications for the patient's concomitant diseases. Expectorants, especially medicamentous, are recommended only for the doctor's prescription, which takes into account the pathogenesis of the disease, the condition of the patient and the nature of the cough.

Particular caution should be exercised during expectorative therapy for pregnant and lactating women. During this period, taking any medication is not recommended. The use of expectorants during pregnancy in the first trimester of expectorants is contraindicated in instructions to most drugs - ACS, Carbocysteine, Lazolvan (Ambroxol), Bromgexin, Sinecodu, in the 2nd and 3rd trimester - only for vital indications, although embryotoxic effects of these drugs have not been revealed.

The effect of Erespal on the human fetus has not been sufficiently studied, however, in the experimental animals, cubs with "wolf mouth" were born. It is not recommended for women who are expecting a child.

The above drugs are found in breast milk, so it is not recommended for breastfeeding mothers. If a woman needs to take any of these, breastfeeding will have to stop.

The following preparations are not contraindicated for use in the period of gestation: plant-based herbion, Muciltin tablets and syrup; In the second and third Trimester, it is permitted to take Pertussin; only in the third - Thermopsis. However, only if the future mother does not have allergies to the components of the drug, complications and threat of miscarriage, a strong early toxicosis (plant expectorants increase the gag reflex). It is not recommended to use Herbion syrups with ivy and primrose during pregnancy, Doctor Mom, Bronhicum. In the first trimester, Perthussinus is banned, in the first and second - Thermopsis.

During pregnancy, medicinal herbs are not contraindicated: plantain, althae, thyme - with a short course and with caution. Licorice, mother-and-stepmother are not recommended to pregnant women.

Pick up an expectorant against coughing with lactation, it would seem, is easier. There is no threat of miscarriage and toxicosis, however, the effect of plant-based drugs on infants has not been investigated, so manufacturers often do not recommend them. Therefore, first of all, you need to consult a doctor. Unequivocally has no contraindications to plantain. It is not recommended mother-and-stepmother and ledum, as well as preparations containing ethyl alcohol.

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

The safest expectorants in this period are soda, salt and honey (if there is no sensitization). And also - water! Humidification of the air and abundant drink also contributes to the liquefaction of mucus and acts no worse than medications.

Nevertheless, any pregnant woman should agree with her doctor, even the most natural and innocuous.

Expectorants for children

Coughing in a child can be caused by various causes, most often a viral infection or as it is also called a cold. 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 will be air humidification, rinsing (nasal cleansing), chest massage and copious drinking. Infants are just often applied to the chest. Usually such measures are well justified and other efforts are not required.

If the cough does not go away, but intensifies, they turn to the pediatrician, who will examine the child, possibly prescribe the necessary diagnostic procedures and after the diagnosis is established will prescribe the treatment. Expectorants to children are prescribed 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. This milk, soda, raspberry jam and honey, thermal procedures are possible with the help of paraffin or potato tortillas. However, even treatment with alternative and seemingly safe means should not be started without consulting a pediatrician whom you trust.

Since recently, the French, and after them - the Italians at the legislative level have banned the appointment of expectorant and thinning medicines to children until the age of two. The prohibition extends to such active substances as cysteine derivatives, bromhexine hydrochloride, ambroxol hydrochloride, terpenoids and some others, which are often part of combined over-the-counter cough syrups. Such a ban is caused by the appearance of many serious complications when using these drugs in young children. By the way, despite widely spread information about this, our pediatricians often recommend treating a child with ARVI with one of these drugs.

However, there are cases when the appointment of expectorants to young children is justified. Preferred for children are herbal preparations, without alcohol, flavors and flavor additives in the form of a solution or syrup. The effectiveness of taking such drugs is increased against a background of copious drinking.

It is especially difficult to choose an expectorant for a child up to a year. Almost all plant syrups with expectorant properties, sold in pharmacies, have restrictions on the age of up to two years. Independently to treat an infant without harm for him it is possible only with water - humidification of the air, rinsing (cleaning) of the spout, abundant drinking (if you are already giving water to the child) will not do him harm. A child who has not tried anything other than breast milk needs to be often applied to the breast. Massage with light patting movements on the back and feet of the baby also helps to get rid of sputum faster.

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

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

Expectorants to infants should not be given without medical advice, even plant origin. From medicinal plants at this age, alternative healers recommend brewing not herbal preparations, but any one of the herbs: raspberry and willow-tea leaves, thyme grass, chamomile flowers (from semiannual age), plantain. Although herbs also have contraindications, their influence on the children's body has not been investigated, so the recommendations are mixed.

Tablets Termoposol can be prescribed even to infants.

Syrup Bronchicum C (with thyme and ethyl alcohol) is allowed according to the instructions for use from the age of six months, the Alteika syrup is not limited by age.

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

Antitussive drops for oral administration Sinecode according to the manufacturer's instructions can be given to children from two months of age.

There is a children's syrup with banned Acetylcysteine, which according to the instructions can be taken from the age of ten. In the instructions to Ambroxol, Bromhexine also dosages are prescribed for infants. The parents should discuss the expediency of using such a remedy with the attending physician, and there must be very good reasons for considering their application.

Expectorants for children from 2 years should also be prescribed by a doctor. At this age, the spectrum of drugs is greatly expanded. It is allowed to use almost all medicinal herbs, except for poisonous (Ledum). Plant-based syrups Herbion, Dr. IOM, from licorice root, Muciltin is no longer contraindicated. Serious mucolytics - ATSTS, Lazolvan (Ambroxol), Bromhexine is already on the list of permitted drugs.

Children over the age of three already have almost no restrictions on the use of expectorants and mucolytics. It is possible that in some cases this is necessary. Expectorants for children from 3 years, too, should not just buy in a pharmacy, just because they are on a free sale. At this age, it is possible to prepare teas from medicinal herbs for the child, to treat them with alternative methods. And the use of products of the pharmaceutical industry must always be agreed with the doctor.

[30], [31], [32]

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 the use of expectorants, only some drugs can be used with the proviso that there is no hypertonia, a threat of miscarriage, pathological nausea.

Children under the age of two should not, without serious reasons, prescribe drugs that facilitate expectoration and dilute sputum.

Bromhexine and Ambroxol have practically no contraindications for diseases. Common 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.

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

Intolerance to fructose, insufficiency of sucrose-isomaltose, impaired absorption of glucose-galactose. When diabetes is prescribed with caution.

Medicinal herbs and herbal preparations also have contraindications, which should be read before they are used. Thus, licorice is contraindicated in pregnant women and infants, hypertensive patients, cores and bleeding patients. Plantain should not be used in patients with peptic ulcer, hyperacid gastritis, tendency to thrombosis. Thymus is undesirable to use for people with vascular pathologies, hypothyroidism, impaired liver and kidney function. Mother-and-stepmother is contraindicated in pregnant and lactating women, children under two years of age, people with a sick liver. Ginger also has contraindications: peptic ulcer, gastritis, cholelithiasis, hypertension, a tendency to bleeding. Althae has no contraindications.

[22], [23]

Side effects of the expectorants

Any synthetic, herbal or combined preparation can cause an allergic respiratory reaction, skin rashes, angioedema.

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

Acetylcysteine, in addition, it can provoke diarrhea, heartburn, stomatitis, in addition, it reduces pressure, there may be a noise in the ears and headache, as well as tachycardia. Acetylcysteine can cause bronchospasm.

Carbocysteine - pain in the stomach, gastrointestinal hemorrhage.

Ascoril can exert a stimulating effect on the nervous system, cause tremor, convulsive muscle contractions, headache, digestive disorders, relapses of peptic ulcer, abnormalities in liver function tests, hypotension (up to collapse), tachycardia, urine color changes, paradoxical bronchial spasm.

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

[24], [25]

Overdose

Exceeding the recommended dose of drugs usually shows symptoms of side effects. In expectorants of any origin, most often, an overdose is manifested by vomiting and vomiting.

Besides:

For acetylcysteine are characterized by: digestive disorders, in children of infant age the overdose is manifested by hypersecretion of sputum.

Overdose Carbocysteine manifests itself in epigastric pain, nausea, diarrhea.

When the dose of Perthussin is exceeded, symptoms of bromism can be observed - rashes, runny nose, lacrimation, malaise, asthenic syndrome, gastroenterocolitis, discordant movements and speech, slowing of the pulse.

Overdosing with Ascoril causes nervous excitement, tremor, convulsive muscle contractions, headache, digestive disorders, recurrences of peptic ulcer disease, abnormal liver function tests, hypotension (up to collapse), tachycardia, urine color change, paradoxical bronchial spasm.

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

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

[33], [34], [35], [36]

Interactions with other drugs

Combined use of expectorant and mucolytic agents with drugs that depress cough reflex and reduce sputum secretion should be avoided.

Besides:

Acetylcysteine does not combine with antibiotics of the tetracycline series, except doxycycline. With other antibacterial drugs, incompatibility is not detected, however, it is recommended to observe an interval of at least two hours between antibiotic and acetylcysteine. Strengthens the vasodilating effect of nitroglycerin.

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

Bromhexine can be prescribed in combination with antibiotics, bronchodilating, cardiopreparations and other medications.

Medicinal interaction between Erespal and Sinekoda is not described.

The storage conditions and expiration date of expectorants are indicated on the package. Solutions of powders, effervescent tablets, inhalation are prepared immediately before use. Decoctions and infusions of herbs should be used within a day.

[37]

Reviews

Pharmacies contain many expectorants of natural and chemical origin. Both those and others have different price levels. More expensive are imported plant-based syrups, however, the domestic pharmaceutical industry produces many plant products 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 feedback of the members of the forum, inexpensive and effective natural expectorants of Alteika, Pertussin, breastfeeding, Bronchophyte helped many. They are successfully treated and adults and children.

Preparations containing synthetic components should never be consumed without a medical prescription. Even if they are sold without prescription. The doctors' comments about them are very ambiguous, and for successful coughing it is necessary to observe the regime of abundant drinking and pure cool moist air. Without these conditions, the most modern expectorant is not effective.