Expectorant stimulants

Reflex acting drugs

Reflex-acting drugs, when taken orally, have a moderate irritating effect on the stomach receptors, which reflexively excites the vagus nerve center in the medulla oblongata. This increases the secretion of the mucous glands of the bronchi, liquefies bronchial secretions, and enhances peristaltic contractions of the bronchial muscles. A slight excitation of the nearby vomiting center is also possible, which reflexively increases the secretion of the bronchial glands.

Since the effect of these drugs is short-lived and an increase in a single dose causes vomiting, frequent administration of optimal doses (every 2 hours) is necessary.

The drugs of this group promote rehydration of bronchial mucus, strengthening of the motor function of the bronchi and expectoration due to peristaltic contractions of the bronchial muscles, and increased activity of the ciliated epithelium.

The active ingredients of expectorants with reflex action are alkaloids and saponins:

Infusion of thermopsis herb from 0.6-1 g per 200 ml of water, taken 1 tablespoon every 2 hours 6 times a day.

An infusion of ipecac root of 0.6 g per 200 ml of water is taken 1 tablespoon every 2 hours 6 times a day.

A decoction of the root of the hyssop from 20.0 g per 200 ml of water, taken one tablespoon 5-6 times a day.

An infusion of the root of the bluehead from 6-8 g per 200 ml of water, taken 3-5 tablespoons a day after meals.

Licorice root is used as an infusion of 6 g per 200 ml of water, 1 tablespoon 6 times a day; it is part of breast collection No. 2 (brew 1 tablespoon per 1 glass of boiling water, leave for 30 minutes, take 1/4 glass 4 times a day); it is also part of the breast elixir.

Glycyram is a drug obtained from licorice root, has an expectorant, anti-inflammatory and adrenal cortex stimulating effect. It is used in tablets of 0.05 g. Prescribed 1-2 tablets 4 times a day. Licorice root preparations in case of overdose can cause an increase in blood pressure, sodium and water retention, and the appearance of edema.

Marshmallow root in the form of an infusion of 8 g per 200 ml of water, 1-2 tablespoons 5-6 times a day. Included in the composition of chest collection No. 1 (marshmallow root, coltsfoot, oregano). 1 tablespoon of the collection is poured with 1 glass of boiling water, infused for 30 minutes, taken 1/4 glass 6 times a day.

Mucaltin tablets containing a mixture of polysaccharides from the herb marshmallow. Prescribed 3 tablets 4-6 times a day. One tablet contains 50 mg of the drug.

Lycorine is an alkaloid found in plants of the Amaridis and Liliaceae families, it increases the secretion of the bronchial glands, liquefies sputum, and has a bronchodilator effect. It is available in tablets of 0.0002 g, prescribed 1-2 tablets 4 times a day.

An infusion of plantain leaves of 10 g per 200 ml of water, taken 2 tablespoons 6 times a day.

A decoction of coltsfoot leaves of 10 g per 200 ml of water, taken 1 tablespoon every 2-3 hours.

A decoction of elecampane root from 20 g per 200 ml of water, taken 1-2 tablespoons 6 times a day.

Medicinal plants of this group are used most often in the treatment of chronic bronchitis and are included in various collections. S. S. Yakushin (1990) proposed 3 types of prescriptions of medicinal herbs for the treatment of chronic bronchitis.

Collection No. 1 (the dominant property of the collection is antiseptic)

• Plantain leaves 1 tsp.
• Licorice root 1 tsp.
• Sage leaves 1 tsp.
• Pine buds 2 hours.
• Black elderberry flowers 1 tsp.

An infusion or decoction is prepared from collection No. 1 (1.5-2 tablespoons of the collection are placed in an enamel bowl, 200 ml of water is poured in, the lid is covered and the mixture is placed in a boiling water bath. The infusion is heated for 15 minutes, the decoction - for 30 minutes with frequent stirring, then filtered, the remaining raw material is squeezed out, the finished extract is brought to 200 ml with boiled water). Take 1 tablespoon every 1.5-2 hours, i.e. 8-10 times a day. Collection No. 1 is prescribed for exacerbation of chronic bronchitis of varying degrees of activity, primarily for purulent bronchitis and bronchiectasis.

Collection No. 2 (mainly bronchodilating effect)

• Coltsfoot leaves 1 tsp.
• Oregano herb 1 tsp.
• Licorice root 2 tsp.
• Ledum herb 2 tsp.

Collection No. 2 is used primarily for obstructive chronic bronchitis.

Collection No. 3 (anti-inflammatory and expectorant effect)

• Elecampane root 1 tsp.
• Marshmallow root 2 tsp.
• Oregano herb 1 tsp.
• Birch buds 1 tsp.

Collections No. 2 and No. 3 are prepared and used in the same way as collection No. 1. Collection No. 3 is used in patients with mild exacerbation of chronic bronchitis and in the absence of exacerbation (primarily as an expectorant). The above collections of medicinal plants can be used throughout the entire hospital stay, as well as for a long time after discharge from the hospital (2-3 months).

One of the collections recommended for chronic bronchitis by E. Shmerko and I. Mazan (1993):

Collection #4

• Marshmallow root 2 tsp.
• Plantain leaves 2 tsp.
• Chamomile flowers 2.5 h.
• Immortelle herb 2 tsp.
• Roots of spring primrose 2 hours.
• Coltsfoot leaves 1.5 tsp.
• Pine buds 1 tsp.
• Licorice root 1.5 tsp.
• Blackcurrant leaves and fruits 5 hours.
• Oat seeds 5 h.

Pour 500 ml of boiling water over two tablespoons of collection No. 4, leave for about an hour, and drink in sips throughout the day.

For each patient, the collection must be selected individually. If the patient has a severe cough and bronchospasm, then celandine herb, thyme herb, mint, valerian root, oregano are added to the collection. In case of a severe irritating cough with hemoptysis, the amount of mucus-forming raw materials (marshmallow root, mullein flowers, coltsfoot leaves) is increased in the collection; in case of bronchiectasis, bactericidal substances (pine buds, chamomile flowers) are added to the collection. The following collections can also be recommended:

Collection #5

• Ledum herb 10 g
• Coltsfoot leaves 10 g
• Wild pansy herb 10 g
• Chamomile flowers 10 g
• Calendula flowers 10 g
• Licorice roots 10 g
• Elecampane root 10 g
• Anise fruits 10 g
• Plantain leaves 10 g

Place two tablespoons of collection No. 5 in an enamel bowl, cover with a lid, bring to a boil in a water bath, boil for 15 minutes, cool for 45 minutes at room temperature, squeeze out the remaining raw materials. Bring the volume of the resulting infusion to 200 ml with boiled water. Take 1/4 cup 4 times a day (primarily for bronchitis accompanied by bronchospasms).

Collection #6

• Licorice root 15 g
• Polemonium root 15 g
• Chamomile flowers 20 g
• Valerian roots 10 g
• Motherwort herb 10 g
• Mint herb 20 g
• St. John's wort herb 10 g

Prepare as collection No. 5. Take 1/4 cup 4-5 times a day after meals (primarily for asthmatic bronchitis).

Collection #7

• Coltsfoot leaves 20 g
• Oregano herb 10 g
• Chamomile flowers 20 g

Pour 2 tablespoons of the mixture with 500 ml of boiling water, leave for 6 hours, drink 1/2 cup 4 times a day before meals warm. It is better to brew in a thermos.

Collection #8

• Plantain leaves 20 g
• St. John's wort herb 20 g
• Linden flowers 20 g

Prepare as collection No. 7. Take 1/2 cup 4 times a day.

Collection #9

• Elecampane root 30.0
• Calendula flowers 30.0
• Plantain leaf 50.0
• Thyme herb 50.0
• Coltsfoot leaves 50.0

Brew two tablespoons of collection No. 9 in 200 ml of water, leave for 40 minutes. Take 1/4 cup 4 times a day.

Collection #10

60 t (3 tablespoons) of crushed flaxseed are poured into 1 liter of hot water, shaken for 10 minutes, and filtered. 50 g of licorice root, 30 g of anise, 400 g of honey are added to the resulting liquid and mixed thoroughly. The mixture is brought to a boil, infused until cool, filtered and taken 1/2 cup 4-5 times a day before meals (expectorant and soothing effect on painful cough). Not recommended for honey intolerance.

Collection No. 11 (antioxidant)

Alder cones, wild pansy herb, string herb, knotweed herb, black elder flowers, hawthorn berries, immortelle flowers, black currant leaves, plantain leaves, 50 g each. Mix 10 g of the mixture, pour 300 ml of boiling water, heat in a water bath for 15 minutes, leave for 45 minutes, squeeze. Take 100 ml 3 times a day 15 minutes before meals. The collection has an expectorant and antioxidant effect (inhibits lipid peroxidation).

Resorptive drugs

Resorptive drugs are absorbed in the gastrointestinal tract, then secreted by the bronchial mucosa, increase bronchial secretion, liquefy sputum and facilitate expectoration. Iodine-containing expectorants, together with leukocyte proteases, also stimulate the breakdown of sputum proteins.

Potassium iodide 3% solution, take 1 tablespoon 5-6 times a day with milk or plenty of liquid. Duration of treatment is 5-7 days, longer intakes can lead to iodism phenomena (nasal congestion, runny nose, lacrimation).

Sodium iodide is available as a 10% solution of 10 ml in ampoules for intravenous administration. On the first day, 3 ml is administered, on the second - 5 ml, on the third - 7 ml, on the fourth - 10 ml, then 10 ml once a day for another 3 days, the course of treatment is 10-15 days. Intravenous administration of sodium iodide is better tolerated than oral administration of potassium iodide, no accumulation is observed.

Thyme herb in the form of an infusion of 15 g per 200 ml of water, taken 2 tablespoons 5-6 times a day.

Pertussin (thyme extract - 12 parts, potassium bromide - 1 part, sugar syrup - 82 parts, 80% alcohol - 5 parts), taken 2 tablespoons 5-6 times a day.

Terpin hydrate in tablets of 0.25 g, prescribed 2 tablets 4-5 times a day.

Anise fruits in the form of an infusion of 10 g per 200 ml of water, taken 2 tablespoons 4-6 times a day.

Ammonia-anise drops ("Danish king's drops"). Ingredients: 2.8 ml of anise oil, 15 ml of ammonia solution, up to 100 ml of 90% alcohol. Take 15-20 drops 3-5 times a day.

Eucalyptus oil - 10-20 drops for inhalation per 1 glass of boiling water.

Eucalyptus tincture - 10-20 drops 4-6 times a day.

Mucolytic drugs

Mucolytic drugs affect the physical and chemical properties of sputum and liquefy it.

Proteolytic enzymes

Proteolytic enzymes break the peptide bonds of the sputum gel protein, making it liquefied and easy to cough up.

Trypsin, chymotrypsin - 5-10 mg in 3 ml of isotonic sodium chloride solution for inhalation. The course of treatment is 10-15 days.

Chymopsin - 25-30 mg in 5 ml of isotonic sodium chloride solution for inhalation. Inhalations are done 1-2 times a day, the course of treatment is 10-15 days.

Ribonuclease - 25 mg in 3-4 ml of isotonic sodium chloride solution for inhalation 2 times a day, course of treatment - 7-10 days.

Deoxyribonuclease - 2 mg in 1 ml of isotonic sodium chloride solution for inhalation 3 times a day, course of treatment - 5-7 days.

Profezym is a proteolytic drug obtained from the culture of Bact. subtilus, administered endobronchially 0.5-1 g in a dilution of 1:10 (diluted with polyglucin) once every 5 days.

Terrilitin is a proteolytic drug obtained from the aspergillus fungus. A 200 U bottle is dissolved in 5-8 ml of physiological solution and 2 ml is inhaled 1-2 times a day. It is combined with antibiotics and dimexide, and can be used in the form of electrophoresis.

When treating with proteolytic enzymes, there may be side effects: bronchospasm, allergic reactions, pulmonary hemorrhage. Proteolytic enzymes are not prescribed for obstructive bronchitis.

Amino acids with SH group

Amino acids with the SH group break the disulfide bonds of sputum proteins, while the macromolecules become less polymerized, the normalization of the physical properties of very viscous mucus is accompanied by an acceleration of mucociliary clearance.

Acetylcysteine (mukomist, mucosolicinum) - a 20% solution is used in inhalations of 3 ml 3 times a day or orally 200 mg 3 times a day. During inhalation, bronchospasm is possible in patients with bronchial asthma, therefore it is advisable to use bronchodilators before inhalation.

In recent years, the protective properties of acetylcysteine have been identified, manifested in counteracting free radicals, reactive oxygen metabolites, which are responsible for the development of acute and chronic inflammation in the bronchopulmonary system.

Carbocisteine (mucodin) - is similar in mechanism of action to acetylcysteine. It is available as a syrup for oral administration. Adults are prescribed 15 ml (3 teaspoons) orally 3 times a day, after improvement the dose is reduced: up to 10 ml (2 teaspoons) 3 times a day. There are also capsules of 0.375 g, the daily dose is 3-6 capsules. Children are prescribed 1 teaspoon of syrup 3 times a day. Unlike acetylcysteine, it does not cause bronchospasm. Tolerability is good, nausea, diarrhea, headache are rare.

Mistabron (mesna) is a sodium salt of 2-mercaptoethanesulfonic acid. The mucolytic action of the drug is similar to that of acetylcysteine, but it more effectively breaks the bisulfide bonds of macromolecular compounds of sputum, which reduces the viscosity of sputum. It is easily absorbed from the respiratory tract and quickly excreted from the body unchanged. It is available in ampoules for inhalation and for intrabronchial infusions.

Inhalations are carried out through a mouthpiece or mask using appropriate devices under atmospheric pressure in a sitting position. The contents of 1-2 ampoules are inhaled without dilution or in a 1:1 dilution with distilled water or isotonic sodium chloride solution. Inhalations are carried out 2-4 times a day for 2-24 days.

Eudobronchial administration of the drug is administered through an intratracheal tube every hour (1-2 ml together with the same volume of distilled water) until the sputum is liquefied and removed. This method is usually used in intensive care settings. The drug cannot be used together with aminoglycoside antibiotics, as they reduce the activity of mystabrone. Bronchospasm and cough are possible with inhalation of mystabrone. The drug is contraindicated in bronchial asthma.

Mucoregulators

Mucoregulators are a new generation of mucolytic drugs - visicine derivatives. These drugs have a mucolytic (secretolytic) and expectorant effect, which is due to the depolymerization and destruction of mucoproteins and mucopolysaccharides of sputum. In addition, they stimulate the regeneration of rhinenous cells of the ciliated epithelium and increase its activity. Mucoregulators also stimulate the synthesis of surfactant in alveolar pneumocytes of type II and block its decay. Surfactant is the most important factor maintaining the surface tension of the alveoli, positively affecting their functional properties, in particular, elasticity, extensibility and counteracting the development of pulmonary emphysema. Surfactant is a hydrophobic boundary layer lining the alveoli, facilitates the exchange of non-polar gases, has an anti-edematous effect on the membranes of the alveoli. It also participates in the transport of foreign particles from the alveoli to the bronchial region, where mucociliary transport begins.

Bromhexine (Bisolvan) - is available in tablets of 0.008 g and in ampoules of 2 ml of 0.2% solution for intramuscular and intravenous administration, in a solution for oral and inhalation use containing 8 mg of bromhexine in 4 ml of solution. In the body it is converted into ambroxol. It is used orally at 0.008-0.16 g (1-2 tablets) 3 times a day, intravenously at 16 mg (2 ampoules) 2-3 times a day or as inhalations of 4 ml 2 times a day.

The drug is well tolerated, side effects (skin rashes, gastrointestinal disorders) are rare. In chronic liver failure, bromhexine clearance decreases, so its dose should be reduced. Combined use of oral and inhalation is also effective. For inhalation, 2 ml of the solution is diluted with distilled water in a 1:1 ratio. The effect is noted after 20 minutes and lasts 4-8 hours, 2-3 inhalations are performed per day. In very severe cases, bromhexine is administered subcutaneously, intramuscularly or intravenously daily 2-3 times 2 ml (4 ml). The course of treatment is 7-10 days. In chronic recurrent diseases of the respiratory system, longer use of the drug (3-4 weeks) is advisable. In these cases, simultaneous use of situational drainage and vibration massage is indicated.

Ambroxol (lasolvan) is an active metabolite of bromhexine. It is available in tablets of 30 mg in a solution for inhalation and internal use (2 ml contains 15 mg) and in ampoules for intravenous and intramuscular administration of 2 ml (15 mg).

At the beginning of the treatment, 30 mg (1 tablet or 4 ml of solution) is prescribed orally 3 times a day for 5 days, then the dose is reduced by half, the maximum effect is observed by the 3rd day of treatment. Ambroxol can be used in the form of inhalations of 2-3 ml of inhalation solution diluted with distilled water 1:1. Before inhalation, it is advisable to use a bronchodilator to prevent possible bronchospasm and opening of the airways. Parenterally, the drug is used subcutaneously and intravenously 2-3 ampoules per day (1 ampoule contains 15 mg of ambroxol), in severe cases the dose can be increased to 2 ampoules (30 mg) 2-3 times a day. The drug can be administered intravenously by drops in glucose solutions, Ringer's, and also intramuscularly. When used together with antibiotics, ambroxol increases the penetration of amoxicillin, cefuroxine, erythromycin, doxycycline into the bronchial secretion. Side effects are rare: nausea, abdominal pain, allergic reactions.

Lasolvon-retard - capsules with slow absorption, containing 75 mg of ambroxol. The drug ensures the maintenance of its uniform concentration in the blood for 24 hours. It is used once a day, the tolerance is good.

Mucus secretion rehydrators

Mucus secretion regulating agents increase the aqueous component of sputum, making it less viscous and easier to cough up.

Alkaline mineral waters (Borjomi and others) are taken 1/2-l glass 4-5 times a day.

Sodium bicarbonate is used in the form of inhalations of 0.5-2% solution.

Sodium benzoate is usually added to the composition of expectorant mixtures:

• Thermopsis herb infusion of 0.8 g per 200 ml
• Sodium bicarbonate 4 g
• Sodium benzoate 4 g
• Potassium iodide 4 g
• Breast elixir 30 g

Take 1 tablespoon 6-8 times a day.

Sodium chloride is used in the form of inhalation of a 2% solution.

The best expectorants for chronic bronchitis are mucoregulators: bromhexine, lasolvan. In case of frequent and painful cough, expectorants can be combined with antitussives.

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