Rational choice of mucolytic therapy in the treatment of respiratory diseases in children. Mucoactive therapy in the treatment of acute respiratory infections in children Ambroxol or carbocysteine ​​which is better

transcript

1 20 MUCOLYTIC DRUG ACETYLCYSTEINE IN PEDIATRIC PRACTICE: MYTHS AND REALITY A.R. Denisova, Ph.D., I.A. Dronov, Candidate of Medical Sciences, Associate Professor, Department of Children's Diseases, First Moscow State Medical University. THEM. Keywords: children, acetylcysteine, cough, respiratory infections, mucolytic agents Keywords: children, acetylcysteine, cough, respiratory tract infections, mucolytic agents statistics over 50%). Cough the most common symptom in practice. It may be a manifestation a large number diseases. The main causes of cough in childhood are inflammation of the upper and lower respiratory tract, bronchial asthma, foreign bodies in the bronchi, malformations of the lungs and bronchial tree. It can also occur in diseases of cardio-vascular system and gastrointestinal tract. Cough is a protective reaction of the body, contributing to the restoration of airway patency. Cough is useful, as it clears the airways, but provided that the properties of the bronchial secretion are preserved and there are no obstacles during its evacuation. The doctor must be able to manage the patient's cough, using rational pharmacotherapy for this. To do this, the doctor must have a good understanding of the answers to a number of questions related both to the cough itself and to the methods of its treatment, including specific drugs. The mucolytic acetylcysteine ​​has been widely used in clinical practice for several decades, including in children. However, there are still some myths and misconceptions about this drug among pediatricians. Some of these questions will be discussed in this article. WHEN SHOULD MUCOLYTICS BE ADVISED TO PATIENTS WITH COUGH? Among pediatricians, there is an opinion that mucolytic drugs should be prescribed only

2 22 for wet, productive cough. Is it really? The leading link in the development of inflammatory processes in the respiratory tract is a violation of the process of mucociliary transport, which, in turn, is associated with excessive formation or increased viscosity of bronchial secretions. This disrupts the work of the ciliated epithelium, which leads to inadequate drainage of the bronchial tree. In addition, when producing a viscous secretion, not only inhibition of ciliary activity is noted, but also bronchial obstruction occurs due to the accumulation of mucus in respiratory tract. Bronchial secretion is the net product of goblet cell secretion, extravasation of plasma components, metabolism of motile cells and vegetative microorganisms, and pulmonary surfactant. In addition, alveolar macrophages, lymphocytes, immunoglobulins and non-specific protective factors (lysozyme, transferrin, opsonins, etc.) are also found in bronchial secretions. The bronchial secret consists of two layers of liquid (sol) and insoluble (gel). It is in the ashes that the cilia of the ciliated epithelium make oscillatory movements and transfer their kinetic energy to the outer layer of the gel. When inflammation of the respiratory organs occurs, the composition of the bronchial secretion changes already in the first hours: the concentration of mucins increases and the specific gravity of water decreases, which leads to an increase in the viscosity of the bronchial secretion. Although sputum is already forming in the airways, it is not yet shed, resulting in a dry, non-productive cough. Viscous sputum, in turn, promotes increased adhesion of pathogenic microorganisms to the mucous membrane of the respiratory tract. In addition, when the composition of mucus changes, the concentration of secretory immunoglobulin A decreases, which leads to a decrease in the bactericidal properties of bronchial secretions. Thus, a violation of the drainage function of the bronchial tree causes ventilation disorders, reduces the local immunological protection of the respiratory tract with a high risk of developing a severe course of the disease and may contribute to its chronicity. In this regard, pathogenetically substantiated areas of cough therapy are measures to improve the drainage function of the bronchi, normalize the rheological properties of bronchial secretions and restore mucociliary clearance. It should be noted that children, especially early age, most often cough is due to increased viscosity of bronchial secretions and insufficient activity of the ciliated epithelium. Therefore, the main task in this case is to thin the sputum and reduce its adhesiveness. The rapid initiation of treatment during the first day of illness will not only facilitate the separation of viscous secretions, but also eliminate one of the important factors of reversible bronchial obstruction and reduce the likelihood of microbial colonization of the respiratory tract.

3 23 HOW DO MUCOLYTICS WORK? In many medical and pharmaceutical publications, mucolytics and expectorants are presented as one group of drugs. Is there a difference between them and what is it? Mucolytics include 3 groups of drugs that differ in the mechanism of action on the properties of sputum. 1. Proteolytic enzymes (trypsin, chymotrypsin, streptokinase, ribonuclease, dornase-α, etc.). Currently, most of these drugs are not used due to serious side effects in the form of allergic reactions and the risk of hemoptysis. Some of them are prescribed to patients with severe chronic lung diseases (cystic fibrosis, etc.). 2. Derivatives of the amino acid cysteine ​​(acetylcysteine, carbocysteine). Despite the common chemical structure, the drugs of this group have fundamentally different mechanisms of action. Acetylcysteine ​​has a direct mucolytic effect due to the destruction of disulfide bonds between the molecules of acid mucopolysaccharides and glycoproteins, causing a decrease in the viscosity of sputum, which is more easily evacuated, thereby restoring the work of the ciliated epithelium. Carbocysteine ​​activates the sial transferase of goblet cells, resulting in the normalization of the ratio of acidic and neutral sialomucins of the bronchial secretion and a decrease in its viscosity. 3. Vizicine derivatives (bromhexine, ambroxol). The drugs of this group activate the movement of cilia, improving mucociliary clearance, reduce the viscosity of bronchial secretions by changing the chemistry of its mucopolysaccharides. AT pediatric practice for the treatment of cough, expectorants of predominantly plant origin are also often used (marshmallow, licorice, thermopsis, plantain, etc.). However, these drugs should be used with caution in children with broncho-obstructive syndrome and / or a decrease in the cough reflex, since drugs in this group can just significantly increase the volume of bronchial secretions and lead to the “swamping syndrome”. In addition, herbal preparations can cause allergic reactions, and if not dosed correctly, increase the gag reflex or cause a laxative effect. WHAT IS THE EVIDENCE BASE FOR THE EFFICACY OF ACETYLCYSTEINE? Often in the professional medical environment there is an opinion that the effectiveness and safety of mucolytics has not been proven. Is there really an evidence base for mucolytic drugs? There are currently more than 700 publications on randomized clinical trials of acetylcysteine ​​in the US National Library of Medicine, which is about two times more than the total figure for other major mucolytic drugs (ambroxol, bromhexine, carbocysteine, dornase-α). Such a high scientific and practical interest in acetylcysteine ​​throughout the world is associated not only with a large mucolytic activity, but also with a number of additional therapeutically beneficial effects. To date, the scientific literature provides extensive evidence regarding the efficacy and safety of the use of acetylcysteine ​​in children as a mucolytic. An updated Cochrane systematic review was published in 2013 that evaluated the efficacy and safety of acetylcysteine ​​and carbocysteine ​​for the treatment of acute upper and lower respiratory tract infections in children without chronic bronchopulmonary disease. The meta-analysis included clinical trials as well as data from the pharmacovigilance system. Most of the work was devoted to acetylcysteine. Efficacy was evaluated in 6 randomized control

4 24 ongoing studies (approximately 500 patients): found that these drugs have some benefit in the treatment of respiratory infections. In particular, it has been shown that mucolytics significantly reduce the duration of cough in children and have a positive effect on the quality of life of patients. HOW SAFE IS ACETYLCYSTEINE USED IN CHILDREN? Often, doctors are of the opinion that the use of mucolytics causes the "swamping of the lungs" syndrome. Is it so? When evaluating the safety of any mucolytic drug, an important issue is its ability to lead to the development of "lung swamping" as a result of an increase in sputum volume against the background of an ineffective cough. This phenomenon can be observed with the use of various expectorants and mucolytics, but is most characteristic of herbal preparations, which can significantly increase bronchorrhea. Since when using acetylcysteine, the volume of sputum usually increases slightly, the development of the syndrome "swamping of the lungs" is unlikely. The aforementioned Cochrane systematic review assessed the safety of acetylcysteine ​​and carbocysteine ​​in 34 studies (more than 2000 patients) and found that the drugs generally have a high safety profile in children. However, in children under 2 years of age, mucolytic drugs should be used with caution, as there is evidence that at an early age they can cause an increase in bronchorrhea. WHAT ADDITIONAL EFFECTS DOES ACETYLCYSTEINE HAVE? Practically any medicinal product, in addition to the main action, has additional effects that can be both therapeutically beneficial and undesirable. Does acetylcysteine ​​have therapeutic benefits? In respiratory tract infections of bacterial etiology, the therapeutic effect of acetylcysteine ​​is not limited to one mucolytic effect. It was found that acetylcysteine ​​reduces the adhesion of bacteria to epithelial cells bronchial mucosa, preventing bacterial colonization. Experimental studies suggest that acetylcysteine ​​has a devastating effect on bacterial biofilms. The most important clinical property of acetylcysteine ​​is the presence of a pronounced antioxidant effect. In the process of metabolism, deacetylation of the drug occurs with the release of the amino acid L-cysteine, which is a precursor of glutathione, a powerful intracellular antioxidant that ensures the functional activity and morphological integrity of body cells. In addition, acetylcysteine ​​​​has a direct antioxidant effect, the drug is able to directly react with free radicals, which leads to their neutralization. Due to its powerful antioxidant action, acetylcysteine ​​also has antitoxic and anti-inflammatory effects. To date, oxidative stress, caused by increased formation of free radicals, is considered as the most important pathogenic mechanism damage respiratory system with inflammation. IS IT POSSIBLE TO PRESCRIBE ACETYLCYSTEINE SIMULTANEOUSLY WITH ANTIBIOTICS? It is known that acetylcysteine ​​is able to interact with antibacterial drugs leading to a decrease in their activity. So is it possible or not to prescribe acetylcysteine ​​along with antibiotics? Indeed, the interaction of antibiotics for oral administration with the thiol group of acetylcysteine ​​is possible. However, cases of antibiotic inactivation

5 25 RU with acetylcysteine ​​were observed exclusively during in vitro experiments with direct mixing of the latter. To avoid a decrease in the antibacterial activity of antibiotics, it is necessary to follow the regimen: the interval between taking acetylcysteine ​​and antibiotics should be at least 2 hours. Studies have shown that the combination of acetylcysteine ​​and an antibiotic leads to a significant decrease in the duration of the disease of upper respiratory tract infections by 3 days. WHAT IS IMPORTANT TO REMEMBER WHEN USING ACETYLCYSTEINE? When prescribing mucolytic therapy, certain rules must be observed, among which the most important are the following: do not prescribe mucolytics in combination with drugs that depress the cough reflex, and explain in detail to parents how to drain the lungs when using mucolytics. Despite the fact that acetylcysteine ​​is the most well-studied drug among mucolytics and has been successfully used in pediatric practice for decades, errors in its use are often observed. For example, it is important to follow the regimen of prescribing the remedy, the last dose should be no later than 18 hours, since with a later intake of the drug, the maximum sputum discharge is observed at night, which causes concern for the child and worsens his condition. After taking acetylcysteine ​​in minutes, it is necessary to organize the drainage of the bronchial tree, to do breathing exercises. This provision is especially relevant when using the drug in young children, since the mucolytic effect is achieved especially quickly, and the cough reflex is still underdeveloped. Acetylcysteine, like other mucolytics, is recommended to be taken after meals, as in this case the risk of adverse events from the gastrointestinal tract is reduced. Given the presence of a number of additional conditions for effective and safe application acetylcysteine, synergism between the actions of the doctor and the patient (or in the case of a sick child of his parents) is very important. Thus, the mucolytic drug acetylcysteine ​​occupies an important place in the arsenal of pediatricians among the means for the treatment of respiratory diseases. The drug is characterized by high mucolytic activity, has a high safety profile and has a number of therapeutically beneficial additional effects. The acetylcysteine ​​ACC preparation is presented on the Russian pharmaceutical market, which is produced in several dosage forms and dosages: 100 mg / 5 ml syrup granules, 100, 200 and 600 mg effervescent tablets, 100 and 200 mg solution granules, 200 and 600 mg hot drink granules). Such a variety of forms of release makes it possible to use the drug in children of any age. The bibliography is under revision.

The use of the mucolytic drug acetylcysteine ​​in medical practice: frequently asked questions Respiratory diseases are the most common cause seeking medical help. According to

First MGMU them. THEM. Sechenov (University children's clinical Hospital) Modern methods treatment of cough in acute respiratory diseases in children ON THE. GEPPE, Ph.D. ON THE. SELIVERSTOV,

First MGMU them. THEM. Sechenova Lazolvan in the treatment of cough in children Doctor of Medical Sciences, prof. ON THE. GEPPE, Ph.D. M.N. SNEGOTSKAYA The main goals of antitussive treatment are sputum thinning, restoration of functions

Rational choice of mucolytic therapy in the treatment of respiratory diseases in children MSMSU Respiratory diseases are one of the most important problems in pediatrics, since until now,

RESPIRATORY DISEASES Experience in the prevention and treatment of respiratory viral infections in patients with allergic diseases G.I. Drynov INDEPENDENT PUBLICATION FOR PRACTITIONING DOCTORS www.rmj.ru DISEASES

2 Biologically active additive Bronchogen is a peptide complex containing amino acids: alanine, glutamic acid, aspartic acid, leucine, which has a normalizing effect

Mini-doctor.com Instructions Acetal C powder for oral solution 600 mg/3 g x 3 g 10 ATTENTION! All information is taken from open sources and is provided for informational purposes only. Acetal

Vicks active ekspektomed reviews >>> Vicks active ekspektomed reviews Vicks aktiv ekspektomed reviews Release form: Vicks active ekspektomed - effervescent tablets, white or white with a yellowish tint, round,

LIBEXIN Libexin 1 (prenoxdiazine) Libexin Muco 2% 2 (carbocysteine) Libexin Muco 5% 3 (carbocysteine) Tablets from 0 years With caution childhood Syrup for children from 2 years old Syrup for adults and teenagers

Practical lesson 9 on the topic: “CLINICAL AND PHARMACOLOGICAL APPROACHES TO THE SELECTION AND USE OF DRUGS IN THE PHARMACOTHERAPY OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE. CLINICAL PHARMACOLOGY OF MUCOACTIVE

E.V. BOYTSOVA, Doctor of Medical Sciences, Head of the Laboratory of Pediatric Pulmonology, Research Institute of Pulmonology, St. Petersburg State Medical University. acad. I.P. Pavlova MUCOLYTIC THERAPY IN CHILDREN Inflammatory respiratory diseases in children are

Treatment of cough is indicated only in cases where it significantly disturbs the well-being and condition of the patient. The choice of antitussive therapy in pediatrics is determined by the following factors: the cause of

To help the doctor O.I. Simonova Scientific Center for Children's Health, Russian Academy of Medical Sciences, Moscow Features of the use of direct-acting mucolytics in pediatric practice Contact information: Simonova Olga Igorevna, Doctor

615.235:616.23/.24-085-036-053.2 Features of the treatment of bronchopulmonary diseases in children Sheremet I. A. Kharkov National Medical University, Kharkov, Ukraine (61022, Kharkov, avenue

Package leaflet: Information for the patient ACC, granules for oral solution, 100 mg and 200 mg Active ingredient: acetylcysteine ​​Before you start taking this drug

LECTURES TREATMENT OF COUGH IN CHILDREN G.A. SAMSYGINA Department of Children's Diseases 1, Russian State Medical University Cough in the life of a person, and even more so a child, is extremely common.

Mucoregulators in the treatment of respiratory diseases N.V. Trushenko, S.Yu. Chikina Cough is one of the most common symptoms of respiratory diseases, significantly affecting the quality

RESPIRATORY STIMULANTS. According to the main direction of action, respiratory stimulants are divided into the following groups: Drugs that directly activate the respiratory center: bemegride, caffeine,

Why doesn't the doctor prescribe antibiotics for me???? Antibiotics are not effective in most cases of respiratory tract infections. What is an acute respiratory tract infection? Acute respiratory tract infection occurs

Mini-doctor.com Instructions for Abrol tablets 30 mg 20 (10x2) ATTENTION! All information is taken from open sources and is provided for informational purposes only. Abrol tablets 30 mg 20 (10x2)

THE EFFICIENCY OF THE PHYSIOTHERAPEUTIC DEVICE "DOCTOR LIGHT" IN SARS IN INFANT CHILDREN N.А. Korovina, Doctor of Medical Sciences, Professor, Honored Doctor of the Russian Federation, Head of the Department of Pediatrics, RMAPE;

Mini-doctor.com Instructions Acecex powder for solution for oral use 200 mg in a bag 24 ATTENTION! All information is taken from open sources and is provided exclusively

continuous professional education O.I. Simonova 1, 2 1 Scientific Center for Children's Health, Moscow, Russian Federation 2 First Moscow Medical State University them. THEM. Sechenov, Russian

It is impossible to see your child choking with a cough, this is a serious test for parents. Therefore, every mother who has ever experienced a sleepless night over her baby is interested in how to treat

Long-awaited news! Code in the price list ARGO 0821 ED Medicine presents a colloidal phytoformula for active support and protection of the bronchopulmonary system BronchoLine Only the most effective natural ingredients!

Mini-doctor.com Instructions for Licorice Root Syrup 250 mg/5 ml, 50 g per vial ATTENTION! All information is taken from open sources and is provided for informational purposes only. Licorice Root

In the practice of pediatrician M.I. Petrovskaya, T.V. Kulichenko Scientific Center for Children's Health, Russian Academy of Medical Sciences, Moscow Herbal medicines in the treatment of inflammatory diseases of the upper respiratory tract Contact information: Kulichenko

Http://www.rmj.ru/articles_7230.htm Diagnosis and treatment of cough in medical practice general practice 1145 Bunyatyan N.D., Uteshev D.B., Sviridenko A.V. Cough is a common symptom of respiratory disease.

Application information: information for the consumer Flavamed forte 30 mg / 5 ml, oral solution Active ingredient: ambroxol hydrochloride The active drug ingredient is ambroxol

Mini-doctor.com Instructions Ambroxol tablets 30 mg 100 (10x10) ATTENTION! All information is taken from open sources and is provided for informational purposes only. Ambroxol tablets 30's

Interstitial News of clinical disease lung pharmacology and other pharmaceuticals granulomatosis Combined mucolytics in the practice of a general practitioner N.M. Shmelev Mandatory conditions for effective

Cough in children with respiratory infections: current approaches to therapy

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION P N014180/01 INSTRUCTIONS for the use of the medicinal product for medical use BRONHOBOS Trade name of the drug: Bronchobos International

the ’ˆ íôè úè ô ô ı illa illa illa â â ı ı ô ô ô ô ô` ô â q.

THEM. Kosenko St. Petersburg State Pediatric Medical University, Russian Federation Cough in children rational approach to treatment Contact information: Kosenko Irina Maksimovna,

The trade name SECRAZOL FOR CHILDREN IS APPROVED by the Order of the Chairman of the Committee for the Control of Medical and Pharmaceutical Activities of the Ministry of Health and social development Republic of Kazakhstan

Instructions for use of the medicinal product for medical use Libeksin Muko Registration number: P N013994/02. Trade name of the drug: Libeksin Muko. International generic

Mini-doctor.com Instructions Ambroxol tablets 30 mg 20 (10x2) ATTENTION! All information is taken from open sources and is provided for informational purposes only. Ambroxol tablets 30's

SERETIDE MULTIDISK Powder for inhalation Information for patients Registration number: P 011630/01-2000 of 01/17/2000 international title: Salmeterol/Fluticasone propionate (Salmetrol/Fluticasone

Original article by I.V. Davydova 1, T.V. Turti 1, L.S. Namazova-Baranova 1, 2, 3, A.Yu. Simonova 1, 2, L.R. Tarasova 1, V.V. Altunin 1 1 Research Center for Children's Health, Russian Academy of Medical Sciences, Moscow 2 First Moscow State

RENGALIN COUGH TREATMENT is an innovative drug for complex treatment cough in acute respiratory infections due to the regulation of reflex and inflammatory mechanisms of its occurrence 1. www.rengalin.ru

ALTAI PHYTOCAPSULES BREATHE FULLY According to statistics, 5 million people suffer from diseases of the bronchopulmonary system in Russia Only 35 million people die from tobacco smoking in the world

Package leaflet: Information for the patient ACC 100 mg, 100 mg powder for solution for internal use ACC 100 mg, 100 mg suukaudse lahuse pulber ACC 200 mg, 200 mg powder

Mini-doctor.com Instructions Acetylcysteine-Fs tablets, 200 mg 20 (10x2) ATTENTION! All information is taken from open sources and is provided for informational purposes only. Acetylcysteine-Fs

DKV-99 Dihydroquercetin Glucaferon Prevention colds St. Petersburg, 2 0 1 7 DKV-99 Glucaferon Pharmacological action of dietary supplement DKV-99 Glucaferon original anti-cold

Pathogenetic and symptomatic therapy for cystic fibrosis in children Nauryzalieva Shamshagul Tulepovna the highest category Mandatory

NEW ANTIVIRAL DRUG AERUS IN THE TREATMENT OF SARS, INCLUDING THE FLU Knyazheskaya N.P. Associate Professor of the Department of Pulmonology of the Federal University of Higher Education, Russian National Research Medical University named after A.I. N.I. Pirogov ICD-10 definition of acute bronchitis Acute bronchitis

Package leaflet: Information for the patient ACC 100 mg, 100 mg effervescent tablets ACC 100 mg, 100 mg kihisevad tabletid ACC 200 mg, 200 mg effervescent tablets ACC 200 mg, 200 mg kihisevad tabletid

New possibilities for the treatment of broncho-obstructive syndrome in respiratory infections Rechkina, Dr. med. n. GU " National Institute Phthisiology and Pulmonology named after F.G. Yanovsky NAMS of Ukraine, Kyiv

Mini-doctor.com Manual Helpex Breeze coated tablets, 40 (20x2) ATTENTION! All information is taken from open sources and is provided for informational purposes only. Helpex Breeze

Cough? Bronchitis? Bronchipret soothes coughs thins hard-to-remove inflammation in the bronchi Extra strong and highly concentrated * * extra strong relative to the amount taken from the original

INSTRUCTIONS for use of a medicinal product for medical use AMBROBENE Registration number: P N014731/01 Trade name: Ambrobene International generic name(INN): ambroxol

Mini-doctor.com Instructions Cycloferon coated tablets, enteric-soluble 0.15 g 10 (10x1) ATTENTION! All information is taken from open sources and is provided for informational purposes only.

Be healthy and do not cough 01/30/2017 Pharmaceutical Bulletin January, 2017 3 Market overview of antitussive and expectorant drugs Cough accompanies almost all colds, not

Mucolytic drugs in the treatment of respiratory diseases in children: modern look on problem 49 Zaitseva O.V. RSMU Respiratory diseases are one of the most important problems in pediatrics, occupying

Mini-doctor.com Instructions Privitus oral suspension, 708 mg/100 ml, 200 ml vial ATTENTION! All information is taken from open sources and is provided for informational purposes only.

16 PRACTICE EXPERIENCE OF COLLEAGUES CHOICE OF AN EFFECTIVE PHYTOTHERAPY IN THE THERAPY OF RESPIRATORY DISEASES IN CHILDREN Key words: respiratory infections, cough, herbal medicine, essential oils, medicinal plants,

The role and place of different groups medicines in treatment bronchial asthma in accordance with current guidelines (GINA 2007) Drugs used in bronchial asthma Drugs

Trade name LASOLVAN Junior LASOLVAN APPROVED by the Order of the Chairman of the Committee for Control of Medical and Pharmaceutical Activities of the Ministry of Health of the Republic of Kazakhstan dated July 15, 2014

2 Biologically active food supplement Vezilut is a peptide complex containing amino acids: glutamic acid, aspartic acid, which has a normalizing effect on cells

GA Samsygina Doctor of Medical Sciences, Professor, Russian State Medical University, Moscow Cough reflex aimed at restoring airway patency (AP). In human life, it occurs extremely often.

Bronchial Asthma School for Patients Definition Bronchial Asthma (BA) is a chronic inflammatory disease of the airways in which many cells and cellular elements play a role. Chronic

Cough? Bronchitis? Bronchipret soothes coughs liquefies hard-to-remove inflammation in the bronchi Extra strong and highly concentrated* * Extra concentrated relative to the total amount

State Budgetary Educational Institution of Higher Professional Education "Russian National Research Medical University. N.I. Pirogov" Ministry of Health and Social Development of the Russian Federation, Moscow Arbidol as a means of increasing the effectiveness of therapeutic and preventive measures for influenza

APPROVED Order of the Ministry of Health of Ukraine 24.07.2015 462 Registration certificate UA/9928/02/02 INSTRUCTIONS for the medical use of the drug ABROL (ABROL) Composition: active substance:

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION INSTRUCTIONS FOR THE MEDICAL USE OF THE DRUG Ambroxol-SOLOpharm Registration number: Trade name: Ambroxol-SOLOpharm International

Mini-doctor.com Instructions ACC Children's powder for oral solution, 100 mg/5 ml, 150 ml vial ATTENTION! All information is taken from open sources and is provided for informational purposes only.

"EUCALYPTUS-PLUS" INTRODUCTION Chronic pathology of the respiratory system is one of the most important problems of therapy due to its significant prevalence, reduced ability to work, and often

Research work "Evaluation of the effectiveness of cough medicines" Completed by: Petrova Nyurguyaana Ivanovna, student of the 10th grade of the MBOU "Kyrgydai secondary school named after. D.A. Gulyaeva" Head:

HOW TO TREAT COUGH IN CHILDREN G. A. Samsygina, Doctor of Medical Sciences, Professor of the Russian State Medical University, Moscow 04/01/2000 What are possible reasons cough in children? What are the basic principles of antitussive therapy? cough reflex,

CLINICAL PHARMACOLOGY of antitussive and expectorant drugs LECTURE PLAN Clinical pharmacology expectorants Clinical pharmacology of mucolytic drugs Modern approaches to rational

For citation: Zaitseva O.V. Rational choice of mucolytic therapy in the treatment of respiratory diseases in children. 2009. No. 19. S. 1217

Respiratory diseases are one of the most important problems in pediatrics, because so far, despite the progress made, according to official statistics, they occupy one of the first places in the structure of childhood morbidity. One of the main pathogenic factors respiratory diseases is a violation of the mechanism of mucociliary transport, which is most often associated with excessive formation and / or increased viscosity of bronchial secretions. Stagnation of bronchial contents leads to a violation of the ventilation and respiratory function of the lungs, and inevitable infection leads to the development of endobronchial or bronchopulmonary inflammation. In addition, in patients with acute and chronic respiratory diseases, the produced viscous secret, in addition to inhibiting ciliary activity, can cause bronchial obstruction due to the accumulation of mucus in the airways. In severe cases, ventilation disorders are accompanied by the development of atelectasis.

Therefore, mucociliary transport is the most important mechanism that ensures the sanitation of the respiratory tract, one of the main mechanisms of the local respiratory protection system and provides the necessary potential for the barrier, immune and cleansing functions of the respiratory tract. Purification of the respiratory tract from foreign particles and microorganisms occurs due to their sedimentation on the mucous membranes and subsequent excretion along with the tracheobronchial mucus, which under normal conditions has a bactericidal effect, tk. contains immunoglobulins and nonspecific protective factors (lysozyme, transferrin, opsonins, etc.). The increase in mucus viscosity not only impairs the drainage function of the bronchi, but also reduces the local protection of the respiratory tract. It was shown that with an increase in the viscosity of the secret, the content of secretory Ig A and other immunoglobulins decreases in it.
Thus, inflammatory diseases of the respiratory tract are characterized by a change in the rheological properties of sputum, hyperproduction of viscous secretion and a decrease in mucociliary transport (clearance). As a result, a cough develops, the physiological role of which is to cleanse the airways of foreign substances that have entered from the outside (both infectious and non-infectious) or formed endogenously. Therefore, coughing is a protective reflex aimed at restoring airway patency. However, cough can perform a protective function only with certain rheological properties of sputum.
Treatment of cough in children should begin with the elimination of its cause, therefore, the effectiveness of therapy primarily depends on the correct and timely diagnosis of the disease. However, the need to treat the actual cough, that is, the appointment of the so-called antitussive therapy, arises only when it disturbs the well-being and condition of the patient (for example, with an unproductive, dry, obsessive cough). A feature of this cough is the absence of evacuation of the secret accumulated in the respiratory tract, while the receptors of the mucous membrane of the respiratory tract are not released from irritating effects, for example, during irritative, infectious or allergic inflammation.
Obviously, in children, the need for cough suppression using true antitussive drugs is extremely rare, their use, as a rule, is unjustified from pathophysiological positions. Antitussive drugs include drugs of both central action (narcotic - codeine, dionine, morphine and non-narcotic - glaucine, oxeladin, butamirate), and peripheral action (prenoxdiazine).
It should be emphasized that in children, especially at an early age, an unproductive cough is more often due to increased viscosity of bronchial secretions, a violation of the “sliding” of sputum along the bronchial tree, insufficient activity of the ciliated epithelium of the bronchi and contraction of bronchioles. Therefore, the purpose of prescribing antitussive therapy in such cases is primarily to thin the sputum, reduce its adhesive properties and thereby increase the effectiveness of cough, that is, increase cough, provided that it is transferred from dry, unproductive to wet, productive.
Medications that improve expectoration of sputum can be divided into drugs that stimulate expectoration and mucolytic (or secretolytic). In terms of composition, they can be either of natural origin or synthetically obtained. Expectorants increase bronchial secretion, thin sputum and facilitate expectoration. Mucolytic drugs (acetylcysteine, bromhexine, ambroxol, carbocysteine, etc.) effectively dilute sputum without significantly increasing its amount.
Plentiful drinking increases the aqueous part of the bronchial secretion very effectively; alkaline mineral waters are the best. Drinking plenty of fluids may be effective in children mineral water type "Borjomi", especially in combination with alkaline inhalations. In the presence of a respiratory disease, humidification of the surrounding air is also useful, especially in winter in a room with central heating batteries.
Means that stimulate expectoration are designed to increase the volume of bronchial secretions. This group includes preparations of plant origin (thermopsis, marshmallow, licorice, etc.) and preparations of resorptive action (sodium bicarbonate, iodides, etc.). The use of expectorants of reflex action is most effective in acute inflammatory processes in the respiratory tract, when there are still no pronounced changes in goblet cells and ciliated epithelium, in the presence of a dry, unproductive cough. Their combination with mucolytics is very effective. However, drugs of this group are not recommended to be combined with antihistamines and sedatives, as well as used in children with broncho-obstructive syndrome.
It is known that drugs that stimulate expectoration (mainly herbal remedies) are often used in the treatment of cough in children. However, this is not always justified. First, the action of these drugs is short-lived, frequent appointments small doses (every 2-3 hours). Secondly, an increase in a single dose causes nausea and, in some cases, vomiting. So, preparations of ipecac contribute to a significant increase in the volume of bronchial secretions, enhance or cause a gag reflex. Enhances vomiting and cough reflexes herb thermopsis. Anise, licorice and oregano have a pronounced laxative effect and are not recommended if a sick child has diarrhea. Menthol causes spasm of the glottis, leading to acute asphyxia. Thirdly, drugs in this group can significantly increase the volume of bronchial secretions that young children are not able to cough up on their own, which leads to the so-called "bogging syndrome", a significant impairment of lung drainage function and reinfection.
According to Professor V.K. Tatochenko, expectorant herbal remedies are of dubious effectiveness and in young children can cause vomiting, as well as allergic reactions (up to anaphylaxis). Thus, their purpose is more of a tradition than a necessity. It should also be noted that vegetable origin medicine does not yet mean its complete safety for the child: the success of herbal medicine depends on the quality of raw materials and the technology of its processing.
Mucolytic (or secretolytic) drugs in the vast majority of cases are optimal in the treatment of respiratory diseases in children. Mucolytics include cysteine ​​derivatives: N-acetylcysteine ​​(ACC, fluimucil, N-AC-ratiopharm), carbocysteine; benzylamine derivatives: bromhexine, ambroxol, as well as dornase, proteolytic enzymes (deoxyribonuclease), etc. It should be noted that the mention of proteolytic enzymes is rather of historical significance; can provoke bronchospasm, hemoptysis, allergic reactions. The exception is the recombinant α-DNA-ase (dornase), which in last years administered to patients with cystic fibrosis.
Mucolytic drugs act on the gel phase of bronchial secretions and effectively thin the sputum without significantly increasing its amount. Some of the drugs in this group have several dosage forms that provide various methods of drug delivery (oral, inhalation, endobronchial, etc.), which is extremely important in complex therapy respiratory diseases in children.
Generally accepted when choosing mucolytic therapy is the nature of the lesion of the respiratory tract. Mucolytics can be widely used in pediatrics in the treatment of diseases of the lower respiratory tract, both acute (tracheitis, bronchitis, pneumonia) and chronic (chronic bronchitis, bronchial asthma, congenital and hereditary bronchopulmonary diseases, including cystic fibrosis). The appointment of mucolytics is also indicated for diseases of the upper respiratory tract, accompanied by the release of mucous and mucopurulent secretions (rhinitis, sinusitis).
At the same time, the mechanism of action of mucolytics is different, so they have different efficiencies.
Acetylcysteine ​​(ACC, etc.) is one of the most active and frequently used mucolytic drugs. Its mechanism of action is based on the effect of breaking the disulfide bonds of sputum acid mucopolysaccharides. This leads to depolarization of mucoproteins, helps to reduce the viscosity of mucus, thin it and facilitate excretion from the bronchial tract, without significantly increasing the volume of sputum. The release of the bronchial tract, restoring the normal parameters of mucociliary clearance, helps to reduce inflammation in the bronchial mucosa. The mucolytic effect of acetylcysteine ​​is pronounced and fast, the drug well dilutes viscous thick sputum, facilitates its discharge with a cough. Moreover, acetylcysteine ​​is active against any type of sputum, incl. and purulent, since, unlike other mucolytics, it has the ability to thin pus.
The effectiveness of acetylcysteine ​​in relation to any type of sputum is especially important in bacterial infections, when the viscosity of sputum with purulent inclusions must be quickly reduced in order to allow it to be evacuated from the respiratory tract and prevent the spread of infection. In addition, acetylcysteine ​​inhibits the polymerization of mucoproteins, reduces viscosity, adhesiveness, thereby optimizing the function of mucociliary transport and reducing the degree of damage to the bronchial epithelium.
Acetylcysteine ​​has the ability to inhibit the adhesion of bacteria to the epithelium of the upper respiratory tract, significantly reducing the frequency of infectious complications of acute respiratory viral infections in children, because reduces the colonization of bacteria and viruses of the mucous membranes, thereby preventing their infection. The drug also stimulates the synthesis of secretion of mucosal cells that lyse fibrin and blood clots, which, of course, increases its effectiveness in infectious inflammation in the respiratory tract.
The high efficiency of acetylcysteine ​​is due to its unique triple action: mucolytic, antioxidant and antitoxic. The anti-oxidant effect is associated with the presence of a nucleophilic thiol SH-group in acetylcysteine, which easily donates hydrogen, neutralizing oxidative radicals. The drug promotes the synthesis of glutathione, the main antioxidant system of the body, which increases the protection of cells from the damaging effects of free radical oxidation, which is characteristic of an intense inflammatory reaction. As a result, inflammation of the bronchi decreases, the severity clinical symptoms, increases the effectiveness of the treatment of inflammatory diseases of the bronchopulmonary system. On the other hand, the direct antioxidant effect of acetylcysteine ​​has a significant protective effect against aggressive agents that enter the body with breathing: tobacco smoke, urban smog, toxic fumes and other air pollutants. The antioxidant properties of acetylcysteine ​​provide additional protection of the respiratory organs from the damaging effects of free radicals, endo- and exotoxins formed during inflammatory diseases respiratory tract.
Acetylcysteine ​​has a pronounced non-specific antitoxic activity - the drug is effective in poisoning with various organic and inorganic compounds. The detoxifying properties of acetylcysteine ​​are used in the treatment of poisoning. Acetylcysteine ​​is the main antidote for paracetamol overdose. I. Ziment described the prevention of liver damage not only with an overdose of paracetamol, but also with hemorrhagic cystitis caused by alkylating substances (in particular, cyclophosphamide).
There are literature data on the immunomodulatory and antimutagenic properties of acetylcysteine, as well as the results of a few experiments that testify to its antitumor activity [Ostroumova M.N. et al.]. In this regard, it has been suggested that acetylcysteine ​​seems to be the most promising in the treatment of not only acute and chronic bronchopulmonary diseases, but also to prevent the adverse effects of xenobiotics, industrial dust, and smoking. It is noted that the properties of acetylcysteine ​​are potentially important, associated with its ability to influence several metabolic processes, including glucose utilization, lipid peroxidation and stimulate phagocytosis.
Acetylcysteine ​​is effective when administered orally, parenterally, with endobronchial and combined administration. The action of the drug begins in 30-60 minutes. and lasts for 4-6 hours. Obviously, the use of acetylcysteine ​​is indicated primarily in cases of non-productive cough due to viscous, thick and difficult to separate sputum. The drug is especially effective in the treatment of acute respiratory diseases in residents of large cities, smokers, etc., i.е. in case of a high risk of developing complications or chronic inflammation of the respiratory system. In otolaryngology, the pronounced mucolytic effect of the drug is also widely used in purulent sinusitis to improve the outflow of the contents of the sinuses.
Indications for the use of acetylcysteine ​​are acute, recurrent and chronic diseases of the respiratory tract, accompanied by the formation of viscous sputum. These are acute and chronic bronchitis with an unproductive cough, incl. smoker's bronchitis. The use of acetylcysteine ​​is necessary for patients who are constantly exposed to adverse factors: working in hazardous industries, living in large cities, near industrial enterprises, smokers. Also, acetylcysteine ​​is prescribed during intratracheal anesthesia in order to prevent complications from the respiratory tract.
The high safety of acetylcysteine ​​is associated with its composition - the drug is an amino acid derivative. It has been shown that in patients with respiratory diseases, the frequency side effects requiring discontinuation of therapy does not exceed that of placebo.
There are indications in the literature that acetylcysteine ​​is recommended to be used with caution in patients with bronchial asthma, tk. some authors sometimes noted an increase in bronchospasm in adult asthmatics. However, in children, there was no increase in bronchospasm when taking acetylcysteine. It has been established that bronchospasm with the use of acetylcysteine ​​is possible only with bronchial hyperactivity and in isolated cases (this is noted in the instructions). At the same time, bronchospasm can occur mainly with inhalation administration of the drug, which does not indicate the properties of acetylcysteine ​​itself, but the method of its administration. Data from numerous clinical studies and our own experience indicate that acetylcysteine ​​has been successfully used in the treatment of bronchial asthma.
Mucolytics, including acetylcysteine, do not cause swamping of the lungs, since these drugs do not increase the volume of bronchial secretions, but make it less viscous, thereby improving evacuation. The only exceptions are children in the first months of life: with inhalation administration of the drug, it is quite rare, but an increase in sputum volume can be observed. The use of any mucolytics in combination with drugs that suppress the cough reflex (codeine, oxeladin, prenoxdiazine and others) is not recommended: this can lead to stagnation in the lungs of a large amount of sputum (the phenomenon of "swamping of the lungs"). Therefore, the combined use of such drugs is contraindicated. Especially carefully it is necessary to use drugs of this class in children of the first year of life with an imperfect cough reflex, and in those prone to a rapid deterioration in mucociliary clearance. It should be noted that "swamping of the lungs" with the use of mucolytics is extremely a rare occurrence. However, this phenomenon can develop if the patient has a violation of mucociliary transport, a weak cough reflex, and the irrational use of expectorant drugs.
In many years of clinical practice, both in adults and children, the drug acetylcysteine ​​- ACC has proven itself and is widely used. Indications for its use are acute, recurrent and chronic diseases of the respiratory tract, accompanied by the formation of viscous sputum. These are acute and chronic bronchitis with an unproductive cough, incl. smoker's bronchitis. Application of ACC necessary for patients who are constantly exposed to adverse factors: working in hazardous industries, living in large cities, near industrial enterprises, smokers. Compared to other mucolytics (including ambroxol), the secretolytic effect of ACC develops faster, which makes the choice of the drug preferable for acute respiratory infections, especially in urban residents. Besides, therapeutic effect enhance the antioxidant properties of ACC. Optimal is the appointment of ACC and patients with mucopurulent or purulent sputum.
ACC can be used in children from 2 years of age without a prescription, and in infants under 2 years of age - only on the recommendation of a doctor (prescription). ACC is produced in granules and effervescent tablets for the preparation of a drink, incl. hot, in dosages of 100, 200 and 600 mg and is applied 2-3 times / day. Doses depend on the age of the patient. Usually, children from 2 to 5 years old are recommended 100 mg of the drug per dose, over 5 years old - 200 mg each, always after meals. ACC 600 (Long) is prescribed 1 time / day, but only for children over 12 years old. The duration of the course depends on the nature and course of the disease and ranges from 3 to 14 days for acute bronchitis and tracheobronchitis, with chronic diseases- 2-3 weeks. If necessary, courses of treatment can be repeated. Injectable forms of ACC can be used for intravenous, intramuscular, inhalation and endobronchial administration. The duration of the course depends on the nature and course of the disease and ranges from 3 to 14 days for acute bronchitis and tracheobronchitis, and 2-3 weeks for chronic diseases. If necessary, courses of treatment can be repeated.
It is well known that delivery methods, organoleptic properties and even appearance medicines in pediatrics are no less important than the medicine itself. The effectiveness of the drug largely depends on the method of delivery. Acetylcysteine ​​preparations for oral administration were previously presented only in the form effervescent tablets and granules for solution, which was not well suited for the treatment of young children and therefore limited the use of these highly effective mucolytics. Therefore, the emergence of a new over-the-counter form of acetylcysteine ​​in the most popular pediatric ACC dosage form (granules for syrup preparation: 100 mg of acetylcysteine ​​per 5 ml of syrup) is of undoubted interest.
The advantages of the new form of ACC are obvious: the drug does not contain sugar and alcohol, it is distinguished by pleasant organoleptic properties, it is possible to dose ACC for children under 2 years of age. Practical packaging is designed for a full course of treatment.
Method of application and dosage of ACC: in the dosage form of granules for the preparation of syrup. Apply after meals. Children under the age of 2 years are recommended to take 2-3 times / day. 2.5 ml (1/2 measuring spoon), children aged 2-5 years - 2-3 times / day. 5 ml (1 scoop), children aged 6-14 years - 3-4 times / day. 5 ml (1 measuring spoon).
Discussing the rational use of mucolytics, it should be noted that the most widely used in pediatric practice are preparations based on acetylcysteine ​​and ambroxol. Comparative clinical studies of the efficacy and safety of mucolytic drugs indicate the indisputable advantage of acetylcysteine ​​and ambroxol compared to bromhexine in both acute and chronic bronchopulmonary diseases.
Ambroxol belongs to a new generation of mucolytic drugs, is a metabolite of bromhexine and gives a more pronounced expectorant effect. In pediatric practice, in the complex therapy of the respiratory system, it is preferable to use ambroxol preparations that have several dosage forms: tablets, syrup, solutions for inhalation, for oral administration, for injection and endobronchial administration.
Ambroxol affects the synthesis of bronchial secretions secreted by the cells of the bronchial mucosa. The secret is liquefied by the breakdown of acid mucopolysaccharides and deoxyribonucleic acids, while secretion is improved. An important feature ambroxol is its ability to increase the content of surfactant in the lungs, blocking the breakdown and enhancing the synthesis and secretion of surfactant in type 2 alveolar pneumocytes. There are indications of stimulation of surfactant synthesis in the fetus if ambroxol is taken by the mother.
Ambroxol does not provoke bronchial obstruction. Moreover, K.J. Weissman et al. . showed a statistically significant improvement in the performance of functions external respiration in patients with bronchial obstruction and a decrease in hypoxemia while taking ambroxol. The combination of ambroxol with antibiotics certainly has an advantage over using a single antibiotic. Ambroxol helps to increase the concentration of the antibiotic in the alveoli and bronchial mucosa, which improves the course of the disease in bacterial infections of the lungs.
Ambroxol is used for acute and chronic diseases respiratory organs, including bronchial asthma, bronchiectasis, respiratory distress syndrome in newborns. You can use the drug in children of any age, even in premature babies. Perhaps the use of pregnant women in the 2nd and 3rd trimesters of pregnancy.
When studying the effectiveness of ambroxol and acetylcysteine ​​in chronic lung diseases, a certain advantage of ambroxol was shown, especially if inhalation of the drug was necessary, however, in an acute infectious process, a higher efficiency of ACC was obvious (primarily due to a faster mucolytic effect and the presence of antioxidant and antitoxic drugs in the drug). properties).
In what cases is it preferable to prescribe ACC to children and, in particular, ACC in the form of a syrup? Firstly, if it is necessary to quickly achieve the effect of dilution and, accordingly, the removal of sputum from the respiratory tract. It is ACC, due to its direct effect on the rheological properties of sputum, that acts quickly and effectively. Ambroxol, having mainly mucoregulatory action, affects the rheological properties of sputum in the direction of reducing its viscosity after a longer time. Secondly, ACC has the ability to break down purulent sputum, which is not a property of ambroxol, and this is very important in bacterial infections, when it is necessary to quickly help evacuate purulent sputum from the respiratory tract and prevent the spread of infection. Therefore, when prescribing antibiotics for bacterial infections of the respiratory tract, it is rational to choose ACC as a drug for treating cough.
To evaluate the safety and efficacy of mucolytics, including different methods delivery, we conducted a comparative study of some expectorant and mucolytic drugs in children of different age groups suffering from acute and chronic bronchopulmonary diseases for 3 years. The work was carried out under the guidance of employees of the Department of Children's Diseases of the Russian State Medical University at three clinical bases in Moscow: Children's Clinical Hospital No. 38 FU MEDBIOEKSTREM, Morozov City Children's Clinical Hospital, and the maternity hospital at City Clinical Hospital No. 15.
In total, the study included 259 children with acute and chronic bronchopulmonary pathology aged from the first days of life to 15 years. Of these, 92 children received acetylcysteine ​​granulate ( tradename ACC-100, 200), 117 children - ambroxol in the form of tablets, syrup, inhalation and injection, 50 patients made up the comparison group (of which 30 patients were prescribed bromhexine, 20 - mukaltin). The methods of drug administration depended on the nature of the respiratory pathology and the age of the child. The drugs were used in the usual therapeutic dosages, the duration of therapy was from 5 to 15 days. The timing of the onset of a productive cough, its decrease in intensity, and the time of recovery were assessed. In addition, the viscosity of sputum was assessed.
The exclusion criterion was the use of other mucolytics, expectorants or antitussives less than 14 days prior to the start of the study.
As a result of the observations, it was found that the best clinical effect in children with acute bronchitis was obtained by using acetylcysteine. So, on the 2nd day after the appointment of ACC, the cough increased somewhat, but became more productive, on the 3rd day of treatment, the cough weakened and disappeared on the 4th-5th day of the drug. With the appointment of ambroxol in half of the children, the intensity of cough significantly decreased on the 4th day of therapy, on the 5th-6th day, as a rule, the child recovered. Bromhexine in our study demonstrated a good mucolytic effect, but contributed to the improvement of the rheological properties of sputum and a decrease in cough intensity on average 1-2 days later than ambroxol and 2-3 days later than acetylcysteine. When prescribing Mukaltin, the cough was quite pronounced for 6-8 days and recovery occurred by the 8-10th day from the onset of the disease. unwanted effects and adverse reactions was not found in our work.
Thus, as a result of the study, it was found that in children with acute bronchitis, the best clinical effect was achieved when using ACC. When prescribing bromhexine and ambroxol, a pronounced mucolytic effect was also noted, but at a later time than that of acetylcysteine ​​from the start of treatment. Mukaltin had the least clinical efficacy.
One of the observation groups in our study was patients with bronchial asthma (BA) aged 3 to 15 years. In the attack period of BA when prescribing ACC in complex therapy best effect was achieved in children of the younger age group. At the same time, the appointment of ACC to children in the post-attack period of bronchial asthma with the development of bronchitis complicated by a bacterial infection, of course, contributed to the speedy resolution of the disease in all observed patients. We did not observe an increase in broncho-obstructive syndrome in children with BA.
As a result of the study, it was found that in children of the first three years of life with bronchopulmonary diseases, the best clinical effect was achieved when using acetylcysteine. When prescribing bromhexine and ambroxol, a pronounced mucolytic effect was also noted, but at a later time than that of acetylcysteine ​​from the start of treatment. Mukaltin had the least clinical efficacy.
In older children with bronchospasm, the best clinical effect was obtained with the appointment of ambroxol or bromhexine in combination with b2-agonists. The combination of inhalation and oral administration of ambroxol was optimal. Appointment of acetylcysteine ​​was not so effective in the treatment of broncho-obstructive diseases. At the same time, in older children suffering from respiratory pathology without broncho-obstructive syndrome, acetylcysteine ​​had the best clinical effect.
When studying the effectiveness of ambroxol and acetylcysteine ​​in chronic lung diseases, some advantage of ambroxol was shown, especially when inhalation and / or endobronchial administration of the drug is necessary.
Thus, in the complex therapy of respiratory diseases in children, mucolytic drugs are the most commonly used, but their choice should be strictly individual and it is necessary to take into account the mechanism pharmacological action drug, the nature of the pathological process, the premorbid background and the age of the child. Acetylcysteine ​​and ambroxol preparations are widely used in pediatric practice throughout the world. Experience in the clinical use of acetylcysteine ​​in the treatment of children has demonstrated its effectiveness in acute respiratory diseases, as well as in diseases of the respiratory organs, accompanied by the accumulation of mucous or mucopurulent secretions in the respiratory tract. However, in pediatric practice, especially in young children, with acute respiratory diseases, it is preferable to use ACC in the dosage form of granules for the preparation of syrup, the high efficiency of which, good organoleptic properties and ease of packaging increase the compliance of therapy. It can be recommended to use ACC syrup more widely in the treatment of bronchopulmonary diseases in children.

Literature
1. Belousov Yu.B., Omelyanovsky V.V. Clinical pharmacology of respiratory diseases in children. Guide for doctors. Moscow, 1996, 176 p.
2. Korovina N.A. et al. Antitussive and expectorant drugs in the practice of a pediatrician: rational choice and tactics of use. A guide for doctors. M., 2002, 40 p.
3. Samsygina G.A., Zaitseva O.V. bronchitis in children. Expectorant and mucolytic therapy. A guide for doctors. M., 1999, 36 p.
4. Balyasinskaya G.L., Bogomilsky M.R., Lyumanova S.R., Volkov I.K. The use of Fluimucil® (N-acetylcysteine) in lung diseases // Pediatrics. 2005. No. 6.
5. Weissman K., Niemeyer K. Arzneim. Forsch./Drug Res. 28(1), Heft 1, 5a (1978).
6. Bianchi et al. Ambroxol inhibits interleukin 1 and tumor necrosis factor production in human mononuclear cells. Agents and Actions, vol.31. 3/4 (1990) p.275-279.
7. Carredu P., Zavattini G. Ambroxol in der Padiatrie Kontrollierte klinishe stadie gegen Acetylcystein. Asthma, Bronchitis, Emphysema 4 (1984), p.23-26.
8. Disse K. The pharmacology of ambroxol - review and new resalts. Eur. J. Resp. Dis. (1987) 71, Suppl. 153, 255-262.

Increased formation (hypersecretion) of mucus in the respiratory tract accompanies many acute infections, as well as other pulmonary pathologies. With this phenomenon, it is necessary to take expectorant and mucolytic drugs. Their main purpose is to improve the expectoration of sputum and / or reduce its formation.

Mucoactive drugs are divided according to their mode of action into expectorants, mucoregulators, mucolytics and mucokinetics. You can classify them into other groups, but it is this approach that makes it possible to more accurately select the drug necessary for coughing.

A little about the formation of sputum

Accumulation of sputum due to inflammation of the airway wall

At healthy people mucus is secreted in a normal amount and is continuously removed by the ciliated epithelial cells towards the larynx, and then enters the nasopharynx and is swallowed. An increase in mucus secretion can become a problem, especially if the rate of secretion exceeds the rate of movement of sputum particles by ciliated epithelial cells.

hypersecretion of mucus feature ARI, as well as bronchial asthma, COPD and,. During inflammation caused by infection, there is an increase in the number and size of the so-called goblet cells located in the submucosal glands. There is secretory hyperactivity.

Inflammation causes loss of function and destruction of the cilia of the epithelium, a change in the physicochemical properties of the mucous membrane and a violation of the normal composition of sputum. During this process, dead bacteria accumulate and immune cells, desquamated epithelium, forming pus.

Mucus, which forms the basis of sputum, is an oligomer, which consists of water and high molecular weight proteins that form a gel. Medicines that change the physical or chemical characteristics of sputum are called mucoactive and, depending on the main effect, are divided into groups.

Expectorants and mucolytics are prescribed:

• with bronchitis;
• with tracheitis;
• with influenza and acute respiratory infections;
• with smoker's bronchitis;
• with asthma.

Expectorants

These medicines make it easier to cough up phlegm and are better for dry coughs.

thermopsis

Thermopsis cough tablets are a popular expectorant

This substance is well tolerated. Only sometimes after its appointment, a violation of the stomach is possible, liquid stool or signs of bleeding. Possible skin rash or itching.

Contraindications:

• exacerbation of stomach and duodenal ulcers;
• chronic glomerulonephritis of any etiology in the acute stage;
• 1st trimester of pregnancy;

Carbocysteine ​​can be prescribed to children from 1 month in the appropriate dosage.

Medicines containing this substance:

• Bronchobos (syrup and capsules);
• Libeksin Muko (syrup);
• Fluifort (syrup and soluble granules);
• Fluditec (syrup).

Anticholinergic drugs (ipratropium bromide), glucocorticoids, macrolides also have moderate mucoregulatory properties. However, the main effects of these drugs are different, so they are not used for the direct purpose of changing sputum characteristics.

Mucolytics

These drugs reduce the viscosity of sputum, giving it a "fluidity". They are used if the sputum is too thick.

Acetylcysteine

Acetylcysteine ​​thins phlegm

The substance directly affects long molecules and breaks the chemical bonds between them. As a result, the polymeric properties of the mucus weaken, its viscosity decreases. Acetylcysteine ​​is also active against purulent sputum, which distinguishes it from many other drugs.

The substance has an antioxidant effect, that is, it protects cell membranes from the harmful effects of toxins and metabolic products. It enhances the production of glutathione in the body, a substance that actively removes toxins and free radicals.

Acetylcysteine ​​is prescribed for viscous and / or mucopurulent sputum in such cases:

• inflammation of the trachea, bronchi, lungs;
• bronchiectasis;
• lung atelectasis;
• asthma;
• sinusitis.

It can also be given to children as young as 2 years of age. Possible side effects:

• rarely - pathology of the stomach, diarrhea;
• skin rash and itching, bronchospasm;
• when used in a nebulizer - a strong cough, stomatitis;
• nose bleed;
• noise in ears.

Acetylcysteine ​​is contraindicated in exacerbation of gastric and duodenal ulcers, hemoptysis, pregnancy and breastfeeding and in case of drug intolerance. Between taking this substance and antibiotics, you need to take a break of 2 hours.

List of products with acetylcysteine:

• Acestine (tablets regular and soluble);
• Acetylcysteine ​​(powder and soluble tablets);
• ACC (soluble granules, syrup);
• ACC 100 (soluble tablets);
• ACC Inject (solution for deep intramuscular or intravenous administration);
• ACC Long (soluble tablets);
• Vicks Active Expectomed (soluble tablets);
• N-Ac-Ratiopharm (powder and soluble tablets);
• Fluimucil (solutions for oral administration, for inhalation and injection, soluble granules and tablets).

Dornase alfa

The modern drug Pulmozyme is used as a mucolytic in cystic fibrosis. It is based on a genetically engineered enzyme that cleaves extracellular DNA.

When such an aerosol enters the bronchi and lungs, viscous, purulent, with altered properties of sputum in cystic fibrosis splits and liquefies, which greatly enhances its excretion.

In addition to cystic fibrosis, dornase alfa can be used for bronchiectasis, severe COPD, congenital malformations of the lungs, pneumonia against the background of immunodeficiencies.

Side effects of this drug are extremely rare, and their frequency is the same as that of a placebo (neutral non-drug). Most patients who experience any adverse effects associated with the use of Pulmozyme can continue to use it. This aerosol is introduced using a special device - a jet nebulizer. It is contraindicated only with individual intolerance.

Erdostein

Erdomed - modern drug From cough

This substance is the basis of the drug Erdomed, produced in capsules and soluble granules. Such a mucolytic was synthesized quite recently. In addition to mucolytic and antioxidant properties, it reduces the ability of bacteria to "stick" to the wall of the respiratory system. The drug is used in the treatment of bronchitis, COPD, bronchiectasis, sinusitis and other conditions with thick sputum. It is especially indicated for use in smokers.

Contraindications include:

• age up to 2 years;
• 1st trimester of pregnancy;
• for granules - phenylketonuria;
• homocystinuria;
• insufficiency of liver or kidney function;
• individual intolerance.

Side effects are rare. it allergic reaction, nausea, vomiting and loose stools.

Mucokinetics

These drugs are used for obsessive, unproductive coughs to increase the excretion of mucus and clear the bronchi. They act mainly on the cilia of the epithelium, and also reduce the “cohesion” between the mucous membrane and sputum particles. These drugs are Ambroxol and Bromhexine.

Ambroxol

This remedy makes sputum liquid and clears the bronchi of it. Acting on the glandular cells, Ambroxol enhances the production of the liquid part of the mucus. Under its influence, the amount of surfactant in the lungs increases, which ensures the expansion of the alveoli. The drug activates the work of the cilia of the epithelium. Cough under its action is reduced slightly.

Indications:

• bronchitis;
• asthma;
• bronchiectasis;
• respiratory distress syndrome.

You can use the medicine from birth. It is well tolerated, only occasionally causing stomach upset or allergies.

Ambroxol is contraindicated in such cases:

• peptic ulcer;
• 1st trimester of pregnancy;
• convulsions;
• lactation.

Ambroxol drug list:

• Ambrobene (capsules, oral solution and nebulizer, tablets, syrup, solution for intravenous administration);

• Ambrohexal;
• Ambroxol;
• Ambrolor;
• Ambrosan;
• Bronchoxol;
• Bronchorus;
• Lazolvan;
• Lazongin;
• Medox;
• Neo-bronchol;
• Remebrox;
• Suprima-Kof;
• Thoraxol Solution Tablets;
• Flavamed;
• Halixol.

Bromhexine

Bromhexine is a safe cough medicine.

In chemical structure, it is very similar to ambroxol. It is used to combat viscous sputum in tracheitis, bronchitis, asthma, cystic fibrosis and COPD.

The drug is used for oral administration and for. Its effect develops gradually, often only after a few days of use. However, low toxicity and the possibility of use in children of any age make bromhexine a popular mucokinetic drug.

Possible side effects: nausea, stomach discomfort, headache, dizziness, skin rash, sweating, bronchospasm.

The only contraindication is the individual intolerance of the drug, which distinguishes it favorably from Ambroxol.

List of drugs based on bromhexine:

• Bromhexine;
• Bronchostop;
• Solvin.

Multicomponent expectorants and mucolytics

With a persistent cough, drugs are often used that contain several ingredients that mutually reinforce the effect.

Many of these medicines are available without a doctor's prescription. Therefore, it is worth studying the features of their purpose before buying at a pharmacy and choosing the most suitable for yourself. medicine. Here we do not stop at herbal medicine and non-drug methods of cough treatment.

ACC is a mucolytic agent that thins viscous sputum, making it easier to clear from the bronchi. It goes well with other cough medicines, increases the effectiveness of antibiotics. The composition of the active substance includes acetylcysteine. ACC is available in different dosage forms for adults and children from a young age.

In case of intolerance or the occurrence of persistent side effects, the drug is replaced by analogues. Some of them are identical in structure to the original and are called generics. Others contain other active substances, but have the same therapeutic effect. The cost of analogues is often cheaper, which reduces the cost of treatment. The effectiveness of such drugs is not inferior to the original, and in some cases they have advantages in therapy.

Manufacturer Sandoz (Slovenia) or Geksal (Germany), depending on the dosage form.

Composition and mechanism of action

Active substance in the composition of ACC it is represented by acetylcysteine, a derivative of the amino acid cysteine. This is the main component of the drug, which determines the therapeutic effect on the body. Acetylcysteine ​​affects the rheological properties of sputum, which leads to a decrease in its viscosity. It can liquefy both mucous and purulent bronchial secretions.

In addition to mucolytic, it has an antioxidant effect. Neutralizes free radicals formed during inflammation, thereby protecting the bronchial mucosa from damage. Warns attachment pathogenic bacteria and can be used to prevent respiratory diseases.

The excipients include sucrose and lactose. This should be taken into account when prescribing therapy for patients with diabetes and impaired absorption of carbohydrates in the body.

>>Recommended: if you are interested effective methods getting rid of chronic rhinitis, pharyngitis, tonsillitis, bronchitis and constant colds, then be sure to look at this website page after reading this article. The information is based on personal experience the author and helped many people, we hope it will help you. Now back to the article.<<

Dosage forms

ACC is available in several dosage forms for ease of use for adults and children. All options are presented in a liquid consistency, which improves absorption in the digestive tract and softens the irritating effect on the gastric mucosa.

The drug can be purchased in effervescent tablets of 100 mg, which must be dissolved in a glass of water. They have a pleasant blackberry flavor. Mostly given to adults. Children may not like the drug due to the presence of a faint sulfuric odor.

The next dosage form is granules in sachets of 100 mg for the preparation of a solution that is taken orally. They are poured into a glass of water and stirred until a homogeneous liquid appears. The granules can also be diluted in juice or iced tea. The solution has a citrus smell and taste, prescribed for adults and children.

Transparent viscous syrup - the third form of the drug. It has a cherry flavor and a sweet smell. Recommended for use in children, especially at an early age. To take the prescribed dose, use a measuring syringe or cup, which are included in the package.

Indications and contraindications

The drug is used for diseases of the lower, less often upper respiratory tract. ACC shows high efficiency when coughing due to viscous sputum, which is difficult to separate from the bronchi. In chronic pathology of the respiratory system, the drug is included in maintenance therapy along with other drugs.

Professor S.I. Ovcharenko
MMA named after I.M. Sechenov

Chronic obstructive pulmonary disease (COPD) is currently considered as a group of environmentally dependent respiratory diseases (A.G. Chuchalin, 2001) . This primarily emphasizes the decisive role of environmental pollutants (tobacco smoke, occupational dust, chemical vapors, combustion products) both in the development of the disease itself and in the formation of its exacerbations. In addition, infectious factors play a significant role in the development of exacerbations of COPD.

In response to the impact of a damaging infectious and non-infectious agent, the first reaction of the mucosa of the tracheobronchial tree is the development of an inflammatory reaction with mucus hypersecretion. Up to a certain point, the hyperproduction of mucus is protective, but in the future, not only the quantity, but also the quality of the bronchial secretion changes. The secreting elements of the inflamed mucosa begin to produce viscous mucus, as its chemical composition changes towards an increase in the content of glycoproteins. This, in turn, leads to an increase in the gel fraction, its predominance over the sol, and, accordingly, to an increase in the viscoelastic properties of bronchial secretions. The development of hyper and dyscrinia is also facilitated by a significant increase in both the number and area of ​​distribution of goblet cells up to the terminal bronchioles.

The change in the viscoelastic properties of the bronchial secretion is accompanied by significant qualitative changes in its composition: a decrease in the content of secretory IgA, interferon, lactoferrin, lysozyme, the main components of local immunity, which have antiviral and antimicrobial activity.

As a result of deterioration of the rheological properties of bronchial secretions the mobility of the cilia of the ciliated epithelium is also impaired , which blocks their cleansing function. With an increase in viscosity, the speed of movement of bronchial secretions slows down or stops altogether. Thick and viscous bronchial secretion with reduced bactericidal potential is a good nutrient medium for various microorganisms (viruses, bacteria, fungi).

An increase in viscosity, a slowdown in the advancement of bronchial secretions contributes to fixation, colonization and deeper penetration of microorganisms into the thickness of the bronchial mucosa. This leads to an aggravation of the inflammatory process, an increase in bronchial obstruction, and the formation of oxidative stress.

In turn, oxidative stress with the release of a large amount of active radicals in the airways contributes to the development of centrilobular emphysema, and subsequently leads to a gradual loss of the reversible component of bronchial obstruction and an increase in its irreversible component. As is known, the reversible component of bronchial obstruction is formed and prevails in the early stages of the disease. It develops as a result of three components: spasm of smooth muscles, inflammatory edema of the bronchial mucosa, hyper and dyscrinia of bronchial secretions in combination with a violation of mucociliary clearance.

Thus, the circumstances outlined above emphasize the need for the use of drugs in the treatment of patients with COPD that improve or facilitate the separation of pathologically altered bronchial secretions, prevent mucostasis, and improve mucociliary clearance. With the relief of secretion, one of the important factors of reversible bronchial obstruction is also eliminated, and the likelihood of microbial colonization of the respiratory tract is also reduced. This is achieved largely through the use of mucolytic (mucoregulatory) drugs.

According to the mechanism of action, all mucolytics are not means of influencing the main pathogenetic link in COPD - the inflammatory response; they affect the symptoms of the disease (the so-called symptomatic therapy).

The most common are three groups of drugs: ambroxol and its derivatives; carbocysteine ​​and its derivatives; acetylcysteine ​​and its derivatives. The use of proteolytic enzymes as mucolytics is unacceptable due to possible damage to the lung matrix and a high risk of serious side effects such as hemoptysis, allergic reactions and bronchospasm.

Ambroxol

Ambroxol is the active metabolite of bromhexine, a synthetic derivative of the alkaloid vasicin. Bromhexine is administered orally at a daily dose of 3248 mg. When administered orally, bromhexine is converted to the active metabolite ambroxol, and its action is similar to that of ambroxol.

In wide therapeutic practice, various drugs derived from ambroxol chloride and hydrochloride are successfully used.

The mechanism of action of ambroxol is multifactorial. Ambroxol acts as a secretomotor, activating the movement of cilia, it is able to restore mucociliary transport. In addition, the mechanism of action of ambroxol is associated with the stimulation of the formation of low viscosity trachebronchial secretion due to a change in the chemistry of its mucopolysaccharides.

A very important property of ambroxol and its derivatives is the ability to stimulate the production of surfactant, increasing its synthesis, secretion and inhibiting its decay. Being one of the components of the local lung defense system, surfactant prevents the penetration of pathogenic microorganisms into the epithelial cells. The surfactant also enhances the activity of the cilia of the ciliated epithelium, which, combined with an improvement in the rheological properties of the bronchial secretion, leads to an effective cleansing of the respiratory tract, helping the patient to cough well.

The daily dose of ambroxol when taken orally ranges from 60 to 120 mg.

In recent years, publications have appeared describing the anti-inflammatory and antioxidant properties of ambroxol, which can be explained by its effect on the release of oxygen radicals and interference with the metabolism of arachidonic acid in the inflammation site. These data need further clarification.

Carbocysteine

The second group of mucolytic drugs are derivatives of carbocysteine, which simultaneously have both mucolytic (change the viscosity of bronchial secretion) and mucoregulatory effect (increase the synthesis of sialomucins). The mechanism of action of carbocysteine ​​is associated with the activation of sialic transferase enzyme of the goblet cells of the bronchial mucosa, which form the composition of the bronchial secretion. At the same time, under the action of carbocysteine, the mucous membrane is regenerated, its structure is restored, the number of goblet cells decreases (normalization), especially in the terminal bronchi, and hence the amount of mucus produced decreases. In addition, the secretion of immunologically active IgA (specific protection) and the number of sulfhydryl groups (nonspecific protection) are restored, mucociliary clearance improves (the activity of ciliated cells is potentiated). At the same time, the effect of carbocysteine ​​extends to all the upper and lower respiratory tract involved in the pathological process, as well as the paranasal sinuses, middle and inner ear.

Unfortunately, carbocysteine ​​preparations are available only for oral administration (in the form of capsules, granules and syrups). When prescribing carbocysteine ​​preparations, some precautions should be observed: it is not advisable to simultaneously use other drugs that suppress the secretory function of the bronchi, and cough preparations. Drugs should not be prescribed to patients with diabetes mellitus, since one tablespoon of syrup contains 6 g of sucrose.

fenspiride

Improving the work of mucociliary transport can be achieved in another way. Recently, the arsenal of drugs used to treat bronchopulmonary diseases accompanied by broncho-obstructive syndrome has been replenished with a new drug, a derivative of fenspiride Erespalom . Despite the fact that the drug does not have a direct mucolytic and expectorant effect, it can be indirectly attributed to mucoregulators due to its anti-inflammatory properties. Erespal, acting on the key links of the inflammatory process and having a high tropism in relation to the respiratory tract, reduces swelling of the bronchial mucosa and hypersecretion. In addition, it significantly increases the rate of mucociliary transport and counteracts bronchoconstriction. All this leads to an improvement in sputum discharge, a decrease in cough and shortness of breath.

Acetylcysteine

Active mucolytic drugs are derivatives of Nacetylcysteine. These drugs are characterized direct action on the molecular structure of mucus . The acetylcysteine ​​molecule contains sulfhydryl groups that break the disulfide bonds of sputum acid mucopolysaccharides, while depolymerization of macromolecules occurs, and sputum becomes less viscous and is easier to cough up. Acetylcysteine ​​preparations are administered orally in a daily dose of 6001200 mg, divided into 34 doses, in solution in the form of inhalations (2 ml of a 20% solution), intrabronchial instillations of 1 ml of a 10% solution or bronchial lavage during therapeutic bronchoscopy. A significant advantage of acetylcysteine ​​is its antioxidant activity. Nacetylcysteine ​​is a precursor of one of the most important components of the antioxidant defense of glutathione, which performs a protective function in the respiratory system and prevents the damaging effects of oxidants. This quality is especially important for elderly patients, in whom oxidative processes are significantly activated and the antioxidant activity of blood serum decreases.

Of all acetylcysteine ​​preparations, the most active is fluimucil . It also has the least pronounced side effects: it practically does not irritate the gastrointestinal tract. The advantage of fluimucil is the possibility of using its solution during nebulizer therapy in patients with COPD, using its antioxidant activity.

However, when prescribing acetylcysteine ​​drugs, it should be remembered that their long-term use is not advisable, since in this case they can suppress mucociliary transport and secretory IgA production.

In some cases, the mucolytic effect of acetylcysteine ​​may be undesirable because the state of mucociliary transport is negatively affected by both an increase and an excessive decrease in the viscosity of the secret. Meanwhile, acetylcysteine ​​is sometimes able to exert an excessive diluting effect, which can cause a syndrome of the so-called flooding of the lungs and even require the use of suction to remove the accumulated secret.

In the treatment of infectious and inflammatory processes in patients with COPD, it is often prescribed antibiotics . Antibacterial therapy is known to significantly increase the viscosity of sputum due to the release of DNA during the lysis of microbial bodies and leukocytes. In this regard, it is necessary to take measures that improve the rheological properties of sputum and facilitate its discharge. One of these methods is administration of mucolytics in combination with antibiotics .

When prescribing them at the same time, the following information about their compatibility should be taken into account. When taking acetylcysteine ​​orally, antibiotics should be taken no earlier than 2 hours later. Acetylcysteine ​​preparations for inhalation or instillation should not be mixed with antibiotics, as this causes their mutual inactivation. The exception is fluimucil, for which a special form has even been created: fluimucil + IT antibiotic (thiamphenicol glycinate acetylcysteinate). It is available for inhalation, parenteral, endobronchial and topical use. Thiamphenicol glycinate acetylcysteinate is a complex compound that combines the antibiotic thiamphenicol and fluimucil in its composition. Thiamphenicol has a wide spectrum of antibacterial action. It is effective against bacteria that most commonly cause respiratory tract infections. Fluimucil effectively dilutes sputum and facilitates the penetration of thiamphenicol into the area of ​​inflammation, inhibits the adhesion of bacteria to the epithelium of the respiratory tract.

The Federal Program, which provides recommendations for the treatment of COPD, recommends the appointment of mucolytics (mucoregulators) for mucostasis symptoms without exacerbation. In the treatment of COPD exacerbation, it is possible to prescribe mucoregulatory agents through a nebulizer. For this, special solutions of ambroxol (lazolvan) and acetylcysteine ​​(fluimucil) are used.

Lazolvan can be used together with bronchodilators in the same nebulizer chamber. This is extremely important, since bronchodilator therapy in the treatment of patients with COPD is currently the basic therapy.

Bronchodilator therapy potentiates the action of mucolytics and enhances their activity. So, b2 agonists and theophyllines activate mucociliary clearance, increasing secretion, and Mholinolytics (ipratropium bromide), reducing inflammation and swelling of the mucosa, facilitate sputum discharge.

However, data on the use of mucolytics (mucoregulators) in the treatment of patients with COPD are ambiguous. The mucolytic properties of these drugs, their ability to reduce adhesion and activate mucociliary clearance are successfully implemented in COPD patients with dyscrinia and hypersecretion. In the same place where bronchial obstruction is associated with bronchospasm or irreversible phenomena, mucoregulators (mucolytics) do not find a point of application.

This statement is confirmed by the analysis of the Cochrane Library databases (a list of studies compiled by the problem group on respiratory diseases and containing information from the MEDLINE, EMBASE / Excerpta Medica, CINAHL databases, specialized journals, conference proceedings) search by keywords: COPD, COPD, mucolytic drugs, Nacetylcysteine, ambroxol, bromhexine, Scarbocysteine, iodoglycerol. The review included 15 randomized, double-blind, placebo-controlled studies on the use of the above oral mucolytic drugs for 2 months. The analysis revealed significant heterogeneity among the trials included in the review. The observed slight decrease in the average number of days of disability and the number of exacerbations after treatment indicates that the role of oral mucolytic drugs in the treatment of exacerbations of COPD is small.

The effectiveness of mucolytics in COPD continues to be actively studied. But the ambiguous data of studies on COPD did not allow the inclusion of these drugs in the number of basic therapies for patients with COPD. The GOLD program (2001) states: Although in some patients with viscous sputum, the use of mucolytics (mucoregulators, mucokinetics) leads to an improvement in the condition, in general, the effectiveness of mucolytics is low. There is a low level D level of evidence of the effectiveness of the use of mucolytics in the treatment of patients with COPD.

A separate line in the GOLD program discusses the effect of Nacetylcysteine ​​derivatives as antioxidants. Antioxidants, including Nacetylcysteine, have been reported to reduce the incidence of COPD exacerbations and may be of value in the management of patients with frequent exacerbations (Evidence B). However, before widespread use in practice, the results of ongoing randomized placebo-controlled trials must be obtained and carefully evaluated.

Summarizing the above, it should be emphasized that, according to the mechanism of action, mucolytic drugs are not agents that directly affect the main pathogenetic link in COPD, the inflammatory response. They belong to the group of so-called symptomatic drugs. The appointment of mucolytics is justified in the complex therapy of patients with COPD, in which the processes of dyscrinia and hypercrinia predominate, since it is in this situation that the action of mucolytic drugs is most fully realized.

Literature:

2. Shmelev E. I. Pathogenesis of inflammation in chronic obstructive pulmonary diseases. In the book: Chronic obstructive pulmonary disease (edited by A. G. Chuchalin). M., 1998: 82 92.

3. Sinopalnikov A.I., Klyachkina I.L. The place of mucolytic drugs in the complex therapy of respiratory diseases. Russian medical news, 1997; 2 (4): 9 18.

4. Chronic obstructive pulmonary disease. federal program. M., 1999: 15 36.

5. Volkova L. I. et al. Experience in the use of fenspiride (erespal) in exacerbation of chronic bronchitis. Clinical pharmacology and therapy, 2000; 5:65 68.

6. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease: NHLBI / WHO Workshop. 2001: 19.