Antitussive drugs with anesthetic effect. Antitussives - which are better for children and adults

Antitussive drugs are used to suppress attacks that are not due to the need to remove sputum from the respiratory tract. In other words, their appointment is advisable for dry cough. Centrally acting antitussive drugs affect the cough center in the medulla oblongata.

Dry cough - an indication for the appointment of centrally acting drugs

Mechanism of action

With irritation of the cough center, localized in the medulla oblongata, an involuntary cough occurs. If the attacks are unproductive, dry, then they should be suppressed. For this purpose, antitussive drugs with a central mechanism of action are prescribed.

These drugs are suppressed by inhibiting the corresponding areas in the medulla oblongata. This pharmacological group includes morphine derivatives - ethylmorphine, codeine and glaucine, as well as butamirate, prenoxdiazine and oxeladin.

It is important that the action does not affect the respiratory center, which is located in close proximity to the cough. Of these drugs, only codeine and ethylmorphine affect it.

A distinctive property of prenoxdiazine is the ability to reduce the sensitivity of the mucous lining of the respiratory tract. That is, the drug has a local anesthetic effect on areas sensitive to irritation.

Classification categories

Antitussive drugs of central action are divided into narcotic and non-narcotic. Non-narcotic drugs are conditionally divided into those similar in structure to opiates (glaucine, dextromethorfon) and those different in structure (oxeladin, butamirate, pentoxyverine).

Drugs include codeine. Structurally, it is a methylated derivative of morphine.

Opioid receptor agonist. The effect of codeine is similar to morphine, but the analgesic characteristics are less pronounced, the ability to reduce the excitability of the cough center is well expressed.

Codeine depresses the respiratory center, but to a lesser extent than morphine. Another side effect of codeine is the ability to provoke constipation due to a deterioration in intestinal motility.

Non-narcotic drugs with a central mechanism of action include ethylmorphine and dextromethorphan (Alex Plus, Robitussin), butamirate (Sinekod), glaucine (Tusidil, Broncholitin) and oxeladin (Paxeladin). They partially suppress the cough center, while not inhibiting the respiratory center.

They are not inferior to codeine in terms of strength of action, while they do not provoke addiction, they do not affect intestinal motility. Butamirate and oxeladin also have a bronchodilator effect. Butamirate also has anti-inflammatory effects.

Note! Antitussives are not prescribed in case of increased sputum production. Also, they are not used for chronic cough, which is accompanied by excessive bronchial secretion (in case of smoking, asthma, emphysema).

Contraindications for use

Drugs are not prescribed in the following cases:

age up to 2 years;
hypersensitivity to drug components;
respiratory failure;
first trimester of pregnancy;
breastfeeding period;
drug dependence on opioid drugs;
peptic ulcer of the stomach and duodenum.

Non-narcotic drugs are not prescribed in case of hypersensitivity to the components, children under three years of age, women in the first trimester of pregnancy.

special instructions

In the case of prolonged use of codeine, it is required to control the blood picture, as well as indicators of the functional state of the kidneys and liver. As a result of the use of high doses, especially at the first stages of treatment, it is possible to slow down psychomotor reactions, and therefore codeine-containing drugs should not be used if it is necessary to drive vehicles and work on devices that require increased attention.

Side effects

Constipation is a common complication when taking narcotic antitussives.

Against the background of the use of narcotic drugs, the following adverse reactions are possible:

allergic manifestations;
discomfort of the digestive process, in particular, constipation;
dizziness;
thrombocytopenia;
violations of the functionality of the liver and kidneys;
attacks of bronchial asthma.

When using non-narcotic drugs, the following undesirable symptoms are likely:

nausea and vomiting;
diarrhea;
pain in the epigastric region
dizziness;
fatigue and drowsiness;
exanthema.

Important! Against the background of taking dextromethorphan, disturbances in sensory sensitivity, slurred speech, ataxia, and dysphoria are likely.

Antitussive drugs should be prescribed by a doctor. Self-medication is unacceptable. The dosage and duration of the course of treatment is determined by the specialist based on the characteristics of the clinical case.

Cough is a complex reflex protective act aimed at cleansing the respiratory tract from foreign particles or sputum. Irritation of the cough center medulla oblongata (a part of the brain) or mucous membrane of the respiratory tract causes an involuntary cough. Such a cough occurs with many diseases of the respiratory system. The most sensitive to irritation zones are in the larynx, trachea, large and medium bronchi. In addition, coughing can be caused or suppressed voluntarily, since the formation of the cough reflex is under the control of the cerebral cortex.

Cough is productive (with sputum) and unproductive (dry). Since an irritating non-productive cough is useless, it is best to suppress it. That is what is used for antitussives .

Depending on the point of application, antitussive drugs of central and peripheral action are distinguished.

Antitussive drugs of central action suppress the cough reflex, inhibiting the corresponding parts of the medulla oblongata. The main means of this group are derivatives of morphine - codeine And ethylmorphine , butamirate , glaucine , oxeladin And prenoxdiazine. It is very important that the respiratory center, which is also located in the medulla oblongata, remain unaffected. In addition to codeine and ethylmorphine, other drugs in this group do not depress the respiratory center. Prenoxdiazine also reduces the sensitivity of the mucous membrane of the respiratory tract (local anesthetic effect), where the zones are sensitive to irritation.

Antitussive drugs of peripheral action affect the sensitive endings in the mucous membrane of the respiratory tract. They have a softening and local anesthetic effect, reducing the flow of "cough stimuli" from the larynx, trachea and bronchi. A typical example of such a drug is acetylaminonitropropoxybenzene .

In connection with the undesirable side effects of codeine and ethylmorphine (depression of the respiratory center, decrease in respiratory volume, the possibility of addiction, and so on), more and more selective antitussive drugs, both central (glaucine, oxeladin, prenoxdiazine, and others), and peripheral (acetylaminonitropropoxybenzene, tipepidine) actions. These drugs are not addictive, so they are sometimes lumped together under the name "non-narcotic antitussives."

Have you noticed that in theaters and concert halls coughing is constantly heard, and it seems that the number of coughing people is increasing all the time. The way it is. This is another side of voluntary cough control. Excitement or anxiety about the inappropriateness of cough provoke it. Such factors are called psychogenic. In these cases, drugs that have a calming (sedative) effect can help.

The ability to soften, soothe a cough is possessed by some antihistamines , in particular diphenhydramine, better known as diphenhydramine .

Cough medicines are often included in combination cold and flu medicines, which we will discuss later in this chapter.

Individual antitussives are listed below, more details about all the drugs in this group can be found on the website.

[Tradename(composition or characteristic) pharmachologic effect dosage forms firm]

Codelac(herbal product) antitussive, expectorant tab. ICN Pharmaceuticals(USA)

Libeksin(prenoxdiazine) antitussive, antispasmodic, anti-inflammatory, local anesthetic tab. Sanofi-Synthelabo(France)

bluecode(butamirate) antitussive drops for oral administration for children; syrup Novartis Consumer Health SA(Switzerland)

Antitussive drugs in children's practice Dry, raw cough accompanies almost everyone and characterizes the initial stage of the interaction of the microorganism with the epithelium of the upper respiratory tract. As soon as the infectious process gains strength, that is, the infectious agent overcomes the mucous barrier and reaches the secreting glands, sputum appears, marking the qualitative transition of a dry cough into a wet one.

Depending on which microorganism caused the damage to the respiratory tract, sputum may be mucous or purulent. An excruciating cough, up to respiratory arrest, causes a pathogen that creates an epicenter of irritation in the brain stem.

Based on the mechanism of coughing, the antitussives used should either block cough receptors (on the mucous membrane of the respiratory tract or those in the medulla oblongata), or promote the discharge of secreted sputum.

It should be recalled that antitussives are only symptomatic therapy, which, ideally, should be supported by drugs designed to destroy the pathogen. So, all antitussive drugs are divided into two main groups:

In the first group, almost all drugs belong to drugs with a central mechanism of action, with the exception of libexin. Their action is based on the blockade of nerve impulses of the cough center. Ten years ago, microdoses of codeine were widely used for this purpose, added to prefabricated mixtures such as codelac and complex tablet preparations - codeine.

Medications used to suppress cough

Along with dose-dependent suppression of the cough center, such drugs thinned sputum and contributed to its excretion. But due to the increase in the percentage of the drug-addicted population, who bought up all pharmacy preparations containing opium alkaloids (in this case, codeine), a decree was issued banning the free sale of codeine-containing preparations from pharmacies. To replace it, a new line of drugs was developed, with the same mechanism of action, but not related to narcotic substances:

1. "Tusuprex". In the pharmacy market, it competed for the effectiveness of the action in parallel with codeine-containing drugs, but did not become a leader due to the cost. Available only in tablets. Reception is allowed from two years, at a dosage of 5 mg 3 times a day.

2. A fairly old drug - "glaucine", also with a central mechanism of action. But in addition to suppressing the cough center, it causes a peripheral block of vascular receptors, which may be accompanied by a sharp drop in blood pressure in the vessels. Children are prescribed in the form of syrup, at a dosage of 10 mg 2-3 times a day. Recommended for use over 2 years of age.

3. A relatively new drug, also with a central mechanism of action, has become “sinekod”. The release of the drug in drops and syrup allows the use of the drug in babies from the age of two months. Up to a year, the remedy is prescribed 10 drops up to 4 times a day, from a year to three years the dosage reaches 15 drops per dose, and from three years a syrup is allowed for use, used up to the age of six, 5 ml 3 times a day.

Recently, its cheap analogue containing the same active principle (butamirate) - "omnitus", produced by pharmaceutical companies in Serbia and Russia, began to compete with "sinekod" for the sales market. It can be found in tablet form and as a syrup. The form of the drug is prescribed depending on the age of the child. Syrup is allowed when the child reaches three years, and tablets - six years.

4. "Libeksin". A fairly old drug with a peripheral mechanism of action, that is, the action of "libexin" resembles the effect of local anesthetics, it blocks the receptor field of the respiratory mucosa. The instructions for use in children do not indicate age and do not indicate exact dosages, only a general formulation that allows the drug to be taken in the form of ¼ or ½ of the minimum adult dosage, without additional instructions.

Here, in fact, is the whole range of medicines used for dry cough. Unfortunately, in whooping cough and parapertussis, none of the described drugs is able to give a pronounced therapeutic effect, which codeine-containing drugs had.

When the cough becomes productive, that is, a large amount of sputum is formed, there is no point in suppressing it. In this case, it is important to promote sputum discharge by all means. For these purposes, a group of expectorants is used, conditionally divided into two subgroups, based on the nature of the active principle of the drugs.

Medications that improve sputum discharge

I group, which is based on synthesized chemicals. It includes:

1. "Bromhexine" - the pioneer of this group of drugs, which is essentially a chemical analogue of the plant alkaloid vasicin. In the body, "bromhexine is converted into the active substance - ambroxol.

Bromhexine is available in both liquid and solid form. The drug in tablets is given to children from three years old at a dosage of 4 mg three times a day. After 6 years, the dosage of "Bromhexine" reaches 8 mg three times a day. In the form of Bromhexine syrup, it is prescribed to children under two years old, 2 ml of syrup three times a day, up to six years old - 4 ml each and over six years old - 8 ml syrup each.

Directly "ambroxol" itself and its analogues - "lazolvan", "ambrobene", "ambrohexal", "bronchorus". Preparations are produced in several forms: in tablets, syrups, and inhalation solutions.

For inhalation, an aqueous solution of ambroxol is more often used. Up to two years, 7.5 mg of the drug is used once, from the age of two - 15 mg 1-2 times a day.

In the form of syrup "Ambroxol" is taken orally in children under two years old in the amount of 7.5 mg twice a day, up to five years old - 7.5 mg three times a day, over 5 years old "Ambroxol" is prescribed 15 mg three times a day . Tablets are allowed to be taken from 6 years old, 15 mg 2-3 times a day.

Three directions were found in the mechanism of action of this subgroup of drugs:

Of the side effects, in addition to allergic phenomena, dyspepsia is possible.

2. "Acetylcysteine" is good to use in the presence of very thick, difficult to separate sputum, as it has a pronounced mucolytic effect. Able to suppress the production of non-specific protective factors of the mucous membrane of the respiratory tract. It has antioxidant protection, as it carries sulfur ions, which restore the activity of an intracellular enzyme that inactivates toxic oxygen species. The analogue of "acetylcysteine" is "fluimucil".

"Acetylcysteine" (analogue - "ACC") is available in the form of a soluble dosed powder, syrup. All forms are approved for use from the age of two, 100 mg of the active substance 2 to 4 times a day.

In addition to the listed options, there is an inhaled form of acetylcysteine, released as part of an antibiotic of the levomycetin group - “fluimucil + IT antibiotic”.

It is important to know that for the effectiveness of the use of this drug, it is better to use a compressor nebulizer to prevent the destruction of the antibacterial agent. In children, in the form of inhalations, the drug is used from the age of two with a fixed dosage of 125 mg 1-3 times a day.

3. "Carbocysteine". Analogues - "fluditec", "fluifort". Used for difficult to separate sputum. Unlike acetylcysteine, it does not suppress the protective properties of the respiratory mucosa. As bonus properties, "carbocysteine" normalizes the activity of the mucous glands, restores the secretion of immunoglobulin A and the activity of the ciliated epithelium of the respiratory tract.

An interesting property of "fluifort" is its prolonged action, which lasts up to 8 days after a single dose.

In children, "carbocysteine" can be used in the form of a syrup. From one month to two years, the amount of the drug is calculated from the ratio of 5 mg / kg of the child's weight 3 times a day, up to five years - 2.5-5 ml of syrup 4 times a day, over five years - 10 ml three times a day.

"Fluifort" in children under one year is not used. Children under five years of age are prescribed in the amount of 2.5 ml of the drug, after five years - 5 ml of syrup twice a day.

Herbal extracts used for wet cough

II group of medicines, using all kinds of plant extracts as the active substance.

First on this list is thyme extract with proven anti-inflammatory and expectorant effects.

Thyme alcoholic extract contains Pertussin syrup, which has been known since Soviet times. In addition to thyme, the syrup is enriched with the presence of potassium bromide, which, due to bromine, has a general calming effect, thus reducing the excitability of the cough center. It is prescribed from three years in a dosage of 2.5 ml, after five years - 5 ml three times at regular intervals.

Syrup and tablets "codelac broncho" in ancient times contained codeine in their composition. To date, their composition has changed. Instead of codeine, thyme extract was introduced into the composition of the syrup, in connection with which the syrup began to be called “codelac broncho with thyme” (there is a syrup without thyme). In addition to thyme, the syrup contains ambroxol and the synthesized active substance of licorice root - glycyrrhizinate, which suppresses inflammation through its effect on the adrenal glands. Used from the age of two.

Cheap and quite effective for wet cough tablets "mukaltin" contain soda, marshmallow herb extract. In the instructions for the drug, in contraindications, there is no child age, but there is also no exact dosage and its dependence on the age or weight of the child. In such cases, they usually resort to dividing the tablet into half or a quarter, depending on the age of the child, and drink three times a day.

Syrup "bronchicum" contains an alcohol extract of thyme herb. Approved for use in children from 6 months.

Elixir "bronchicum", in addition to thyme extract, contains an extract of primrose roots.

Multicomponent preparation with complex action

Of all the other drugs with a complex action, one can note "ascoril", which is available both in tablets and in syrup. In its composition, "ascoril" contains:

Due to the composition, the drug has mucolytic, mucomotor, bronchodilatory and weak antitussive effects. It is better to use it in case of severe lung pathology, for example, with obstructive, bronchiolitis or bronchial asthma. Children are prescribed in the form of syrup, from the age of three, 5 ml, 2-3 times a day.

Mustard plasters as a means of increasing blood flow

To enhance the effect of antitussive drugs, at home, they often use the imposition of mustard plasters. Considering that the mechanism of their action refers to a locally irritating effect, it is necessary to remember a few rules for their use in young children:

Subject to all precautions, mustard plasters can also be used in babies who have not reached the age of one.

Conclusion

In addition to these drugs, today's pharmaceutical market is replete with other complex products, consisting of all kinds of combinations of plants, often with the addition of synthesized medicines. What is important to remember when choosing a cough medicine:

»» №2 1999 PROFESSOR G.A. SAMSYGINA, HEAD OF THE DEPARTMENT OF CHILDREN'S DISEASES N1, RUSSIAN STATE MEDICAL UNIVERSITY

Cough is a well-known, but very complex reflex in its mechanism, aimed at restoring airway patency. Cough is one of the most common manifestations of respiratory tract diseases. And in this regard, it is usually considered as a phenomenon that any person who does not have special knowledge (parents, relative or acquaintance), a pharmacy pharmacist and, of course, a doctor can handle. This opinion is erroneous and even harmful, since it is often based on incorrectly chosen antitussive therapy.

This is especially true in pediatrics, since both the child's body itself and diseases at this age have their own characteristics. In addition, not only the mechanisms, but also the causes of cough in children can differ significantly from those in adults. Therefore, the use of drugs taken in adult therapeutic practice, especially combined antitussive drugs, may not only not help a coughing child, but even worsen his condition. Unfortunately, even doctors know a relatively small range of drugs and often do not have complete information about the mechanisms of their pharmacological action. The rational choice and use of antitussive therapy in pediatrics requires knowledge of at least two main points: the causes of cough and the features of the mechanism of formation of the cough reflex in childhood and knowledge of the mechanisms of action of the antitussive drugs used. As noted above, the main function of a cough is to remove secretions from the airways to improve their patency and restore mucociliary transport of bronchial secretions (mucociliary clearance).

There are many causes of cough in children:

Infectious and inflammatory process in the upper respiratory tract (acute respiratory viral infections, tonsillitis, pharyngitis, sinusitis, exacerbation of tonsillitis, laryngitis)
Infectious and inflammatory process in the lower respiratory tract (laryngotracheitis, tracheitis, bronchitis, pneumonia)
Irritative inflammation of the mucous membranes of the respiratory tract
Allergic inflammation of the mucous membranes of the respiratory tract
Bronchospasm
Airway obstruction by viscous bronchial secretions, aspirated foreign bodies, fluids, endogenous and exogenous formations, etc.
Edema of the lung parenchyma
Other factors

Most often, coughing is one of the symptoms of an infectious process.

Violation of mucociliary clearance in children can also be due to several reasons. This is hyperplasia of the bronchial mucosa under the influence of infectious, allergic or other inflammation; swelling of the mucous membrane of the bronchial tree; increased secretion of mucus; increase in the viscosity of the secret; reduced formation of surfactant; bronchospasm; bronchial dyskinesia, that is, a decrease in their caliber on exhalation by more than 25% compared to the caliber on inspiration; finally, impaired mucociliary clearance may be caused by a combination of two or more of these factors.

Clinical manifestations range from a severe agonizing cough, accompanied by vomiting, anxiety and / or pain syndrome that disturbs the child’s sleep and well-being, to a constant cough that is imperceptible to the patient himself, which has almost no effect on his behavior. In the latter case, the child usually does not need special antitussive treatment, but finding out the cause of the cough is necessary.

Cough treatment is indicated only in cases where it disturbs the well-being and condition of the patient. In this case, you should always start by eliminating its cause.

The need for the treatment of the actual cough, that is, the appointment of the so-called antitussive therapy, arises mainly when the child has an unproductive, dry, obsessive cough. Its peculiarity is that it does not lead to the evacuation of the secret accumulated in the respiratory tract and / or does not release the receptors of the mucous membrane of the respiratory tract from irritating effects, for example, in case of irritative, infectious or allergic inflammation. It should be emphasized once again that in children, especially young children, 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 to thin the sputum, reduce its adhesiveness and thereby increase the effectiveness of coughing.

Thus, the effectiveness of antitussive therapy is essentially to increase the cough, provided that it is transferred from dry, unproductive to wet, productive. This ultimately leads to his disappearance.

Treatment of a productive cough, which consists in suppressing the cough reflex, is carried out in children only in special situations: when the cough is very intense and exhausts the baby, is accompanied by vomiting, disturbs the child’s sleep, or when there is a high risk of developing aspiration (for example, in children with severe CNS pathology ).

Thus, for the correct choice of antitussive treatment, it is necessary: firstly, to establish a diagnosis of the disease that caused the child's cough, and secondly, to assess its productivity, duration and intensity, and the degree of influence on the patient's condition. Based on anamnestic, physical and, if necessary, additional laboratory and instrumental data, it is advisable to assess the nature of bronchial secretions (mucous or purulent, the degree of viscosity, "mobility", quantity, etc.) and the presence or absence of bronchospasm.

Therefore, the participation of a pediatrician is simply necessary in resolving questions about the need and rational choice of antitussive treatment for a child. Moreover, the correct choice of antitussive therapy is always based on a good knowledge of the mechanisms of action of drugs with antitussive effect.

Among them are:

actually antitussive drugs (central and peripheral action);
drugs with an indirect antitussive effect (bronchodilator, anti-inflammatory, antiallergic, decongestant, and others);
combination drugs.

Antitussive drugs are usually divided into two main groups: central action and peripheral (afferent, efferent and combined). Among the latter, preparations of plant and synthetic origin are distinguished.

Centrally acting antitussives suppress the function of the cough center of the medulla oblongata or other nerve centers of the brain associated with it. These include drugs with a narcotic effect (codeine, dionine, morphine, dextromethorphan) and drugs that have a non-narcotic antitussive effect in combination with an analgesic, sedative and, as a rule, a weak antispasmodic effect. These are glaucine hydrochloride (glauvent), libexin, sinekod, tusuprex and others. This also includes broncholithin - a combined antitussive drug, including glaucine hydrochloride, ephedrine, sage essential oil and citric acid.

Narcotic drugs are used in pediatrics extremely rarely, in a hospital setting and for special indications: mainly for oncological diseases of the respiratory tract (opium drugs, dextromethorphan) to suppress the cough reflex during bronchography, bronchoscopy and other surgical interventions on the respiratory tract.

Non-narcotic drugs are used more widely, but, unfortunately, often incorrectly and unreasonably. The indication for their appointment is the urgent need for cough suppression. In pediatrics, such a need, although it occurs, is rare. In young children, it occurs with whooping cough and in cases of very intense productive cough with excessively abundant and liquid bronchial secretions (bronchorrhea), when there is a real threat of aspiration.

It should be noted that bronchospasm is also rare in young children. Usually obstructive syndrome, and especially pronounced, at this age is caused by hyperplasia and infectious and inflammatory edema of the bronchial mucosa, impaired motor function of bronchioles, decreased secretion mobility due to its increased viscosity and low level of surfactant. Therefore, centrally acting antitussives simply do not have a point of application. Moreover, by suppressing the cough reflex, they slow down the release of secretions from the airways, worsen the aerodynamics of the respiratory tract and the processes of oxygenation of the lungs.

In the older age period, these drugs may be useful in cases of cough associated with moderate bronchospasm. At the same time, they are used alone or as an addition to bronchodilators and drugs that suppress allergic or irritative inflammation.

A group of antitussive non-narcotic drugs of central action is also indicated for cough associated with irritation of the mucous membranes of the upper (epiglottic) respiratory tract due to infectious or irritative inflammation. In these cases, the result of their appointment is usually enhanced when combined with peripheral drugs with an enveloping effect. Broncholitin can serve as a partial example of such a combined effect. But its use is justified only in the absence of pronounced changes in the mucosa of the lower sections of the bronchial tree, since the ephedrine included in it "dries" the bronchial mucosa, increases the viscosity of the bronchial secretion and aggravates the violation of mucociliary transport, and, accordingly, increases the unproductiveness of cough in the presence of bronchitis and pneumonia. In addition, ephedrine has a stimulating effect on the central nervous system, disturbs the child's sleep and contributes to an increase in unproductive cough and shortness of breath.

Peripheral antitussives affect either the afferent or efferent components of the cough reflex, or have a combined effect. Drugs with an afferent effect act as mild analgesics or anesthetics on the mucous membrane of the respiratory tract and reduce the reflex stimulation of the cough reflex. In addition, they change the formation and viscosity of the secret, relax the smooth muscles of the bronchi. Preparations with an efferent action increase the mobility of the secret, as if improving its "sliding" along the mucosa, reduce the viscosity of the mucus, or increase the effectiveness and strength of the cough mechanism itself.

One of the effective afferent antitussive drugs of peripheral action is moisturizing the mucous membranes. This is primarily the use of aerosols and steam inhalations, which reduce mucosal irritation and reduce the viscosity of bronchial secretions. Water vapor inhalation alone or with the addition of medications (sodium chloride or benzoate, sodium bicarbonate, ammonium chloride, plant extracts such as eucalyptus) is the simplest, most affordable and common method of moisturizing. Along with this, a plentiful drink can be used (including medicinal teas, when efferent and afferent mechanisms of action are combined), and in severe cases (in a hospital setting) - intravenous fluid infusions.

Enveloping agents also refer to peripheral afferent antitussives. These drugs are mainly used for coughs that occur when the mucous membrane of the upper supraglottic sections of the respiratory tract is irritated. Their action is based on the creation of a protective layer for the mucous membrane of the nasopharynx and oropharynx. Usually they are oral lozenges or syrups and teas containing plant extracts (eucalyptus, acacia, licorice, wild cherries, etc.), glycerin, honey and other components. Local anesthetics (benzocaine, cyclain, tetracaine) are also afferent agents, but are used only in a hospital according to indications, in particular for afferent inhibition of the cough reflex during bronchoscopy or bronchography.

Efferent drugs include expectorants. These are plant extracts (marshmallow, anise, ninesil, wild rosemary, oregano, ipecac, coltsfoot, plantain, sundew, licorice, pine buds, violet, thyme, thermopsis, etc.), terpinhydrate, iodides.

The mechanism of action of these drugs is based on the removal of bronchial secretions from the respiratory tract by reducing its viscosity with an increase in volume. Most of the expectorant drugs increase the secretion of mucus due to reflex irritation of the glands of the bronchial mucosa. Some, for example, iodides and a number of herbal preparations (thyme, sundew, thermopsis, ipecac, etc.) also have a direct effect on secretory bronchial cells and are released into the lumen of the bronchial tree, while increasing the secretion of mucus and increasing its volume. They partly activate the motor function of the bronchioles and the ciliated epithelium of the bronchial mucosa. Along with this thermopsis, ipecac also enhance the activity of the vomiting and respiratory centers of the medulla oblongata.

Plant extracts are included in syrups, drops and cough tablets, are components of breast fees.

EXPECTORANT DRUGS OF PLANT ORIGIN

Ingredients: extracts of marshmallow, anise, rosemary, ninesil, oregano, ipecac, coltsfoot, sundew, plantain, licorice, pine buds, violet, thyme, thermopsis.

Dosage forms:

decoctions, infusions, teas
tablets (cough tablets based on thermopsis and sodium hydrochloride, mukaltin based on marshmallow extract, glycyram based on the ammonium salt of glycyrrhized acid isolated from licorice, bronchicum lozenges)
syrups (bronchicum based on honey, thyme, rosehip, pimpinella root, primrose and grindelia, eucabal based on plantain and thyme)
drops (bronchicum based on thyme, soapwort, quebracho bark and menthol, eucabal based on sundew and thyme).

It should be noted that the herbal origin of the drug does not yet mean its complete safety for the child, especially at an early age. So, preparations of ipecac contribute to a significant increase in the volume of bronchial secretions, enhance the gag reflex. Enhances vomiting and cough reflexes herb thermopsis. Therefore, in children of the first months of life, in children with CNS damage, they should not be used: they can cause aspiration, asphyxia, atelectasis, or increase vomiting associated with coughing. Anise, licorice and oregano have a rather pronounced laxative effect and are not recommended if a sick child has diarrhea.

A significant increase in sputum volume is also noted with the use of iodides (potassium iodide, sodium iodide, iodized glycerol). The use of these drugs in pediatrics should also be limited, since the expectorant effect of iodides is observed only when they are administered in doses close to intolerable, which is always dangerous in pediatric practice. In addition, they have an unpleasant taste (an exception is iodized glycerol, but its effect is extremely insignificant).

The most effective antitussive drugs with efferent peripheral action are mucolytics. They well dilute the bronchial secret by changing the structure of the mucus. These include proteolytic enzymes (deoxyribonuclease), acetylcysteine (ACC, carbocysteine, N-acetylcysteine (fluimucil), bromhexine (bisolvan), ambroxol (ambrohexal, lasolvan), dornase (pulmozyme), etc. sputum, they practically do not increase its volume.The liquefying effect of proteolytic enzymes is based on breaking the peptide bonds of bronchial secretion protein molecules.Acetylcysteine, carbocysteine and N-acetylcysteine, bromhexine and ambroxol break the integrity of the disulfide bonds of acid mucopolysaccharides of the sputum gel, thereby diluting it.Bromhexine and ambroxol also has the ability to stimulate the production of endogenous pulmonary surfactant (antatelectatic factor).The latter ensures the stability of alveolar cells during breathing, protects them from the effects of external adverse factors, improves the "sliding" of bronchopulmonary secretion along the epithelium of the bronchial mucosa.Reducing the viscosity of mucus and improving its sliding makes it easier secretion of sputum from the respiratory tract.

MAIN INDICATIONS FOR THE CHOICE OF ANTICOUGH DRUGS IN CHILDREN

Drugs (according to the mechanism of action)	Main indications for use	Restrictions on the appointment and contraindications
Central action (libeksin, broncholitin)	Dry, obsessive cough, accompanied by pain (dry pleurisy, whooping cough, etc.)	Productive cough. Early age of the child. Productive cough in children with CNS lesions. Infection of the lower parts of the DP. Pulmonary edema. Foreign bodies. Aspiration
Moisturizers	Unproductive nature of cough	Dry pleurisy. Foreign bodies DP. Aspiration of liquids. Pulmonary edema
Enveloping	Unproductive cough with ARI, tonsillitis, exacerbation of tonsillitis, pharyngitis, etc.	No
Local anesthetics	Carrying out medical manipulations on the respiratory tract	All other situations
Expectorants	Diseases of the upper respiratory tract. Infectious and inflammatory diseases of the lower respiratory tract in children older than 3 years, cough associated with bronchospasm (in combination with bronchodilators and anti-inflammatory drugs)	Productive cough. Early age of the child. High risk of developing aspiration. Bronchorea of any etiology. Pulmonary edema
Mucolytics	Cough due to difficulty in passing viscid, thick sputum from the respiratory tract	Bronchospasm
Preparations based on guaifenesin (coldrex-broncho, tussin, robitussin - cough mixture)	The same	Age up to 3 years
Antihistamines	Allergic edema of the nasal and oropharyngeal mucosa, bronchorrhea	All other situations
Combined drugs (Loraine, Hexapneumine)	Acute respiratory (respiratory-viral) infection with high fever and cough due to irritation of the mucous membrane of the upper parts of the DP, severe rhinitis, etc.	Unproductive cough in infectious and non-infectious diseases of the lower parts of the DP. Bronchospasm. Pulmonary edema. Foreign bodies. Aspiration
Combined drugs (trisolvan, solutan)	Bronchospasm	All other situations

Acetylcysteine, bromhexine and ambroxol can be widely used in pediatrics in the treatment of cough caused by diseases of the lower respiratory tract (tracheitis, laryngotracheitis, bronchitis, pneumonia, etc.), especially in children of the first five years of life, in whom increased viscosity of bronchial secretions is the main pathogenic factor in the formation of cough. The tendency to insufficiency of surfactant synthesis justifies the use of drugs such as ambroxol in neonatological practice and in children during the first weeks of life.

But one of the disadvantages of acetylcysteines (ACC, carbocysteine and fluimucil) and, in part, bromhexine is their ability to increase bronchospasm. Therefore, the use of these drugs in the acute period of bronchial asthma is not indicated.

Acetylcysteine, bromhexine and ambroxol have proven themselves well in chronic bronchitis, bronchiectasis, cystic fibrosis, and other fermentopathies, which are characterized by increased viscosity and often purulent or mucopurulent sputum. But in this situation, mucolytics such as proteolytic enzymes and dornase have advantages, as they more effectively dilute purulent sputum.

Currently, the drug guaifenesin is widely used. It is included in such products as coldrex broncho, robitussin - cough mixture, tussin (a combination drug that includes caramel, glycerin, citric acid, sodium benzoate, corn syrup along with guaifenesin) and a number of other widely advertised over-the-counter antitussives. The dose of guaifenesin is usually 100 to 200 mg taken every 4 hours. Guaifenesin may be used in children over 3 years of age. In its action, guaifenesin occupies an intermediate position between expectorant and mucolytic drugs. Unlike the expectorants described above, the action of guaifenesin is based on a decrease in surface tension and adhesion of sputum to the bronchial mucosa and a decrease in its viscosity due to the depolymerization of acid mucopolysaccharides of mucus. But the ability to increase the secretion of mucus (albeit less viscous) brings guaifenesin closer to expectorants. Side effects of guaifenesin are not noted, but there are no reliable data on its effectiveness.

The use of drugs with mediated antitussive action in pediatrics has very limited indications. For example, antihistamines are not recommended for use in the treatment of cough in children, especially young children, since their "drying" effect on the bronchial mucosa enhances an unproductive cough caused by the already viscous nature of the secret. For the same reasons, decongestants (decongestants) used for acute rhinitis and cough in adults are not used in children.

Bronchodilators (eufillin, theophylline) are indicated if cough is associated with bronchospasm. The use of atropine is generally undesirable in both children and adults - it thickens sputum, making it more viscous and difficult to remove.

I would like to focus on the use combined cough medicines. This group of drugs, usually over-the-counter or prescribed by doctors, contains two or more ingredients. A number of combined drugs include a centrally acting antitussive, antihistamine, expectorant and decongestant (broncholithin, stoptussin, sinecod, hexapneumine, lorain). Often they also include a bronchodilator (solutan, trisolvin) and / or an antipyretic component, antibacterial agents (hexapneumine, lorain). Such drugs relieve cough with bronchospasm, manifestations of a respiratory viral (eg, rhinitis) or bacterial infection, but they should also be prescribed according to the appropriate indications (see table). Often such drugs are not indicated or even contraindicated in young children, especially in the first months of life.

In addition, combined preparations, in particular those prescribed by doctors, may combine drugs that are opposite in their action, for example, antihistamines and expectorants (Zvyagintseva powder and its variants). Many prescriptions contain suboptimal or low concentrations of drugs, which reduces their effectiveness. But, of course, there are quite justified combinations of drugs.

If the main complaint is the cough itself, it is always better to use one drug and in full dose, but one that acts on the component of the cough reflex specific to this patient. For example, to relieve cough associated with acute upper respiratory tract infections, tablets or syrups with enveloping peripheral action or their combination (in older children and adolescents) with centrally acting non-narcotic drugs such as libexin are indicated. In acute laryngitis, tracheitis, bronchitis and pneumonia, it is most effective to use airway humidification to enhance bronchial secretion and thin viscous sputum. If it is ineffective, expectorants and / or mucolytics are added to the treatment.

Mucolytics are the drugs of choice in the presence of viscous, mucopurulent or purulent sputum and in children with reduced surfactant synthesis (early age, prematurity, prolonged bronchitis, pneumonia, cystic fibrosis, alpha1-antitrypsin deficiency).

When coughing in a patient with symptoms of bronchospasm, it is advisable to prescribe bronchodilators, antiallergic and anti-inflammatory drugs along with moisturizing and expectorant drugs, but centrally acting antitussive drugs and mucolytics such as acetylcysteine are not indicated.

In young children, in children with a pronounced gag reflex, in children with a high risk of aspiration, expectorants that increase the volume of secretion and increase the gag and cough reflexes are contraindicated. And for the purposeful suppression of an unproductive cough, for example, with whooping cough, on the contrary, it is possible to use antitussive non-narcotic drugs of central action.

Literature

1. Artamonov R.G. The state of the bronchi in protracted and chronic segmental and lobar pneumonia in children of the first years of life. Abstract diss. cand. honey. Sciences, M., 1958.
2. Ignatieva E.P., Makarova O.V., Ponikav V.E. Modern expectorants. In the world of drugs, N 1, 1998, p. 10-13.
3. Mashkovsky M.D. Medicines. M., Medicine, 1993.
4. Rachinsky S.V. et al. bronchitis in children. L., Medicine, 1978, p. 211.
5. Tatochenko V.K. et al. Acute respiratory diseases in children. M., Medicine, 1981, p. 206.
6. Guide to medicine. Diagnostics and therapy. M., 1997, v.1, p. 407-410.
7. Reference Vidal. Medicines in Russia. M., 1999.
8. Anmmon H.P. Incrisde the glucose by ACC during hyperglycern Arsne, 1992, 42, 642-645.
9. Bianchi M. el al. Ambroxol inhibits interleucin 1 and tumor necrosis factor production in human mononuclear cell. Agents and Actions, vol. 31, 3/4.
10. Ziment I. Acetilcysteine: a drug with in interest in past end a future. Respiration, 1986, 50 suppl 1; 20-30.

Antitussives are prescribed for various ailments, accompanied by a strong cough.

They have an antitussive, mild bronchodilator, expectorant and anti-inflammatory effect.

These drugs differ in the principle of action and composition.

The modern range of cough medicines is very wide. According to the principle of action, several categories of cough medicines are distinguished.

Drugs that depress the cough center

These drugs block the cough reflex by acting on the cough center in the brain. They are prescribed with great care, especially in children, as they are addictive.

But sometimes it is still impossible to do without them: for example, in the case of pleurisy or whooping cough with severe attacks of debilitating cough. These drugs include: Dimemorphan, Codeine, Ethylmorphine.

Non-narcotic cough medicines

These drugs do not act on the brain's cough center to block the cough reflex and are not addictive. They are prescribed for severe cases and in case of a very strong dry cough.

These medicines include: Glaucine, Butamirate, Prenoxindiosin and Oxeladin.

Mucolytics

Used for dry cough to make it productive. Mucolytics do not depress the cough center, but improve the patient's well-being by thinning the sputum.

Peripheral action

These are cough suppressants such as: Levodropropizine, Prenoxdiazine, Bitiodine and Benpropirine, which act on the afferent part of the cough reflex, exerting an anesthetic effect on the mucous membrane of the respiratory tract and suppressing the reflex stimulation of the cough reflex.

Also, they have an anti-inflammatory effect, relaxing the smooth muscles of the bronchi.

These are lozenges, as well as teas and syrups, which contain extracts of acacia, eucalyptus, wild cherries, licorice, linden, combined with honey, glycerin and some other substances.

combined action

These drugs create the so-called. multi-effect, allowing you to stop inflammation, eliminate spasms of the bronchi and increase the productivity of coughing.

These are tools such as: Codelac phyto and.

medicinal plants

Some plants are also effective for coughs of various etiologies. In particular, licorice roots, wild rosemary shoots, marshmallow, pine buds, istod, plantain, elecampane and thyme help with bronchitis.

In addition, cough remedies are classified according to other criteria, in particular:

release form;
company manufacturer;
composition: natural or synthetic components.

According to the form of release, they distinguish:

syrup;
pills;
drops;
elixirs;
teas with medicinal plant extracts;
lollipops;
chewable lozenges;
rectal suppositories.

Cough preparations for children

This group of tools meets increased security requirements.

It includes the following common drugs:

(also known as Ambrobene and Ambrohexal). The active substance is ambroxol, which strengthens children's immunity and has an anti-inflammatory effect. It is prescribed for dry cough even for infants, including those born prematurely.
Bronkatar(also sold under the names Mukodin and Mukopront). The active substance is carbocysteine, which thins sputum and increases the production of bronchial secretions.
- liquefies sputum, removing it from the respiratory organs.
Bronchicum- a drug sold in the form of an elixir, lozenges and syrup. It is prescribed for children from the age of 6 months in case of dry cough.
. Herbal preparation with antispasmodic, mucolytic and antitussive effects. Indicated for children from 1 year. It can only be taken with a doctor's prescription as it affects blood glucose levels.
Libeksin. Suitable for the first manifestations of a cold. It inhibits the cough reflex by affecting the central nervous system without suppressing respiratory functions. Bitiodin has a similar effect.
Chest collections No. 1-4; Phytopectol No. 1-2. Collections of medicinal herbs intended for self-preparation of infusions. Contain licorice, marshmallow, oregano roots; sage, plantain, coltsfoot, chamomile, wild rosemary, violet, mint, pine buds.

During pregnancy

While waiting for a child, the mother's body is very vulnerable, the immunity of the expectant mother is weakened. We can say that the metabolism of a pregnant woman and an embryo is common for two.

Therefore, when choosing cough remedies during pregnancy, you must be very careful and not take any medication without the advice of a doctor.

During pregnancy, certain drugs are used against cough, in particular:

I trimester of pregnancy: Ekvabal, Mukaltin, marshmallow root are safe herbal preparations. Gedelix, Bronchicum and Dr. MOM - by prescription. Their possible effects on the fetus are still poorly understood. Libexin is a synthetic remedy that is prescribed to pregnant women in the 1st trimester only in exceptional cases. In addition to dietary supplements, such as Mamavit, Florafors, Pregnacare and Bifidophilus can be taken.
II trimester and III trimester: With a dry cough, the same drugs that are indicated for the 1st trimester can be taken, however, in the most severe cases, Bromhexine, Akodin and Stoptussin can be taken instead of Libexin as prescribed by a doctor.

Dry cough remedies

If the cough is dry, separate drugs are prescribed that suppress it, which are not always suitable for a wet cough.

These include:

Dextromethorphan- effectively blocks cough reflexes, but creates side effects in the form of dizziness, nausea and drowsiness. Therefore, before taking Dextromethorphan, you should consult your doctor. For adults, as well as children over 12 years old, according to the instructions, it is recommended to take Dextromethorphan four times a day, 15 mg each.
Codeine- well suited in cases where the cough is so tormenting that it is impossible to even breathe. This drug is a tablet that blocks cough for the whole day. However, this drug is strictly contraindicated when driving a car and drinking alcohol. Its daily dose for an adult is 0.2 g.
Butamirat- a remedy with a bronchospasmolytic effect. It is taken to suppress cough in the postoperative period. Suitable for cough of any etiology. The recommended dose for adults is 1 capsule twice daily, and for children over 12 years of age, 1 tablet daily. Tablets and capsules are taken before meals, without chewing.
Glauvent- a cheap, but quite effective drug that turns an unproductive cough into a productive one and eliminates it entirely. Effectively blocks spasms without causing addiction. It is prescribed for bronchitis and bronchial asthma. It is taken three times daily for 0.5 g.

What do you need to know about treatment?

A disease with symptoms in the form of a cough can only be treated with the help of special means prescribed by a doctor.

However, additional procedures can greatly bring recovery closer, since the key to a quick recovery is complex treatment.

Before you start treating a cough, you must first find out its cause in order to determine the right medications, otherwise there is a risk of not achieving the desired result.

It is unacceptable to simultaneously take mucolytics and drugs that suppress the cough reflex through the central nervous system.

A cough that is combined with very severe shortness of breath and / or vomiting should not be treated at home, especially when the patient is a child.