Means stimulating expectoration

Reflex-acting drugs

Reflex-acting drugs, when taken orally, have a moderate irritant effect on the receptors of the stomach, which reflexively excites the center of the vagus nerve in the medulla oblongata. This increases the secretion of the mucous glands of the bronchi, dilutes the bronchial secretion, enhances the peristaltic contractions of the bronchial musculature. There may also be a slight excitation of the nearby vomiting center, which reflexively increases the secretion of the bronchial glands.

Since the effect of these drugs is short, and increasing the single dose causes vomiting, frequent doses of optimal doses (every 2 hours) are necessary.

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

The active origin of expectorants of reflex action are alkaloids and saponins:

Infusion of herbs of thermopsis from 0.6-1 g to 200 ml of water is taken 1 tablespoon after 2 hours 6 times a day.

Infusion of root ipecacuanas from 0.6 g to 200 ml of water, is taken 1 tablespoon every 2 hours 6 times a day.

Decoction of the root of the runoff from 20.0 g to 200 ml of water is taken one tablespoon 5-6 times a day.

An infusion of cyanosis root from 6-8 g to 200 ml of water is taken by 3-S table spoons a day after meals.

Licorice root is applied in the form of infusion of 6 g per 200 ml of water for 1 tablespoon 6 times a day; is included in the chest collection number 2 (1 tablespoon per 1 cup of boiling water is brewed, it takes 30 minutes, it is taken 1/4 cup 4 times a day); is also part of the thoracic elixir.

Glytsiram - the preparation is derived from licorice root, has an expectorant, anti-inflammatory and cortical stimulating action of the adrenal glands. It is used in tablets 0.05 g. It is prescribed for 1-2 tablets 4 times a day. Licorice root preparations in case of an overdose may cause an increase in blood pressure, sodium and water retention, and edema.

The root of the althea in the form of infusion of 8 g per 200 ml of water 1-2 tablespoons 5-6 times a day. It is part of the breast collection number 1 (root of the altea, mother-and-stepmother, oregano). 1 tablespoon of the collection pour 1 cup of boiling water, insist 30 minutes, take 1/4 cup 6 times a day.

Mukaltin tablets containing a mixture of polysaccharides from the herb althea. It is prescribed for 3 tablets 4-6 times a day. One tablet contains 50 mg of the drug.

Likorin - an alkaloid, contained in the plants of the family of amaridic and lily, enhances the secretion of the bronchial glands, is diluted in sputum, has a bronchodilator effect. Produced in tablets of 0.0002 g, prescribed 1-2 tablets 4 times a day.

Infusion leaves psyllium from 10 g to 200 ml of water, taken 2 tablespoons 6 times a day.

Decoction of leaves of mother-and-stepmother from 10 g to 200 ml of water, is taken 1 tablespoon in 2-3 hours.

Decoction of the root of elecampane from 20 g to 200 ml of water is taken 1-2 tablespoons 6 times a day.

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

Collection number 1 (the dominant property of collection is antiseptic)

• Leaves of plantain 1 hour.
• Licorice root 1 hour.
• Sage leaves 1 h.
• Buds of a pine 2 ч.
• Ebony black flowers 1 hour.

An infusion or a decoction is prepared from collection No. 1 (1.5-2 tablespoons of the collection is poured into enameled dishes, poured into 200 ml of water, covered with a lid and put in a boiling water bath.The infusion is heated for 15 minutes, the broth is 30 minutes with frequent stirring, then filter, the remainder of the raw material is squeezed out, the finished extract is boiled to 200 ml). Take 1 tablespoon in 1.5-2 hours, i.e. 8-10 times a day. Gathering №1 is appointed at an exacerbation of HB of a various degree of activity, first of all, at purulent bronchitis and bronchiectasises.

Collection number 2 (mainly bronchodilating effect)

• Leaves of mother-and-stepmother 1 hour.
• Grass of oregano 1 hour.
• Licorice root 2 h.
• Labrador tea 2 hours.

Gathering number 2 is used for predominantly obstructive chronic bronchitis.

Collection number 3 (anti-inflammatory and expectorant effect)

• The root of elecampane is 1 hour.
• The root of the althea 2 hours.
• Grass of oregano 1 hour.
• Buds of birch 1 h.

Fees No. 2 and No. 3 are prepared and applied in the same way as collection No. 1. Collection number 3 is used in patients with a mildly expressed exacerbation of chronic bronchitis and in the absence of exacerbation (mainly as an expectorant). These collections of medicinal plants can be used during the entire stay in the hospital, as well as for a long time after discharge from the hospital (2-3 months).

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

Collection number 4

• The root of the althea 2 hours.
• Leaves of plantain 2 h.
• Flowers chamomile pharmacy 2.5 h.
• Cassowrava grass 2 h.
• The roots of spring primrose in 2 hours.
• Leaves of mother-and-stepmother 1.5 h.
• Buds of a pine 1 ch.
• Licorice root 1.5 h.
• Leaves and black currant fruit 5 h.
• Oat seeds 5 h.

Two tablespoons of collection № 4 pour 500 ml of steep boiling water, insist for about an hour, use sips during the day.

For each patient collection must be selected individually. If the patient has a strong cough and the phenomenon of bronchospasm, then the collection adds celandine herb, herb thyme, mint, valerian root, oregano. With a strong irritating cough with hemoptysis the collection increases the amount of mucus-forming raw materials (althaea root, mullein flowers, mother-and-stepmother leaves), with bronchoectases, bactericidal substances (pine buds, chamomile flowers) are added to the collection. You can also recommend the following fees:

Collection number 5

• Labrador tea 10 g
• Leaves of mother-and-stepmother 10 g
• Three-color violet grass 10 g
• Chamomile flowers 10 g
• Calendula flowers 10 g
• Licorice roots 10 g
• The root of elecampane is 10 g
• Fruits of anise 10 g
• Leaves of plantain 10 g

Two tablespoons of collection number 5 put in enameled dishes, close the lid, in a water bath bring to a boil, boil for 15 minutes, cool 45 minutes at room temperature, the remaining raw materials squeeze out. The volume of the infusion obtained is brought to 200 ml with boiled water. Take 1/4 cup 4 times a day (mainly with bronchitis, accompanied by bronchospasm).

Collection number 6

• Licorice root 15 g
• Cyanosis root 15 g
• Camomile flowers 20 g
• Roots of valerian 10 g
• Grass of the motherwort 10 g
• Grass mint 20 g
• Grass of St. John's wort 10 g

Cooking as a collection number 5. Take 1/4 cup 4-5 times a day after meals (mainly with asthmatic bronchitis).

Collection number 7

• Leaves of mother-and-stepmother 20 g
• Grass of oregano 10 g
• Chamomile flowers 20 g

2 tablespoons of the collection pour 500 ml of boiling water, insist 6 hours, drink 1/2 cup 4 times a day before eating in a warm form. Brew better in a thermos.

Collection number 8

• Leaves of plantain 20 g
• St. John's wort 20 g
• Lime flowers 20 g

Cooking as a collection number 7. Take 1/2 cup 4 times a day.

Collection number 9

• The root of elecampane 30.0
• Calendula flowers 30.0
• Leaf of plantain 50.0
• Grass of thyme 50.0
• Mother-and-stepmother leaves 50.0

Two tablespoons of collection number 9 brew 200 ml of water, insist 40 minutes. Take 1/4 cup 4 times a day.

Collection number 10

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

Collection number 11 (antioxidant)

Alchus cones, three-colored violet grass, herb grass, herb pocheciuyna grass, blackberry flowers, hawthorn fruits, immortelle flowers, black currant leaves, plantain leaves of 50 g. Mix 10 g of the mixture, pour 300 ml of boiling water, heat on a water bath for 15 minutes, press for 45 minutes, squeeze out. Take 100 ml 3 times a day for 15 minutes before meals. The collection has an expectorant and antioxidant effect (inhibits lipid peroxidation).

Preparations of resorptive action

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

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

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

Grass thyme in the form of infusion of 15 g of 200 ml of water, taken 2 tablespoons 5-6 times a day.

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

Terpinhydrate tablets of 0.25 g, appointed 2 tablets 4-5 times a day.

Fruits of anise in the form of infusion of 10 g of 200 ml of water, take 2 tablespoons 4-6 times a day.

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

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

Tincture of eucalyptus - 10-20 drops 4-6 times a day.

Mucolytic drugs

Mucolytic drugs affect the physical and chemical properties of phlegm and dilute it.

Proteolytic enzymes

Proteolytic enzymes break the peptide bonds of the sputum gel protein, it liquefies and easily clears throat.

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

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

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

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

Prophase is a proteolytic preparation obtained from a Bact culture. Subtilus, is introduced endobronchially 0.5-1 g in a 1:10 dilution (diluted with polyglucin) 1 every 5 days.

Terrylitin proteolytic preparation, obtained from aspergillus fungus, 200 ED bottle is dissolved in 5-8 ml of physiological solution and inhaled 2 ml 1-2 times a day. Combined with antibiotics and dimexide, can be used in the form of electrophoresis.

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

Amino acids with SH group

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

Acetylcysteine (mucomist, mucosolycin) - apply a 20% solution in inhalations of 3 ml 3 times a day or inside 200 mg 3 times a day. During inhalation, bronchospasm is possible in patients with bronchial asthma, therefore it is desirable to use bronchodilators before inhalation.

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

Carbocysteine (mucodin), by the mechanism of action, is close to acetylcysteine. It is available as a syrup for oral administration. Adults are prescribed 3 times a day 3 times a day for 15 ml (3 teaspoons), after improving the dose decreases: to 10 ml (2 teaspoons) 3 times a day. There are also capsules of 0.375 g, the daily dose is 3-6 capsules. Children are prescribed 1 teaspoon of syrup 3 times a day. Unlike acetylcysteine, it does not cause bronchospasm. Tolerance is good, there is rarely nausea, diarrhea, headache.

Mistabrone (mesna) is the sodium salt of 2-mercaptoethane-sulfonic acid. The mucolytic effect of the drug is similar to the action of acetylcysteine, but it more effectively breaks the bisulfide bonds of macromolecular sputum compounds, which reduces the viscosity of sputum. Easily absorbed from the respiratory tract and quickly excreted from the body in an unchanged form. Produced in ampoules for inhalations and for intrabronchial infusions.

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

Eudrobronchially the drug is injected through the intratracheal tube every hour (1-2 ml together with the same volume of distilled water) until the liquefaction and excretion of sputum. Usually this technique is used in conditions of intensive therapy. The drug can not be used in conjunction with aminoglycoside antibiotics, as they reduce the activity of Mistabrone. With the inhalation application of Mystarbone, bronchospasm and cough are possible. The drug is contraindicated in bronchial asthma.

Flour Meters

Mukoregulyatori - a new generation of mucolytic drugs - derivatives of Vizin. These drugs have mucolytic (secretolitic) and expectorant effect, which is due to depolymerization and destruction of mucoproteins and mucopolysaccharides of sputum. In addition, they stimulate the regeneration of renite cells of the ciliated epithelium and increase its activity. Mucoregulators also stimulate the synthesis of surfactant in alveolar pneumocytes of type II and block its disintegration. Surfactant is the most important factor supporting the surface tension of alveoli, which positively influences their functional properties, in particular, elasticity, extensibility and anti-development of emphysema. The surfactant is a hydrophobic boundary layer lining the alveoli, facilitates the exchange of non-polar gases, exerts anti-edematous action on the membranes of the alveoli. He also participates in providing transport of foreign particles from the alveoli to the bronchial region, where mucociliary transport begins.

Bromhexine (bisolvan) - is produced in tablets of 0.008 g and in ampoules of 2 ml 0.2% solution for intramuscular and intravenous administration, in solution for oral and inhalation use with 8 mg of bromhexine in 4 ml of solution. In the body it turns into ambroxol. It is applied internally to 0.008-0.16 g (1-2 tablets) 3 times a day, intravenously at 16 mg (2 ampoules) 2-3 times a day or as inhalations of 4 ml 2 times a day.

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

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

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

Lasolvon-retard - capsules with delayed resorption, containing 75 mg ambroksola. The drug ensures the maintenance of a uniform concentration in the blood for 24 hours. It is applied once a day, tolerability is good.

Regulators of the mucous secretion

Regvdatoraty mucous secretions increase the water component of phlegm, it becomes less viscous and easier to clear up the throat.

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

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

Sodium benzoate, as a rule, is added to the composition of expectorant medicine:

• Herb thermopsis herb from 0.8 g to 200 ml
• Sodium bicarbonate 4 g
• Sodium benzoate 4 g
• Potassium iodide 4 g
• Thoracic elixir 30 g

Take 1 tablespoon 6-8 times a day.

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

The best expectorants for chronic bronchitis are mucoregulators: bromhexine, lasolvan. With frequent and painful cough, it is possible to combine expectorants with antitussive drugs.

[1], [2], [3], [4], [5], [6]