Ambroxol and ACC are taken together. What is better for coughing - ACC or Ambroxol

Phlegm increases inflammation in the bronchi and lungs - expectorants are needed to get it out of respiratory tract. With a dry cough, such drugs are usually not prescribed so as not to worsen the patient's condition.

Expectorants are needed to expel mucus

Action of expectorants

Reflex cough turns on when the normal process of mucus excretion is disturbed in the body. In case of illness, it helps to remove mucus, pus, sputum from the tracheobronchial tree.

Expectorants are prescribed to help the human body cope with sputum that is difficult to separate.

They have different actions:

1. Reflex-stimulating expectoration. Irritates cough and gag reflexes. The action of drugs in this group is short and strong. Overdose causes nausea with vomiting.
2. resorptive action. They make sputum with a wet cough more liquid, which accelerates its removal from the respiratory tract. May cause tearing and nasal congestion.
3. proteolytic enzymes. Reduce the viscosity of sputum by breaking peptide bonds. Medicines in this group can lead to a severe allergic reaction and bronchospasm.
4. Cysteine ​​derivatives. It breaks down disulfide bonds, which thins the sputum. Should not be administered to debilitated patients.
5. Mucoregulators. Increases the amount of pulmonary sufactant - a substance that is located on the surface of the alveoli. The medicine evens out the mucous and liquid parts of the sputum.

Such medicines are not used for dry cough.

Overview of expectorants

Before using expectorant drugs, it is important to consider their contraindications and follow the instructions for use.

Herbion with ivy extract helps with cough with phlegm, respiratory diseases.

When not to take:

• isolmatase deficiency;
• age up to 2 years;
• bearing a child;
• fructose intolerance;
• lactation.

Gerbion - syrup to improve expectoration

Admission rules:

• children under 5 years old drink syrup twice a day before meals, ½ tsp;
• for people over 12 years old, the doctor will prescribe 5-7.5 ml of the drug on an empty stomach 2 times a day.

How it can hurt:

• allergy;
• diarrhea;
• rash;
• nausea.

Price - from 250 rubles.

Mucolytic tablets ACC thin sputum due to the action of acetylcysteine.

Indications:

• pneumonia;
• cystic fibrosis;
• lung abscess;
• tracheitis.

When not to take:

• pregnancy;
• hemoptysis;
• lactation period;
• stomach ulcer;
• lactase deficiency and lactose intolerance;
• should not be used simultaneously with any antitussive drugs.

ACC tablets contain acetylcysteine ​​in their basis

Admission rules:

• babies 2-6 years old are given half a tablet twice a day;
• children 6-14 years old should drink 1 tablet 2 times in 24 hours;
• For adults, the doctor will prescribe 1 pill three times a day.

How it can hurt:

• nausea;
• dyspnea;
• rash;
• noise in ears.

Price - from 200 rubles.

An effective remedy that helps to cope with sputum in adults thanks to the active substance - ambroxol hydrochloride.

Indications:

• bronchial asthma;
• bronchitis;
• pneumonia.

Ambrobene is an effective expectorant

When not to take:

• epilepsy;
• peptic ulcer;
• impaired motility of the bronchi;
• age up to 12 years;

Admission rules:

• 1 capsule per day.

How it can hurt:

• increased cough;
• allergy;
• nausea;
• stomachache.

Ambrobene capsules can be bought at a price of 250 rubles.

Thanks to bromhexine, chloride has a mucolytic effect. Bromgeskin refers to a children's medicine, but can also be prescribed to adults.

Indications:

• cystic fibrosis;
• bronchitis;
• bronchial asthma;
• tracheobronchitis;
• pneumonia.

Bromgeskin syrup is suitable for children and adults

When not to take:

• ulcer;
• first trimester of pregnancy;
• fructose intolerance;
• lactation.

Admission rules:

• two-year-olds drink 2.5 ml of syrup twice a day;
• for children from 3 to 6 years old, parents give 2.5-5 ml 3 times in 24 hours;
• those who are 6 to 14 years old drink 5-10 ml of syrup three times a day.

How it can hurt:

• headache;
• nausea;
• increased sweating;
• bronchospasm.

Price - from 85 rubles.

Used for wet coughs. Active ingredient medicinal product- ivy leaf extract. Prospan is made on a plant basis, so it is often prescribed for children.

Indications:

• pneumonia;
• bronchitis;
• tracheobronchitis.

When not to take:

• children up to a year;
• sensitivity to alcohol;
• allergy to the components of the drops.

Prospan drops contain ivy leaf extract

Admission rules:

• babies under 3 years old are prescribed 10 drops 3-5 times a day;
• children 3-7 years old are prescribed 15 drops 3-5 times a day;
• schoolchildren and adults drink 20 drops 3-5 times a day.

How it can hurt:

• small rash;
• nausea.

Price - from 340 rubles.

A medicine that removes phlegm from the bronchi, diluting it. The active substance of Pertussin is an extract of thyme herb. This tool is inexpensive, but quite good.

Indications:

• whooping cough;
• tracheitis;
• bronchitis.

When not to take:

• lactation;
• heart failure;
• pregnancy.

Pertussin helps to remove phlegm

Admission rules:

• children drink 2.5 ml 3 times a day;
• adults take 1 tbsp. l. three times a day.

How it can hurt:

• heartburn;
• allergy.

Price - from 23 rubles. for a bottle.

Assign to the child when it is required to improve sputum discharge. The active substance is carbocysteine.

Fludetec is a mucolytic and has an anti-inflammatory effect.

Indications:

• bronchopulmonary diseases;
• diseases of the nasal cavity and nasopharynx;
• diseases of the middle ear.

When not to take:

• pregnancy - first trimester;
• intolerance to the components of the syrup;
• peptic ulcer;
• cystitis.

Fluditec - syrup for the treatment of cough in children

Admission rules:

• newborns do not exceed a dose of 100 mg per day.
• children 2-5 years old, 2.5 ml twice a day;
• children over 5 years old, 5 ml twice a day.

How it can hurt:

• nausea;
• hives;
• weakness.

Price - from 370 rubles.

Cheap tablets with herbal active ingredient - marshmallow extract. Mucoltin is prescribed for sputum discharge from the respiratory tract.

Indications:

• laryngitis;
• bronchitis;
• tracheitis.

When not to take:

• intolerance to medicinal components.

Mukaltin - affordable cough tablets

Admission rules:

• three times a day, 1 tablet;
• children dissolve the tablet in 30 ml of warm water.

How it can hurt:

• allergy;
• rash;

Price - from 12 rubles.

The active ingredients of Broncholitin syrup are glaucine hydrobromide, ephedrine hydrochloride.

Indications:

• pneumonia;
• bronchitis;
• bronchiectasis.

When not to take:

• ischemic disease;
• thyrotoxicosis;
• glaucoma;
• insomnia;
• myocardial infarction.

Broncholitin is an effective expectorant.

Admission rules:

• for babies from 3 years old, 5 ml, diluted in 10 ml of water, the drug three times a day;
• children who have reached 5-10 years old, 5 ml 3 times a day.
• adults 10 ml three times a day.

How it can hurt:

• tremor;
• violation of the rhythm of the heartbeat;
• visual impairment;
• dyspnea;
• feeling of dryness in the mouth;
• difficult urination.

Price - from 250 rubles.

Sputum thinning tablets Lazolvan contain active substance- amboxol hydrochloride.

Indications:

• pneumonia;
• bronchitis;
• obstructive pulmonary disease;
• bronchial asthma.

When not to take:

• lactation period;
• sensitivity to components;
• pregnancy in the first trimester.

Lazolvan tablets dilute sputum

Admission rules:

• on a tablet 3 times a day.

How it can hurt:

• anaphylactic shock;
• hives;
• nausea.

Price - from 153 rubles.

The list of active ingredients is as follows: thermopsis extract, ambroxol, sodium bicarbonate, sodium glycyrrhizinate.

Indications:

• COPD;
• various bronchitis;
• bronchiectasis;
• pneumonia.

When not to take:

• ulcer;
• bonchial asthma;
• children under 12;
• kidney and liver failure.

Codelac broncho - combination drug for the treatment of cough

Admission rules:

• adults 1 tablet three times a day.

How it can hurt:

• headache;
• allergic manifestations;
• diarrhea;
• nausea.

Price - from 180 rubles.

Expectorant folk remedies

There are many folk remedies, which and other diseases accompanied by a wet cough. Take after consulting a doctor. Usually, a home-prepared medicine must be used along with medications.

The following recipes are popular:

1. Take 10 g of crushed licorice root and pour 200 ml of boiling water. The product is kept in a water bath for 20 minutes. The broth is filtered, its volume is brought to 200 ml and drunk 1 tbsp. l. 4-5 times a day.
2. Take 1 tbsp. l. chopped elecampane and pour 400 ml of warm water. The medicine is boiled over medium heat for 15 minutes. The broth is filtered and taken 2 tbsp. l. every hour.
3. Chopped marshmallow root (15 g) is poured with water (500 ml). The remedy is insisted for a day, after which it is filtered. Drink it 4-5 times a day for a dessert spoon.
4. Cut off the upper part of the black radish and remove a third of its pulp. Inside put 1 tsp. honey, cover with a cut "lid" and put in a dark place. Drink the resulting juice 3 times a day, 1 tbsp. l.
5. Juice is squeezed out of a scalded lemon. Add honey to taste. Drink the remedy three times a day for 1 tbsp. l.

Lemon juice with honey plain and effective remedy for expectoration

What's better?

Mukaltin or Bromhexine

Mukaltin has a herbal composition and fewer contraindications. The doctor may think that this remedy is the best.

Ambroxol or Mukaltin

Mukaltin cannot replace Ambroxol. Therefore, if the doctor has prescribed a second drug, then it is worth buying it. Syrup is often prescribed to children with pneumonia in complex therapy.

Ambrobene or ACC

Children are more often prescribed Ambroxol. It acts softer and harms the child's body less.

Ambroxol or ACC

For an adult, ACC is the best. Children are more likely to be prescribed Ambroxol because it is sold as a syrup and is easier to give to a child.

Mukaltin or Pertussin

They have the same effect. If it is more convenient for the patient to drink syrup, then Pertussin will be prescribed to him. During pregnancy, Mukaltin will be prescribed.

Codelac broncho or ACC

If the medicine is prescribed to a child, then ACC is a priority. Codelac broncho should not be taken by children under 12 years of age. For smokers, Codelac will be prescribed, because it can relieve the cough of a smoking person.

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 young children.

In case of intolerance or persistent side effects medicine 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

The active substance in ACC is represented by acetylcysteine, a derivative of the amino acid cysteine. This main component a drug that 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.

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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.

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 to date, 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 factors in the pathogenesis of 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 inhibition of 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.

Consequently, 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 settling on the mucous membranes and subsequent excretion along with 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, with 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 dilute 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.
Drugs 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. In children, drinking plenty of Borjomi-type mineral water can be effective, 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 with a 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. Firstly, the effect of these drugs is short-lived, frequent doses of small doses (every 2-3 hours) are necessary. 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 the herbal origin of the drug 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 recombinant α-DNA-ase (dornase), which in recent years has been prescribed 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 the complex therapy of 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 incidence 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 the 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 of clinical symptoms increases, the effectiveness of the treatment of inflammatory diseases of the bronchopulmonary system increases. 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 of the 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 of 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 an extremely 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. The use of ACC is 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. In addition, the antioxidant properties of ACC also enhance the therapeutic effect. 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, and 2-3 weeks for chronic diseases. 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 the appearance of a drug in pediatrics are as important as the drug itself. The effectiveness of the drug largely depends on the method of delivery. Oral acetylcysteine ​​preparations were previously available only in the form of 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 of 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 respiratory function 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 respiratory diseases, 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, some 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.
In order to evaluate the safety and efficacy of mucolytics, including those with different delivery methods, we conducted a comparative study of some expectorant and mucolytic drugs for 3 years in children of various age groups suffering from acute and chronic bronchopulmonary diseases. 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 (trade name ACC-100, 200), 117 children received 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 with the use of 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. No adverse effects or adverse reactions were identified 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 ACC was prescribed in complex therapy, the 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 of the pharmacological action of the 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. The experience of 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.

Coughing is often the real problem - this cold symptom lasts the longest and, as a rule, delivers the most discomfort. Moreover, an untreated cough can cause serious complications. That is why for the treatment of cough it is worth using the most effective, proven means.

The choice of cough remedies should be determined by a number of nuances. Chief among these is whether the cough is wet or dry. For the treatment of wet cough, mucolytic and expectorant agents are used. Treatment of dry cough requires the use of drugs that suppress the cough reflex. Both for the treatment of dry cough and for the fight against wet cough, many products are produced so that it is rather difficult to navigate among them. We bring to your attention the most effective cough remedies: perhaps our review will help you choose the best treatment option.

ACC

ACC is one of the most popular wet cough preparations. The tool helps to thin the sputum, so that it quickly leaves and the cough becomes more productive. ACC acts quite quickly - already in the first days of admission, there is a pronounced relief. The drug can be used by nursing mothers and children from the 10th day of life. It is not recommended for pregnant women.

When using ACC, it is important to consider that the drug is not combined with paracetamol. Also, it should not be used together with other antitussive drugs - otherwise there is a danger of stagnation of the respiratory tract.

The cost is about 250 rubles.

Syrups and lozenges "Doctor Mom"

"Doctor Mom" ​​is a herbal preparation that is used as an expectorant for a wet cough. The medicine contains aloe, basil, ginger, licorice, elecampane and other herbal ingredients. "Doctor Mom" ​​has a very wide scope and can be used in the treatment of a whole range of diseases, from pneumonia to laryngitis. The medicine provides rapid liquefaction and sputum withdrawal. If you use "Doctor Mom" ​​in the treatment of dry cough, it quickly turns into a productive wet cough.

"Doctor Mom" ​​is available in syrup form, as well as in the form of fruit-flavored tablets. Pastilles can be used from the age of 14, the syrup form is used to treat cough in children over 3 years old.

The cost of syrup is about 170 rubles.

Falimint

Falimint is a topical lozenge that is effective for dry, non-productive coughs. Falimint relieves irritation, thins sputum, anesthetizes. The product is quickly absorbed, so that relief comes almost instantly. Falimint tablets can be sucked up to 10 times a day, but they should not be used for more than a few days. This drug is not prescribed to children under four years of age, lactating and pregnant women.

The cost is about 170 rubles.

Libeksin

Libexin is used in the treatment of dry cough, the appearance of which is associated with colds, flu or bronchitis. These cough drops are very affordable and quite effective. The action of Libexin is to reduce the sensitivity of cough receptors and suppress the cough reflex. At the same time, Libexin does not have a depressant effect on the respiratory center. Libeksin has an anti-inflammatory effect, and also provides sputum thinning.

Video recipe for the occasion:

The drug is used to treat dry cough in adults and children, has no serious contraindications. For young children, Libexin should be used with caution.

The cost is about 350 rubles.

Stoptussin

Stoptussin is a popular antitussive drug that simultaneously inhibits the cough reflex and provides a mucolytic effect. Stoptussin is a very effective remedy, however, the tablets have a long list of contraindications. In particular, they should not be used by pregnant and lactating women, as well as children under the age of 12 years. Stoptussin can cause a range of side effects, from allergic reactions to headaches. Therefore, it is better to use it only in cases where the cough is very strong and requires intensive treatment.

The cost is about 160 rubles.

Broncholitin

Broncholitin is a syrup with a combined action. It has an antitussive effect and at the same time expands the bronchi. The action is complemented by an anti-inflammatory effect. Broncholithin is used in the treatment of many diseases, from whooping cough to asthma. The syrup quickly alleviates the condition and is considered quite safe - it is also actively used in pediatrics, for the treatment of cough in children over 3 years old. At the same time, it is not recommended to use Bronholitin during pregnancy and while breastfeeding.

The cost is about 150 rubles.

Bromhexine

Bromhexine is used in the treatment of wet cough. It is available in the form of tablets and medicine and has a mucolytic and expectorant effect. Bromhexine can be used to treat cough, including in children over the age of 3 years. If necessary, the product can be used for a long time - up to 4 weeks without interruption. It has a pronounced effect and helps to quickly cope with a cough.

The cost of the medicine is about 160 rubles.

Ambroxol

Ambroxol is one of the most popular wet cough remedies. Tablets have an expectorant and mucolytic effect, help to cope with a cough very quickly. Ambroxol goes well with a number of other drugs, increasing the effectiveness of antibacterial and anti-inflammatory therapy.

Ambroxol is an inexpensive drug that has many complete analogues (for example, quite expensive Abrobene, Lazolvan, etc.). The drug is often prescribed even to young children - it is safe and at the same time effective.

The cost is about 40 rubles.

Mukaltin

Mukaltin is a very well-known remedy, these are tablets, which contain only one active ingredient - marshmallow extract. Mukaltin is used for wet coughs to thin sputum and make it easier to cough up. Tablets also have an anti-inflammatory effect and increase bronchial secretion. This drug is considered one of the most effective in the treatment of wet cough.

The cost is about 10 rubles.

Warming ointment "Doctor Mom"

When coughing, Doctor Mom ointment is recommended to be applied to the chest or back. It has a warming effect and helps to cope with both wet and dry coughs. The main active ingredients are menthol and eucalyptus oil. This ointment can also be used to treat coughs and colds in young children. The only limitation is that you should not use Doctor Mom ointment at high temperatures (due to the warming effect, it may further increase).

The cost is about 80 rubles.

In any case, the selection of cough remedies is best left to the doctor - self-medication can be dangerous. When using this or that cough remedy, it is important to strictly follow the dosage and instructions for use.

It is important to treat a cough to the end, because otherwise severe complications may appear. It must be remembered that coughing is only a symptom, and therefore, first of all, you need to deal with the root cause. The drug must be selected with care, depending on the cause.

How to choose the right cough medicine

In order for the treatment to be effective, it is important to choose the right drug. First of all, it is necessary to determine the type of cough and what disease it is related to.

There are 2 large groups of cough attacks:

1. Unproductive or dry cough. As a rule, it is accompanied by a sore throat. It is characterized by strong coughing attacks that follow each other. It interferes with sleep, after it there are pains in the muscles of the abdomen and chest. The cause of the cough is irritation of the cough receptors, and in this situation it is recommended to use antitussive drugs (for example, Pectusin).
2. Productive cough. With it, sputum is removed from the lungs, trachea and bronchi. This type goes away as soon as the body gets rid of excess fluid in the airways. In the normal course of the disease, sputum comes out well. But if it is not enough or the consistency is too viscous, the process is disrupted. In these cases, drugs with expectorant action help (Doctor MOM). Mucolytics are also prescribed, which have the ability to thin sputum and help with the withdrawal from the respiratory tract (Ambroxol or ACC).

Before choosing a medicine, you should consult with your doctor. Because if you take what is intended for a different type, you will not only not be cured, but you can also do harm.

To cure a cough, along with drugs, it is worth monitoring the state of the air in the room where the patient is located. It must be damp, to achieve this, leave a damp towel or bowl of water. In addition, it is necessary to drink as much liquid as possible (at least 1.5-2 liters per day).

Ambroxol is one of the best mucolytic agents

In the drug Ambroxol, the main active ingredient is ambroxol hydrochloride. You can buy this medicine in the form of a syrup for children and tablets for adults.

The drug has several mechanisms of action:

1. Improving the functioning of ciliated cilia through the production of low-viscosity sputum. Thus, the productivity of coughing attacks increases.
2. Supports the alveolar network and the functioning of the lung tissue. This is due to the activation of the secretion of the surfactant.

• bronchitis;
• pneumonia;
• poor sputum discharge in asthma;
• bronchiectasis;
• respiratory diseases with viscous sputum;
• sinusitis.

Reviews about this drug are positive. Anna from Moscow noted: “My husband fell ill with ARVI and drank Ambroxol for coughing. It has greatly eased the cough. Used tablets, taking 1 three times a day. In just a few days, relief came. ”

The advantage of the drug over analogues is that when taken, the amount of sputum does not increase much. Therefore, the body is cleansed faster. This remedy is effective in the treatment of diseases of adults and children.

Benefits of using the drug:

1. High efficiency and fast results.
2. Different forms of release of the drug (solution for inhalation, for internal use, syrup, tablets, simple and effervescent).
3. The absence of sugar in the solution.
4. Few contraindications.

Cons of the drug:

• can not be used by pregnant women;
• the risk of an allergic reaction;
• bitter aftertaste.

Ambroxol should not be used simultaneously with antitussive drugs. The fact is that such drugs suppress cough urges and complicate sputum discharge.

ACC for cough relief

ACC is one of the effective means in the fight against cough. The active substance is acetylcysteine. The drug acts as an expectorant, thinner and anti-inflammatory agent. The main purpose of the drug is to rid the respiratory tract of sputum.

ACC has different forms of release:

• effervescent tablets;
• solutions;
• syrup;
• powder (drinks are made from them).

After taking the medicine, it becomes easier on the first day from the start of use. Coughing improves, sensations of discomfort and pain in the chest area decrease.

When is it relevant to use this medicine:

• pneumonia;
• acute bronchitis;
• Chronical bronchitis;
• sinusitis;
• otitis;
• laryngotracheitis;
• mild asthma;
• moderate asthma.

Patients note the speed of the drug and the improvement of the condition from the first application. Alena from Volgograd says about him: “I drink effervescent ACC with acute respiratory infections and acute respiratory viral infections. Relief comes from the first use, and the cough disappears completely in just a week.

The benefits of the drug:

1. Pleasant taste and convenient form of release.
2. Side effects happen infrequently.
3. The drug removes mucus from the respiratory tract.
4. Cough instantly becomes easier to bear, and after a few days it completely disappears.

Negative sides:

1. Fairly high price.
2. A large number of contraindications (including gastrointestinal diseases, pregnant and lactating mothers).
3. Danger of developing an allergic reaction.

As for ACC and Ambroxol, they are not analogues, since their active substances are different. The drugs have a thinning and expectorant effect. If we talk about compatibility, then these medicines are often prescribed in parallel with each other. In addition, doctors sometimes prescribe medications along with mucolytics that reduce bronchial edema.

Joint reception of ACC and Ambroxol

Question: “Can I take ACC and Ambroxol together?” Asks Nadezhda.

The doctor of the highest category, pulmonologist - Sosnovsky Alexander Nikolaevich answers:

There are no official manufacturer's instructions regarding the combined use of ambroxol and ACC (acetylcysteine). This means that the simultaneous use of both drugs is acceptable. Only a logical question arises - why? Both drugs are mucolytics. They dilute sputum, but they can only indirectly increase its discharge. This requires expectorants.

Therefore, mutual synergy from ambroxol and ACC should not be expected. It makes sense to combine any of them with antibiotics, antivirals or expectorants. Taking ambroxol and ACC together is only to achieve polypharmacy and enhance the side effects of both drugs.

Continuous use of beclamethasone

Whistling in the chest during sleep

2 week old baby diagnosed with pneumonia by x-ray

Citrus fruits help strengthen the immune system, but they are not always allowed to be used for lung diseases. Consult with your physician for clarification.

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All about lung and respiratory health

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JMedic.ru

Bronchitis is a disease that is caused by inflammation of the bronchi, which entails hypersecretion of viscous mucus and a strong cough symptom. That is why it is advisable to use expectorants for bronchitis for effective treatment.

However, given that there are a lot of all kinds of medicines on the pharmaceutical market, good and not so good, it is not so easy to cure yourself.

Causes and pathogenesis of the disease

There can be many reasons for the occurrence of bronchitis, however, the most common of them are as follows:

1. Viral or bacterial disease of the respiratory tract. As a result of the interaction of micro- and macroorganism (virus, bacteria and humans), a typical inflammatory reaction occurs.
2. Bronchial asthma or obstructive bronchitis, to put it in the old way. In this case, the inflammation is due to the action of the allergic component.
3. Smoker's bronchitis or chronic obstructive pulmonary disease that results from the deposition of some kind of dust (suspended particles) on the inner lining of the bronchial tree. The same inflammation, however, has been building up over the years.

As a result, as a result of edema of the bronchus wall (its mucous membrane), there is a narrowing of the lumen of the bronchus, the release of a large amount of mucus and a violation of its secretion by the cells of the ciliated epithelium. Naturally, in this case, a very strong cough is observed - the process of "flooding" of the bronchial tree occurs, but all these cough shocks are of little effect due to the fact that the cells of the ciliated epithelium are not able to function normally. There is a violation of mucociliary clearance.

It should be noted that at the very beginning of the disease, there is not a wet (accompanied by sputum discharge), but a dry cough, which is caused by irritation of the cell wall.

That is why the use of expectorant drugs is of key importance in the treatment of this disease.

Examples of drugs

Ambroxol

One of the most basic drugs of this series is ambroxol hydrochloride (it is known under such trade names as Ambroxol - production of the Borshchagovsky plant, Darnitsa, Abrol - products of the Kusum company, Ambrobene - the German company Teva, Lazolvan - the original Swiss drug and many others). They differ in price and very significantly - for 1 unit of Lazolvan's product, you can buy 3-4 packs of Ukrainian Ambroxol. What is the paradox - the quality is quite comparable.

This medicine is available in the form of a syrup (for children) and in the form of tablets (for adults).

The mechanism of action of the drug has a different focus. The main active ingredient affects the formation of a large amount of low-viscosity sputum (which can significantly simplify the work of ciliated cilia of epithelial tissue). This effect is achieved by the destruction of the disulfide bridges of those substances that make up the secretion of sputum. A similar mechanism leads to an increase in the effectiveness (productivity) of coughing.

An important property of Ambroxol is its ability to enhance the synthesis of surfactant - a substance that supports the mechanical basis of the lung tissue and the alveolar network.

Moreover, due to the medicinal properties of ambroxol hydrochloride, the secretion of surfactant is potentiated in specially designed cells that transit fluids through the alveolar-capillary drainage.

The advantage of this medicine is also that under its influence there is no significant increase in the volume of sputum secreted.

Treatment regimen: young children are given at the rate of 0.5 teaspoon twice or thrice a day (correlating with the severity of the child's condition), older children - one teaspoon three times a day, adults and adolescents - one tablet three times a day. In children under 1 year old, it is better to use an ambrobene solution.

Recently, nebulizer therapy has been widely used - the method of inhalation of a solution of Lazolvan or Ambrobene, 5 minutes 3 times a day. Very effective treatment for both children and adults.

An earlier analogue of Ambroxol, Bromhexine, is also an effective drug, but is now produced and sold only in the form of tablets.

The next expectorant that has received worthy recognition among doctors and patients is ACC - acetylcysteine. Its treatment mechanism is in many ways similar to Ambroxol, but this drug has the advantage that it exists not only in the form of tablets and syrup, but also in the form of a sachet. It is easier to dose this medicine than Ambroxol - children should be given a sachet of 100 mg twice a day, adolescents 200 mg twice a day, adults 600 mg 1 time a day. In addition, there is a tablet form of ACC-long - an effervescent tablet, taken at the rate of 1 for 24 hours (very convenient for a busy person).

Children under 2 years of age should not be given the drug.

It should also be borne in mind that ACC is more expensive than Ambroxol.

A more effective drug - Carbocysteine ​​​​(Langes) has a more pronounced therapeutic effect and fewer side effects.

Phytopreparations and dietary supplements

Regarding all other drugs to improve the excretion of sputum (meaning herbal origin). Vivid examples are Alteyka, Prospan, Gedelix, Doctor Tays, Mukaltin, Antitussin, Pertussin and more. Despite the conviction of people in their safety and effectiveness, the expediency of their use is under a very big question, and according to many criteria. Even starting from the positions of the currently advertised evidence-based medicine, there is no evidence (scientific) of the effectiveness of these drugs. Not to mention the empirical approach - the difference is at the placebo level, nothing more.

But the worst thing is how high the number of complications that occur after taking this kind of drugs (especially in children). As a rule, these are all kinds of allergic and peudo-allergic reactions - ranging from angioedema, urticaria and ending with all types of anaphylaxis, Lyell's syndrome).

Alternative treatment

Traditional medicine is generally a separate issue that will be discussed over a long period of time. Probably, until there are significant changes in the minds of our people and modern medicine reaches a more or less decent level.

For cough, even our distant ancestors used oregano, thyme and chamomile. Yes, this is all, of course, very good, but after all, no one in the twenty-first century will use pigeon mail if there is an Internet.

Similarly, in medicine, all such remedies are an anachronism, and in order to obtain a high therapeutic effect at home, we will use only the best modern and proven remedies. By the way, about the fact that "pharmacists poison people with chemicals", as many people think now. Considering the ecological situation, all “herbs” bought on the spontaneous market are much more dangerous for human health than drugs that have passed many controls that are not related to traditional medicine.

The only good non-drug (one might say, folk) remedy is an alkaline drink.

Recipe: 0.5 teaspoon of soda per glass of hot milk 3 times a day. At home, it replaces the infusion of sodium bicarbonate, carried out in a hospital.

conclusions

It is advisable to combine expectorants for bronchitis with drugs aimed at reducing swelling of the bronchus, for example, with Erespal. It is not recommended to take antitussive drugs of central action (codeine) in order to avoid a pronounced syndrome of flooding of the bronchial tree. Drink plenty of fluids.

In case of ineffectiveness of treatment with expectorants alone, it is necessary to add antibiotic therapy (Amoxiclav, Zinnat), it is possible at home.

The optimal scheme for the treatment of bronchitis at home:

1. Bed rest, alkaline drink.
2. Ambroxol 1 tab. 3 times a day (7 days course).
3. Erespal 1 tab. 2 times a day (5 days course).

Acct or Ambroxol, which is better to use when coughing

Cough therapy can be carried out by means with a different type of effect on the respiratory system. Often, to achieve the desired result, you need to combine medicines from adjacent groups. The list of the most effective means traditionally includes ACC or Ambroxol. Should they be used together or separately? Below is the answer to this and other questions.

Brief drug comparison

ACC is a synthetic cough medicine based on acetylcysteine. The drug stimulates the excretion of sputum by thinning the mucus.

Ambroxol is a drug with a pronounced expectorant effect. The drug also dilutes sputum and stimulates the elimination of mucus from the bronchi.

The difference between cough medicines lies in the mechanism of action. ACC destroys mucus molecules by destroying the disulfide "bridges" that bind mucopolysaccharides in the sputum structure. Due to this chemical reaction, the viscosity of mucus decreases, and its elimination from the bronchi is accelerated.

Ambroxol affects the glands located in the mucous membrane of the respiratory tract. The result is a stimulation of goblet cell activity with an increase in the liquid component of sputum, which makes the process of its discharge easier. The drug further enhances the motor function of the ciliated epithelium of the bronchi. The transport of mucus to the outside improves with the normalization of microcirculation.

Fact! ACC additionally increases the synthesis of glutathione, a substance with pronounced antitoxic and antioxidant activity. The negative impact of free radicals and products of secondary drug metabolism is minimized.

ACC pros and cons

Treatment of cough with ACC alone is less common. The reason is the effect of the agent on viscous mucus. If for some reason sputum has not had time to form, the effectiveness of the medicine drops.

• fast onset of action - up to 1 hour;
• good sputum liquefaction, which provides quick clearance of bronchial mucus;
• interesting dosage form. ACC is available in the form of effervescent tablets that dissolve in water, which accelerates the absorption of the drug into the blood.

The good efficacy of the drug against the background of a small number of adverse reactions and contraindications makes ACC in demand on the pharmaceutical market.

• narrow range of indications;
• the need to prescribe additional funds for effective cleaning of the respiratory tract. Due to the lack of influence on the cilia of the epithelium, the drug actually has only a mucolytic effect. The rate of excretion of liquefied mucus depends on the individual characteristics of the human respiratory system.

Despite these disadvantages, ACC in the treatment of cough, accompanied by the formation of thick sputum, takes pride of place. Before using the medication, you should consult your doctor.

Ambroxol, pros and cons

Which is better: ACC or Ambroxol? This question is often asked by patients to doctors. Many make Ambroxol the favorite of the competition.

1. Large evidence base for the effectiveness of the remedy. Dozens of clinical studies have proven the feasibility of prescribing Ambroxol for the treatment of cough of various etiologies;
2. Variety of dosage forms. The drug is sold in tablets, syrups of various concentrations, solutions for inhalation;
3. Security;
4. "People's" love. Ambroxol is the most commonly prescribed cough medicine.

An important advantage of this cough remedy is the effect on the alveoli of newborns. The drug stimulates the synthesis of surfactant, which prevents gluing of the respiratory sacs of the lungs. This therapy is carried out for premature babies suffering from a lack of the corresponding bioactive substance in the body.

1. The impossibility of using the drug in patients suffering from gastric ulcer;
2. The need for dose selection for each age group. Treatment of children under 12 years of age requires the purchase of a syrup with a concentration of Ambroxol 15 mg / 5 ml, which is not always available in pharmacies;
3. The need to drink large amounts of fluid during treatment to stimulate the function of the mucous glands of the bronchi.

How are they similar and what is the difference between them

ACC and Ambroxol reach the maximum concentration in the blood at the same time, within 1-3 hours. The half-life of the funds is almost the same.

General properties of cough medicines:

• liquefaction of sputum;
• elimination of predominantly wet cough;
• availability. The price for both medicines fluctuates within the limits of rubles;
• security;
• similar contraindications. Medicines should not be taken for gastric ulcer or duodenal ulcer due to the risk of aggravating the patient's condition.

Is it possible to use Ambroxol and ACC at the same time

Given the above features, it becomes logical to ask whether it is possible to take ACC and Ambroxol together. In 95% of cases the answer is yes. Standards for the treatment of cough, accompanied by the formation of thick sputum, provide for the simultaneous administration of both drugs.

Good compatibility of agents and interaction of bioactive substances, which accelerate the destruction and elimination of mucus, ensure the recovery of the patient with the normalization of the function of the bronchial epithelium.

If it is necessary to use antibacterial agents, Ambroxol further enhances the concentration of antimicrobial drugs that penetrate the alveoli, increasing the rate of destruction of pathogenic microorganisms.

The compatibility of Ambroxol and ACC has been proven by clinical studies. The dosage and frequency of taking funds in each case is selected individually for the effective elimination of cough. The average duration of complex therapy is 1 week.

ACC or Ambroxol, which is better for coughing for children and adults

ACC and Ambroxol are not always used together. The choice of the appropriate drug depends on the characteristics of the clinical case, the age of the patient, the individual characteristics of the organism.

Adult patients suffering from dry unproductive cough without fever are traditionally prescribed ACC. The reason is a convenient dosage form (effervescent tablets) and good responsiveness of the body to therapy.

Premature babies are prescribed only Ambroxol. Patients from 2 years of age can take any of the drugs described. In the case of using Ambroxol, it is necessary to buy a syrup with a dose of 15 mg / 5 ml.

These situations remain conditional. In each case, the doctor comprehensively assesses the patient's condition and prescribes the most appropriate drug. Often, drug replacement is required due to the nature of the interaction of chemicals with the human body.

Conclusion

Ambroxol and ACC are excellent cough suppressants. High efficiency and affordable price make the drugs leaders among the medicines used in the treatment of diseases of the respiratory system. Means can be used both independently and in combination. The main thing is the selection of an adequate dose and the implementation of the doctor's recommendations.

Ambroxol, Erespal and ACC.

Do not forget about folk methods. Milk with honey. Figs. Onion juice with honey. compresses.

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  ACC or Lazolvan - which is better?

  Sputum overproduction may be a risk factor for patients prone to obstructive reactions in acute and chronic bronchopulmonary diseases. According to the International Organization for the Study of Asthma and Allergy, about 30% of children are prone to obstruction. Why is broncho-obstructive syndrome dangerous? Excessive mucus production leads to blockage of the respiratory tract and respiratory failure. To prevent this from happening, mucolytic agents are used in medical practice. They regulate the production of bronchial secretions, dilute sputum, help it move through the respiratory tract and thus contribute to their purification.

  What is the difference?

  The preparations in question belong to the pharmacological group of mucolytic agents. The main active ingredient in ACC is acetylcysteine(the name of the drug comes from the abbreviation of this component).

  As an active ingredient, Lazolvan contains another substance - ambroxol.

  ACC is produced by Hexal (Germany) and Sandoz (Slovenia). Lasolvan is produced in several countries (Germany, Greece, Spain, France) under the auspices of Boehringer Ingelheim International. The drugs are produced in several dosage forms and in different dosages.

  In the brand line there are such forms of release:

  • syrup with an active ingredient concentration of 20 mg / ml;
  • granules for the preparation of a solution for drinking in dosages of 100, 200 and 600 mg;
  • effervescent tablets (ACC 100, 200 and Long, respectively, 100, 200 and 600 mg).

  Lazolvan is produced in the form:

  • tablets of 30 mg,
  • solution for drinking and inhalation at a dosage of 7.5 mg / ml,
  • lozenges of 15 mg,
  • syrup 15 and 30 mg,
  • capsules with prolonged action and increased to 75 mg dosage of ambroxol (Lazolvan Max).

  How is the action different?

  The basic principle of action of mucolytics, including such as ambroxol or acetylcysteine, is based on the thinning of sputum - a complex of substances secreted by various cells of the tracheobronchial tree.

  With each breath, a person captures millions of dust particles and microorganisms along with the air. If there were no natural mechanism for cleaning the lungs, then as much dust would accumulate in them as you see when you shake out the vacuum cleaner.

  The mucus secretion produced by goblet cells, Clara cells and submucosal cells, as well as the ciliated cells of the respiratory tract, are the "master screws" of the lung clearance mechanism.

  Mucus traps inhaled microparticles. Ciliated cells, so named for the huge number of outgrowths oscillating in one direction, form an upward flow of mucus that is excreted from the respiratory tract. You will be surprised, but the ciliated cells are able to act very quickly: the speed of movement of the mucous secretion with normal viscosity is 1-2 cm per minute.

  Slime is a mixture of:

  • proteins,
  • lipids
  • water,
  • electrolytes,
  • mucoproteins and mucopolysaccharides.

  The latter substances provide bronchial secretion with viscoelastic properties that help to capture microparticles. With inflammation, sputum becomes more viscous, its amount increases, and the activity of the ciliated epithelium, on the contrary, decreases.

  The mucolytic effect of ACC is based on the fact that it dissolves mucus by destroying disulfide crosslinks between mucopolysaccharide molecules. After absorption, acetylcysteine ​​passes into cysteine, which not only has antioxidant properties itself, but is also a direct precursor of glutathione, one of the main antioxidants in our body.

  In addition to mucolytic and antioxidant, it has a number of other beneficial effects:

  • antibacterial,
  • anti-inflammatory,
  • antitoxic.

  If we compare ACC with Lazolvan in terms of therapeutic efficacy, then an almost similar result is revealed, although Ambroxol, the main mucolytic substance of Lazolvan, has a different mechanism of action.

  Ambroxol is a derivative of bromhexine, which in turn is a synthetic analogue of the plant alkaloid vasicin. The main point of application of its biological action is the activation of the synthesis and secretion of pulmonary surfactant.

  Surfactant is a mixture of surfactants of a lipid and protein nature that prevents the lung alveoli from collapsing. It helps to carry out gas exchange, and its role is so important that a decrease in its production leads to hypoxia.

  The expectorant effect of ambroxol is based on the fact that it increases the activity of the ciliated epithelium, contributing to the rapid discharge of sputum. In addition, ambroxol, like ACC, has antioxidant and anti-inflammatory properties.

  Can they be taken together?

  Due to the difference in the mechanism of action, drugs can be prescribed in some cases together. For example, a combination of taking the oral form (table) of ACC and inhalation with Lazolvan is possible.

  In addition, combination preparations containing ambroxol and acetylcysteine ​​have recently appeared.

  In a clinical study conducted on 30 patients with COPD (chronic obstructive pulmonary disease), it was shown that when using a combination of 30 mg of ambroxol and 200 acetylcysteine ​​for 10 days (3 times a day) in patients against the background of a pronounced improvement in the function of external respiration, no adverse events were observed.

  However, we should not forget that there are many reasons leading to inflammation of the respiratory tract, the appearance of cough and sputum. Therefore, in each specific case, only a doctor can prescribe Lazolvan and ACC at the same time, based on the patient's history and safety considerations for his health.

  What is best for children?

  At this age, they are prescribed quite often, because in children under 5 years of age there is a tendency to increase bronchopulmonary secretion against the background of insufficient synthesis of surfactant.

  The high safety of drugs allows the use of Lazolvan in children from a very young age, and ACC - starting from 2 years.

  Often Lazolvan is the drug of choice in children in the treatment of infectious diseases, since it has the ability to increase the content of antibiotics in bronchial secretions. It can be prescribed in the form of inhalations, which increases the effectiveness of therapy.

  Differences in contraindications and costs

  What is better to choose in the nearest pharmacy with an equivalent therapeutic value. Let's compare the prices of the most popular products.

  100 ml Lazolvan syrup costs about 210 rubles. The same amount of ACC syrup is 20% more expensive. The cost of a pack of Lazolvan tablets (20 pcs.) Is approximately 170 rubles. The same number of ACC 200 effervescent tablets will cost 35% more.

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  Comments

  thanks! Very clear and well written

  ACC is combined with Ambrobene, is it possible to take them at the same time?

  Is it possible to drink ACC and Ambrobene together?

  The drugs can be taken at the same time.

  Let's take a look at the composition. ACC contains acetylcysteine, which has an expectorant and mucolytic effect. It dilutes sputum, promotes its exit from their respiratory tract. Ambroben contains Ambroxol, which has a different mechanism of action, but the same effect. These substances do not interact with each other, are not incompatible. And the proof of this is the presence of a combined agent that contains both acetylcysteine ​​and ambroxol. This is Pulmobreeze.

  However, with a normal cough, one drug is enough for a person. Even taking two, a person will not get rid of sputum much faster. Therefore, it is not very rational to take drugs at the same time, spending extra money on them. It's better to stop at one.

  Ambrobene, like ACC, has a mucolytic and expectorant effect on the bronchi in acute bronchitis, chronic bronchitis, and for the treatment of cough. These two medicines thin the mucus and clear the airways.

  The active component of Ambrobene is Ambroxol, ACC has an acetylcysteine ​​component.

  Together, Ambrobene and ACC can be taken, but with moderate and severe bronchopulmonary diseases and not with self-treatment.

  To rapid and effective treatment while taking these two drugs will lead if you do inhalation with Ambrobene and ACC tablets.

  ACC in the form of syrup can be given to children from 2 years of age.

  Ambrobene syrup is indicated for children from infancy.

  Ambrobene (holds lazolvan + mukosolvan) and ACC are designed to thin sputum and what's the point of giving them together.

  You can replace them with Mukoltin, it is cheaper and sometimes more effective.

  The difference between these pills is only in terms of treatment. ACC is given to the child for 3 days, and Ambrobene is longer.

  At the same time, inhalation with Berodual can be carried out (as well as ACC for no more than 3 days), it expands the bronchi and sputum will come out better.

  In ambrobene, the active ingredient is ambroxol, and ACC is acetylcysteine, their action is different, although both drugs are prescribed for dry cough, as they contribute to thinning and better sputum separation. For me, ACC is a stronger and more effective drug, but it should not be taken for a long time. There are cases when doctors prescribe both of these drugs at the same time, but usually this happens in a severe course of the disease, when the use of one of these drugs is not very effective. But then it is recommended to use different forms of administration, inhalation with ACC and ambroxol orally in tablets or in the form of a suspension. It is not recommended to combine these drugs without a doctor's prescription, since the side effects from taking them double, these drugs already have enough contraindications.

  They can not be drunk at the same time, but you can alternate. If you drink, for example, three times a day at a standard dose of each of the drugs, then they will enhance the effect of each other, that is, it is fraught with an overdose and side effects. But on the other hand, you can drink one of the medicines during the day, and the other - in the morning and in the evening. Since they act in a similar way, such treatment will also be effective and safe.

  First, we will study the instructions enclosed in the box with the drug.

  Most likely there will be an answer to this question.

  And it will be negative, because drugs of similar action - sputum thinning.

  Those. you can start with ACC, and after three days finish the treatment with ambrobene.

  It is forbidden. Both drugs greatly thin the sputum, in this regard they have a similar effect. That is, taking both drugs, you essentially exceed twice the recommended dosage, and this cannot be done. If you drank one of the drugs for 5-7 days, and the cough did not go away, you can replace it with another.