General principles of treatment of bronchopulmonary diseases. Chronic bronchitis in adults - symptoms and treatment, causes, complications Form of drug delivery for bronchopulmonary diseases

Chronic tonsillitis in the acute stage, tonsillitis. 10 days: Echinacea 1-2 capsules 3 times a day with meals + Colloidal Silver gargle 2-3 times a day 1 teaspoon in 1 glass of water. 10 days: PPP, Garlic 1 capsule 2 times a day with meals + Tea tree oil Gargle 2-3 times a day, 1-2 drops per 1 glass of water. 10 days: Bee Pollen Protective formula 2-4 capsules per day with meals + PPP , Garlic 1 capsule 2 times a day with meals, inhalation and rinsing as needed

Pharyngitis, laryngitis, acute tracheitis, acute bronchitis, whooping cough (cough) 1st month: Bres From 2 capsules 3 times a day with meals + Walnut black walnut E-tea PPP , Garlic 1 capsule 3 times a day with meals + CC-A 2 capsules 2 times a day with meals. 3rd month: Black walnut 1 capsule 3 times a day with meals + Morinda

Acute pneumonia (support during convalescence) and recovery from illness 1st month: PPP , Garlic 1 capsule 3 times a day with meals + Bee Pollen 1 capsule 2 times a day with meals or Protective formula 2-4 capsules a day with meals. 2nd month: Red clover Chlorophyll liquid 1 teaspoon per 1 glass of water 2 times a day with meals. 3rd month: Liquid chlorophyll 1 teaspoon per 1 glass of water 2 times a day + According to D'Arco Colloidal minerals 1 time per day 1 teaspoon with one glass of water.

COPD in the acute stage pneumosclerosis, emphysema, bronchiectasis 1st month: According to D'Arco 2 capsules 2 times a day with meals + Black walnut 1 capsule 3 times a day with meals. 2nd month: Bres From 2 capsules 2 times a day with meals + Black Walnut 1 capsule 3 times a day with meals. 3rd month: Black walnut 1 capsule 3 times a day with meals + Morinda 1 capsule 3 times a day with meals. With attacks of bronchospasm Complex with valerian 1 capsule 3 times a day with meals.

Bronchial asthma, chronic obstructive bronchitis, bronchospasm 1st, 2nd and 3rd months: PPP, Garlic 1-2 capsules 2 times a day with meals + Black walnut 1 capsule 3 times a day with meals. For asthma attacks and bronchospasm, take the Complex with valerian 2 capsules at the same time.

Liquorice root

Scientific name: licorice (Glycyrrhiza glabra), another name is often used - licorice or licorice. It is licorice that is part of numerous pharmaceuticals such as potions, emulsions, pills, as well as infusions and tinctures.

The list of diseases for which licorice can be used is actually very large.

Licorice naked (legume family) is a perennial herbaceous plant 50-100 cm high. The stems are strong, erect, branched. The rhizome forms a multi-tiered underground network consisting of intertwining horizontal and vertical sections. The roots penetrate to a depth of 7-8 meters, reaching the level of groundwater. You should pay attention to this! The deeper the root system penetrates, the richer, primarily in terms of mineral composition, the plant. You can draw an analogy with alfalfa and morinda. We used to call ginseng the most valuable plant of the East, but this is just a "promoted" trademark. In traditional texts, this root is given no more attention than other medicinal plants. But licorice root in ancient recipes oriental medicine occurs very often. It was licorice that was the primary medicinal drug.

FROM therapeutic purpose the roots and rhizomes of licorice are used. Licorice roots contain a variety of biologically active substances: glucose, fructose, sucrose, maltose, starch, mannitol, polysaccharides, cellulose; organic acids, triterpene saponins, steroids, phenolcarboxylic acids (including salicylic), coumarins, flavonoids (glabren, quercetin, kaempferol, apigenin, etc.). It is not yet possible to say exactly how licorice "works". It often makes no sense to isolate one active ingredient from any plant material, since a combination of natural organic compounds works most effectively. Licorice root contains a unique, sweet-tasting natural compound called glycyrrhizin.

Studies have shown that glycyrrhizin is a potassium and calcium salt of tribasic glycyrrhizic acid (GLA), which is a saponin, i.e. a substance capable of producing abundant foam. Under the action of acids, glycyrrhizin decomposes into glucuronic and glycyrrhizic acids. When scientists deciphered the structure of GLA, it turned out that it is very similar to the structure of the molecule of hormones produced by the cortical layer of the adrenal glands (cortisone, etc.). Therefore, licorice has a corticosteroid-like effect, on which its anti-inflammatory effect largely depends.

But with all the advantages of this herb, there is one property that patients with hypertension need to consider. It's a raise blood pressure with prolonged use of large doses of licorice.
In addition, clinicians should be aware that licorice, due to its mineralocorticoid effect, removes potassium from the body, and a doctor's consultation is required before prescribing licorice, especially in people using diuretics.
Licorice has a weak estrogen-like effect, so it is not recommended for pregnant women.

In general, the positive qualities of the drug manifest themselves well with short courses of treatment up to 2-3 weeks. Its use for a longer time and in large doses requires medical supervision.

The main object for treatment with licorice is the broncho-pulmonary system.

Licorice - very strong expectorant. It is especially effective when the cough is just beginning.

IN traditional medicine"herbalists" recommend taking licorice twice: at sunset and closer to midnight.
Licorice sharply increases the volume of secreted mucus. And the mucus in the lungs is the main evacuator of microbes. Tracheobronchial secretion consists of substances produced by mucous and serous cells under the mucous glands and goblet cells. The composition of the tracheobronchial secret, in addition to mucus, includes plasma components, immunoglobulins, products of degeneration and decay of one's own cells and microorganisms
An important component of the secret is the alveolocyte surfactant. Surfact is not translated, from English it means surfactant. Lung surfactant is a unique natural complex of phospholipids and specific proteins.

Glycyrrhizin and foaming substances of licorice root - saponins - contribute to an increase secretory function epithelium respiratory tract, a change in the surface-active properties of the pulmonary surfactant and exhibit a stimulating effect on the function of the cilia of the epithelium. Under the influence of licorice preparations, sputum is liquefied, its coughing is facilitated. But the means of restoring the surfactant are, first of all, lecithin and Omega-3, the intake of which should be recommended from the first days of the disease and continue after recovery, as well as during dispensary observation(few weeks). In severe forms of pulmonary pathology, which include pneumonia and chronic obstructive pulmonary disease (COPD), such as nonspecific bronchitis, chronic bronchitis, emphysema, bronchial asthma, it is recommended to prescribe cordyceps along with licorice.

A feature of " Licorice root" (Eicorice root) from Nature's Sunshine Products is that licorice undergoes a special enrichment method (concentration of plant extracts and enhancement of their action). It is a concentrated product, contains 4 times more active substances in 1 capsule, than in ordinary licorice root.

It has anti-inflammatory properties, has a corticosteroid-like effect.
Maintains the normal functional state of the mucous membrane gastrointestinal tract and bronchi, increases the production of protective mucus.
Reduces spasm of smooth muscles of the bronchi, intestinal wall, bile ducts.
It has an estrogen-like effect.

In folk medicine, licorice root was consumed without restrictions. But theoretically, if there are heart rhythm disturbances or there are serious violations water and electrolyte balance, you should refrain from taking licorice. Licorice does not contain hormones, although it enhances the activity of corticosteroid hormones that have anti-inflammatory effects. But the task of natural compounds is not just to suppress inflammation, but to mobilize all the body's defenses. Licorice also contributes to the mobilization and stimulation of all the body's defenses.

Composition: 1 capsule: Licorice root concentrate (Glycyrrhiza glabra) 410 mg

Contraindications: individual intolerance to the components of the product, pregnancy, breastfeeding, hypertonic disease, liver cirrhosis, liver failure, potassium deficiency in the blood, disorders of water-salt metabolism. Despite these limitations, the drug is very well tolerated by children, also due to its natural sweet taste.

1. Bronchitis

Classification of bronchitis (1981)

Acute (simple) bronchitis

Acute obstructive bronchitis

Acute bronchiolitis

Recurrent bronchitis, obstructive and non-obstructive

With the flow:

exacerbation,

remission

1.1. Acute (simple) bronchitis is usually a manifestation of respiratory viral infection. The general condition of the patients was slightly disturbed. Typical cough, fever for 2-3 days, may be more than 3 days (the duration of the temperature reaction is determined by the underlying viral disease). There are no percussion changes in the lungs.

Auscultatory-common (scattered) dry, coarse and medium bubbling wet rales. The duration of the disease is 2-3 weeks.

Examination methods: patients with acute bronchitis do not need X-ray and laboratory examinations in most cases. A chest x-ray and blood test are needed if pneumonia is suspected.

Treatment of patients with bronchitis is carried out at home. Hospitalization is required for young children and patients with a persistent temperature reaction. Children are in bed for 1-2 days, at a low temperature, a general regimen can be resolved. Treatment table 15 or 16 (depending on age). Drinking regimen with sufficient fluid intake; compotes, fruit drinks, water, sweet tea, screams, older children - warm milk with Borjomi.

Drug therapy is aimed at reducing and alleviating cough. In order to reduce cough, they are prescribed:

libexin 26-60 mg per day, i.e. 1/4-1/2 tablets 3-4 times a day to swallow without chewing);

tusuprex 6-10 mg per day, i.e. 1/4-1/2 tablets 3-4 times a day or Tusuprex syrup 1/2-1 tsp. (in 1 tsp - 6 ml);

glauvent 10-25 mg, i.e. 1/1-1/2 tablets 2-3 times a day after meals.

Relieve cough, promote mucus thinning, improve function ciliated epithelium bromhexine and mucolytic drugs, Bromhexine is recommended for children aged 3 to 6 years - at a dose of 2 mg, i.e. 1/4 tablet 3 times a day, from 6 to 14 years - 4 mg, i.e. 1/2 tablet 3 times a day. Bromhexine is not prescribed for children under the age of 3! Ammonia-anise drops and breast elixir have a mucolytic effect (to take as many drops as the child's age), percussion (to take from 1/2 tsp to 1 des.l 3 times a day) and chest preparations (No. 1 : marshmallow root, coltsfoot leaf, oregano herb - 2:2:1; No. 2: coltsfoot leaf, plantain, licorice root - 4:3:3; No. 3: sage herb, anise fruit, pine buds, marshmallow root, licorice root - 2:2:2:4:4). Prepared decoctions give 1/4-1/3 cup 3 times a day.

In the hospital, from the first days of illness, steam inhalations are prescribed (for children over 2 years old!) With a decoction chest fees or infusions of chamomile, calendula, mint, sage, St. John's wort, wild rosemary, pine buds (decoctions are prepared immediately before use in the form of 5-10% solutions, inhalations are carried out 3-4 times a day). You can use ready-made tinctures of mint, eucalyptus, calendula, plantain juice, kolanchoe from 15 drops to 1-3 ml per inhalation, depending on age. Thermal procedures: mustard plasters on chest, warm baths.

Dispensary observation for 6 months. In order to prevent recurrence of bronchitis, the nasopharynx is sanitized in persons surrounding a sick child. After 2-3 months. prescribe (for children over 1.6-2 years old) inhalations with decoctions of sage, chamomile or St. John's wort daily for 3-4 weeks and a complex of vitamins. Preventive vaccinations are carried out after 1 month. subject to full recovery.

1.2. Acute obstructive bronchitis is the most common form acute bronchitis in young children. Obstructive bronchitis has all the clinical signs of acute bronchitis in combination with bronchial obstruction. Observed; prolonged exhalation, expiratory noise ("whistling" exhalation), wheezing on exhalation, participation in the act of breathing of auxiliary muscles. At the same time, there are no signs of severe respiratory failure. Cough dry, infrequent. The temperature is normal or subfebrile. The severity of the condition is due to respiratory disorders with mild symptoms of intoxication. The current is favorable. Respiratory disorders decrease within 2-3 days, wheezing wheezes are heard for a longer time.

Young children with bronchial obstruction syndromes must be hospitalized.

Examination methods:

General blood analysis

ENT specialist consultation

Allergy examination of children after 3 years of age for the purpose of early diagnosis of allergic bronchospasm

Consultation with a neurologist if there is a history of perinatal CNS injury.

1. Euphyllin 4-6 mg/kg IM (single dose), with a decrease in symptoms of bronchial obstruction, continue to give euphyllin 10-20 mg/kg per day evenly every 2 hours orally.

2. If eufillin is ineffective, administer a 0.05% solution of alupent (orciprenaline) 0.3-1 ml IM.

3. In the absence of effect and deterioration of the condition, administer prednisolone 2-3 mg/kg IV or IM.

In the following days, antispasmodic therapy with eufillin is indicated for those children in whom the first administration of the drug was effective. A 1-1.5% solution of etimizole IM 1.5 mg/kg (single dose) can be used.

Dispensary observation is to prevent repeated episodes of bronchial obstruction and recurrence of bronchitis. For this purpose, inhalations of decoctions of sage, St. John's wort, chamomile are prescribed daily for 3-4 weeks in the autumn, winter and spring seasons of the year.

Preventive vaccinations are carried out after 1 month. after obstructive bronchitis, subject to complete recovery.

1.3. Acute bronchiolitis is a widespread lesion of the smallest bronchi and bronchioles, leading to the development of severe airway obstruction with the development of symptoms of respiratory failure. Mostly children of the first months of life are ill (parainfluenza and respiratory syncytial bronchiolitis), but children of the second or third year of life can also be ill (adenoviral bronchiolitis).

Obstructive syndrome often develops suddenly, accompanied by a sonorous dry cough. The increase in respiratory disorders is accompanied by a sharp anxiety of the child, low-grade (with parainfluenza and respiratory syncytial infection) or febrile (with adenovirus infection) temperature. The severe and extremely serious condition of the patient is due to respiratory failure. Chest distention, a boxed shade of percussion sound is determined, a mass of small bubbling and crepitating rales is heard during auscultation of the lungs. diffuse changes in the lungs against the background of severe obstruction with very big share probabilities (up to 90-95%) rule out pneumonia. Radiographically determined swelling of the lungs, increased bronchovascular pattern, possible microatelectasis. Complications of bronchiolitis can be reflex respiratory arrest, the development of pneumonia, repeated episodes of bronchial obstruction (in almost 50% of patients).

Examination methods:

Radiography of the lungs in two projections

General blood analysis

Determination of the acid-base state of the blood (KOS)

Mandatory hospitalization for emergency care

oxygen inhalation. Humidified oxygen supply through nasal catheters, children over 1-1.6 years old in the oxygen tent DPC-1 - 40% oxygen with air

Removal of mucus from the respiratory tract

Infusion therapy in the form of intravenous drip infusions is indicated only taking into account hyperthermia and fluid loss during shortness of breath

Antibiotic therapy is indicated, since it is difficult to exclude pneumonia on the first day of the increase in the severity of the patient's condition. Semi-synthetic penicillins are prescribed, in particular, ampicillin 100 mg / kg per day in 2-3 injections (it should be noted that antibiotic therapy does not reduce the degree of obstruction!)

Eufillin 4-5 mg/kg IV or IM (single dose), but not more than 10 mg/kg per day (reduction in the severity of obstruction is observed only in 50% of patients!!)

If eufillin is ineffective, inject a 0.05% solution of adupent (orciprenaline) 0.3-0.5 ml / m. You can use inhalations of Alupent 1 silt for one inhalation, the duration of inhalation is 10 minutes.

Obstructive syndrome, which is not stopped for a long time by the administration of aminophylline, alupent, requires the appointment of corticosteroids: prednisolone 2-3 mg / kg parenterally (in / in or / m)

Cardiotonic drugs for tachycardia!) - intravenous drip of a 0.05% solution of corglycone 0.1-0.6 ml every 6-8 hours.

Antihistamines are not indicated! Their drying, atropine-like action may exacerbate bronchial obstruction.

In severe cases of respiratory failure, mechanical ventilation is prescribed.

Dispensary observation of children who have had bronchiolitis is aimed at preventing further sensitization and recurrent episodes of bronchial obstruction. For children with repeated obstructive episodes, after the age of 3 years, skin tests with the most common allergens (dust, pollen, etc.) are recommended.

Positive skin tests, as well as attacks of obstructive boa virus infection, indicate the development of bronchial asthma.

Preventive vaccinations for patients with bronchiolitis. carried out no earlier than 1 month. subject to full recovery.

1.4. Recurrent bronchitis - bronchitis that recurs 3 times or more during the year with an exacerbation duration of at least 2 weeks, occurring without clinical signs of bronchospasm, with a tendency to a protracted course. It is characterized by the absence of irreversible, sclerotic changes in the bronchopulmonary system. The onset of the disease can be in the first or second year of life. This age is of particular importance in the occurrence of relapses of bronchitis due to weak differentiation of the epithelium of the respiratory tract and immaturity. immune system. However, the diagnosis can be made with certainty only in the third year of life. Recurrent bronchitis affects mainly children of early and preschool age.

The clinical picture of bronchitis recurrence is characterized by an acute onset, an increase in temperature to high or subfebrile numbers. Recurrence of bronchitis is possible at normal temperatures. At the same time, a cough appears or intensifies. Cough has the most diverse character. More often it is wet, with mucous or mucopurulent sputum, less often dry, rough, paroxysmal. It is the cough that grows in intensity that often serves as a reason for going to the doctor. Cough can be provoked by physical activity.

Percussion sound above the lungs is not changed or with a slight box shade. The auscultatory picture of bronchitis recurrence is diverse: against the background of harsh breathing, wet coarse and medium bubbles are heard. as well as dry rales, variable in nature and localization. Wheezing is usually heard for a shorter time than cough complaints. It should be noted that in patients with recurrent bronchitis, increased coughing is often detected, i.e. children begin to cough after a slight cooling, physical activity, with the next SARS.

Forecast. In the absence of adequate therapy, children get sick for years, especially those who fell ill in the early preschool age. There may be a transformation of recurrent bronchitis into asthmatic and bronchial asthma. A favorable course of recurrent bronchitis is observed in children in whom it is not accompanied by bronchospasm.

Examination methods:

Blood test

Bacteriological examination of sputum

X-ray of the lungs (in the absence of an X-ray examination during periods of previous relapses of bronchitis and if pneumonia is suspected)

Bronchoscopy to diagnose the morphological form of endobronchitis (catarrhal, catarrhal-purulent, purulent)

Cytological examination of bronchial contents (smears-prints from the bronchi)

Examination of the function of external respiration; pneumotachotomy to determine the state of airway patency, spirography to assess the ventilation function of the lungs

Immunogram

Patients with exacerbation of recurrent bronchitis are desirable to be hospitalized, but treatment is also possible on an outpatient basis.

It is necessary to create an optimal air regime with an air temperature of 18-20C and a humidity of at least 60%

Antibacterial therapy, including antibiotics, is prescribed if there are signs of bacterial inflammation, in particular, purulent sputum. Courses of antibiotic therapy (ampicillin 100 mg/kg, gentamicin Z-5 mg/kg, etc.) are prescribed for 7-10 days

Inhalation therapy is one of the most important types therapy in a medical complex prescribed to eliminate the violation of bronchial patency.

It is carried out in three stages. At the first stage, he prescribes inhalations of solutions of salts, alkalis and mineral waters. The mixture prepared from equal volumes of 2% sodium bicarbonate solution and 5% ascorbic acid solution is effective for thinning and sputum discharge, the volume of the inhalation mixture by age. In the presence of mucopurulent sputum, enzyme preparations are administered by inhalation (Appendix No. 1). The duration of the first stage is 7-10 days.

At the second stage, antiseptics and phytoncides are administered by inhalation. For this purpose, onion and garlic juice, decoctions of St. The duration of the second stage is 7-10 days.

At the third stage, oil inhalations are prescribed. Uses vegetable oils with a protective effect. The duration of the third stage is also 7-10 days.

Mucolytic (secretolytic) agents (see section acute simple bronchitis) are prescribed only at the first stage of inhalation therapy

Expectorant (secretory) means; decoctions and infusions of herbs (thermopsis, plantain, coltsfoot, thyme, wild rosemary, oregano), marshmallow root, licorice and elecampane, anise fruits, pine buds. Of these medicines make up medicinal fees used to relieve coughs

Physiotherapeutic procedures: microwaves on the chest (electromagnetic oscillations of ultra-high frequency of the centimeter range, SMV, the Luch-2 apparatus and the decimeter range, UHF, the Romashka apparatus.

Treatment of patients with exacerbation of recurrent bronchitis is carried out (at home or in a hospital) for 3-4 weeks. Patients with recurrent bronchitis should be registered with the dispensary. Children are supervised by local pediatricians. The frequency of examinations depends on the duration of the disease and the frequency of relapses, but at least 2-3 times a year. If there is no recurrence of bronchitis within 2-3 years, the patient can be deregistered. Consultations of specialists are carried out according to indications: a pulmonologist in case of suspected development of a chronic bronchopulmonary process; an allergist in case of bronchospasm; otolaryngologist to monitor the condition of the ENT organs.

Rehabilitation of patients with recurrent bronchitis is carried out according to the principle of improvement of frequently ill children:

1. Sanitation of foci of chronic infection in the upper respiratory tract: chronic tonsillitis, sinusitis, adenoiditis

2. Elimination of concomitant diseases of the digestive system: dyskinesia of the biliary system, intestinal dysbacteriosis, etc.

3. Correction of metabolic disorders is prescribed during the year. Approximate scheme:

August - riboxin and potassium orotate;

September - vitamins B1, B2, calcium pantetonate and lipoic acid;

October - Eleutherococcus tincture;

November multivitamin preparations (decamevit, aerovit, undevit, hexavit, kvadevit, etc.), lipoic acid;

December - tincture of aralia, inhalation with a decoction of plantain;

January - vitamins B1, B2. calcium pantetonate and lipoic acid;

February - riboxin and potassium orotate;

March - multivitamin preparations;

April - vitamins B1, B2, calcium pantetonate, lipoic acid;

May - Eleutherococcus tincture (Pantocrine).

Complexes are prescribed in age dosages for 10-day courses

4. Adaptogen preparations: methyluracil 0.1-0.6 orally 3-4 times a day after or during meals, 3-4 weeks. Dibazol 0.003-0.03 1 time per day. 3-4 weeks

b. Inhalations with sage decoction, 25-30 inhalations daily in winter, spring

6. Reaferon (genetically engineered - interferon) intranasally in doses of 300 and 600 IU for 6 days (winter, spring)

7. Speleotherapy for children over 5 years of age to normalize mucociliary clearance and improve sputum evacuation, daily, 20 sessions

8. Therapeutic exercise

9. Massage: acupressure, classic, vibration

10. Hardening procedures.

During the rehabilitation period, an immunological examination of patients is carried out. In cases of detection of immunodeficiency syndrome, immunocorrective therapy is indicated after consultation with a clinical immunologist.

1.6. Recurrent obstructive bronchitis has all the clinical symptoms of recurrent bronchitis, accompanied by episodes of bronchial obstruction. Like recurrent bronchitis, it refers to pre-asthma.

Examination methods:

Functional ventilation test with bronchodilators. The following indicators are used: lung capacity (VC). maximum lung ventilation (MVL), expiratory pneumotachometry (PTV), forced vital capacity (FVC).

The listed ventilation parameters are recorded before and after the introduction of a bronchodilator (ephedrine, aminophylline). The presence of bronchospasm in the examined patients is indicated by an increase in 2-3 out of 4 indicators, more often VC and MVL. A positive functional ventilation test with bronchodilators, indicating bronchospasm, requires a differential diagnosis of recurrent obstructive bronchitis with asthmatic bronchitis.

Other methods of examination of patients with obstructive recurrent bronchitis are similar to examination of children with recurrent bronchitis.

Treatment of patients with recurrent obstructive bronchitis is carried out according to the same principle as in patients with recurrent obstructive bronchitis. In addition, bronchospasmolytics are prescribed - eufillin, alupent (see Treatment of acute obstructive bronchitis). Dispensary observation of patients is aimed at preventing recurrence of bronchial obstruction and bronchitis. Rehabilitation of patients is based on the same principle as for patients with recurrent bronchitis. Rehabilitation measures are planned taking into account the results of an allergological examination with the most common allergens. In the process of dispensary observation and according to the allergological examination, the diagnosis of "recurrent obstructive bronchitis" can be verified. Probable diagnoses may be asthmatic bronchitis, and in the presence of typical attacks of suffocation - bronchial asthma.

1.6. Bronchial asthma is a chronic allergic disease in which the immunopathological process is localized in the bronchopulmonary system and is clinically characterized by recurrent, reversible asthma attacks caused by an acute violation of bronchial patency.

Classification of clinical forms of bronchial asthma (S.S. Kaganov, 1963)

Form of the disease

1. Atopic

2. Infectious-allergic

3. Mixed

Typical:

1. Severe attacks of bronchial asthma

2. Asthmatic bronchitis

Atypical:

Attacks of acute emphysematous swelling of the lungs

Severity

2. Moderate

3. Heavy

Severity indicators:

1. Frequency, nature and duration of seizures

2. The presence and severity of changes in the interictal period from:

a) respiratory systems;

b) cardiovascular system;

c) nervous system;

d) metabolic processes:

e) physical development;

1. With individual attacks, with an asthmatic condition, with asphyxia syndrome

2. With bronchopulmonary infection, with inflammatory changes in the nasopharynx

3. With concomitant allergic diseases:

a) with allergic dermatoses (eczema, urticaria, Quincke's edema);

b) with other clinical forms of respiratory allergies (allergic rhinitis, sinuitis, tracheitis, bronchitis, pneumonia, eosinophilic pulmonary infiltrate)

4. With complications:

a) chronic (persistent) pulmonary emphysema;

b) cor pulmonale;

c) lung atelectasis;

d) pneumothorax;

e) mediastinal and subcutaneous emphysema;

e) neurological disorders;

With a mild degree of the course of the disease, exacerbations are rare and short-lived, with moderate-severe bronchial asthma, exacerbations are monthly. The severe course of bronchial asthma is characterized by frequent exacerbations. Attacks of suffocation occur weekly, and often daily with the transition to an asthmatic state. An attack of bronchial asthma, lasting from several minutes to several hours and days, is determined by acute bronchospasm. There is expiratory dyspnea with noisy wheezing. Patients are concerned about coughing with difficult to separate viscous sputum. Percussion of the lungs reveals a boxy shade of percussion sound, auscultation reveals multiple dry rales. In young children, different-sized moist rales are heard in the lungs, since at this age during an attack of bronchial asthma, not bronchospasm prevails, as in older children, but inflammatory swelling of the bronchial mucosa and excessive production of mucus.

The atopic form of bronchial asthma is characterized by acute development attack and in mild cases, bronchial patency can be restored fairly quickly.

Exacerbation of infectious-allergic bronchial asthma begins slowly and gradually. Obstructive syndrome, with the appointment of bronchospasmolytic agents, is stopped slowly.

In the lungs for a long time, not only dry, but also various wet rales are heard.

With a mild attack of bronchial asthma, the well-being of patients suffers little. A moderately severe attack has a clinical picture of asthmatic suffocation. Auxiliary muscles are involved in the act of breathing, tachycardia and an increase in blood pressure are observed. A severe attack is characterized by clinical symptoms of respiratory failure against the background of severe asthmatic suffocation.

An intractable attack of bronchial asthma lasting 6 hours or more is classified as an asthmatic condition that can turn into status asthmaticus. With asthmatic status II and III Art. there comes a total obstruction of the bronchi as a result of filling them with a thick viscous secret, a pronounced inflammatory infiltration of the mucous membrane and spasm of smooth muscles. Breathing noises disappear in the lungs ("silence" syndrome), there is a decrease in blood pressure, muscle hypotension, and a drop in cardiac activity.

Forecast: the course of bronchial asthma is difficult to predict. Parents of sick children should not count on a speedy recovery. Their energy should be directed to long-term treatment, which would prevent the occurrence of new attacks, and alleviate their severity. The atopic form of bronchial asthma is prognostically more favorable with the timely detection of causally significant allergens and specific hyposensitization. Infectious-allergic and mixed forms of bronchial asthma more often than atopic, remain throughout childhood, adolescence and become a disease of an adult.

Examination methods:.

1. Complete blood count

2. Immunogram (determination of T-I B-lymphocytes, Tn-helpers, Ts-suppressors, Tn / Ts index, serum immunoglobulins, circulating immune complexes (CICs)

3. Study of the acid-base state of the blood (KOS)

5. Consultation of an ENT specialist with subsequent sanitation of foci of chronic infection in the ENT organs

6. In the interictal period, skin prick tests with non-infectious allergens.

7. Radioallergosorbent test (RAST), which allows to detect specific immunoglobulins (class E-IgE) in blood serum.

A mild asthma attack can be relieved at home. For this purpose, bronchospasmolytics are prescribed orally or in the form of inhalation: ephedrine (for children from 2 to 6 years old, 0.003-0.01 g each, from 6 to 12 years old, 0.01-0.02 g each), eufillin 3-4 mg / kg (single dose) up to 12-16 mg / kg per day. Can be used combined preparations: theofedrin, antasman (children from 2 to 6 years old 1/4-1/3 tablets per dose, children from 6 to 12 years old 1/2-3/4 tablets), solutan at a dosage of 1 drop for 1 year of life. It is also recommended orciprenaline (0.76 mg per inhalation or 1/4-1/2 tablets orally), alupent (1-2 inhalations or 1/4 tablets for children under 6 years old, from 6 years and older 1/2 tablets), 1 5% solution of Asthmopent and Berotek 1-2 inhalations, salbutamol (inhalation pack -0.1 mg of the drug, children from 4 to 7 years old 1 inhalation, school-age children 1-2 inhalations), ventolin (in inhalation packs are prescribed in the same dosage, like salbutamol, orally for children 3-4 years old 1/6 tablet, 6-7 years old 1/3 tablet, 7-14 years old 1/2 tablet).

Patients with moderate to severe asthma attacks should be hospitalized immediately. The following activities should be carried out in the hospital.

A moderate attack can be stopped with fast-acting sympathomimetics, for example, parenteral administration of a 0.1% solution of adrenaline s / c at the rate of 0.01 mg / kg in combination with a 5% solution of ephedrine 0.6-0.75 mg / kg. The action of adrenaline occurs after 15 minutes, ephedrine after 45 minutes, the duration of the action of these drugs is 4-6 hours. 6 mg/kg single dose). After the removal of acute manifestations of a moderate attack, in order to stabilize the condition of patients, it is advisable to conduct a 5-7-day course of treatment with eufillin or ephedrine, prescribing a single dose of drugs orally 3-4 times a day.

Antihistamines are used if there is no difficulty in sputum discharge. Obligatory oxygen therapy!

A severe attack of bronchial asthma requires immediate intravenous administration of aminophylline at the rate of 6-8 mg/kg (single dose) or 1 ml per year of life, but not more than 10 ml. Outside the hospital, the drug can be injected in a jet, but slowly, over 5-10 minutes. in 10-15 ml of 15-20% glucose solution. In the hospital, it is necessary to administer aminophylline IV, drip into 150-250 ml of isotonic sodium chloride solution. Severe respiratory failure and resistance to previously used sympathomimetics require intravenous administration of prednisolone (1-2 mg/kg) or hydrocortisone (5-7 mg/kg).

Oxygen therapy in a somatic hospital: humidified oxygen for 20-30 minutes. every 2 hours, in a specialized department, an oxygen-air mixture containing 35-40% oxygen.

After the removal of an attack of bronchial asthma, treatment with eufillin should be continued until the obstructive syndrome is completely eliminated, but the method of administration of the drug can be changed by administering it intramuscularly or orally, or in suppositories. The treatment is supplemented by the appointment of mucolytic drugs (mucaltin, bromhexine, decoctions of herbs: thyme, elecampane, plantain, infusions of birch buds, pine needles, etc.).

Treatment of patients with stage I asthmatic status, which is a prolonged severe attack of bronchial asthma, is carried out according to the same program with the addition of antibiotic therapy due to the activation of bronchopulmonary infection. Semi-synthetic penicillins or aminoglycoside are recommended, cephalosporins may be prescribed.

If metabolic acidosis is detected, in order to correct it, a 4% solution of sodium bicarbonate is prescribed at the rate of 2-2.5 ml / kg under the control of blood pH (the required level is 7.25); heparin 180-200 units / kg (under the control of a coagulogram); 1% solution of lasix 0.5 mg/kg per day (with insufficient diuresis); cardiotonic drugs - 0.06% solution of corglicon for children aged 2 to 5 years 0.2-0.5 ml, from 6 to 12 years 0.5-0.75 ml. Repeated drip introduction of aminophylline! Continue the introduction of prednisolone, but inside 5-7 days with a gradual withdrawal within two weeks. Treatment of asthmatic status should be carried out with the appointment of a hypoallergenic diet or fasting day with kefir.

Asthmatic status II Art. requires expanding the scope of therapeutic intervention aimed at restoring bronchial patency. In this state, the dosage of prednisolone is increased to 3-5 mg/kg, which is administered intravenously along with zufillin. Metabolic acidosis needs to be corrected. Clinical signs of heart failure require the appointment of cardiotonic agents with simultaneous intravenous administration of 50-100 mg of cocarboxylase and potassium preparations. Shown therapeutic bronchoscopy with the removal of mucus and the introduction of sodium bicarbonate solutions into the lumen of the bronchi. As the patient's condition improves, the dose of prednisolone is reduced to 1-1.5 mg / kg with the appointment of it inside for 2-2.5 weeks, followed by cancellation.

Asthmatic status III Art. requires the transfer of the child to the intensive care unit and the appointment of mechanical ventilation. It is possible to carry out plasmapheresis or hemosorption. The dose of prednisolone is increased to 6-10 mg/kg, of which 4-8 mg/kg is administered intravenously, 2 mg/kg orally. At the same time, aminofillin and cardiotonic drugs are prescribed according to the previous program. Treatment with corticosteroids is carried out with their gradual abolition within 3-4 weeks. During the period of withdrawal of corticosteroids, it is advisable to prescribe calcium pantetonate (vitamin B5). vitamin B6, etimizol, glyceram, inductothermy on the adrenal region. Withdrawal syndrome can be prevented by administering hormone aerosols: becotide, beclamat.

Rehabilitation

1. Home regimen with the exclusion of causally significant allergens. A complete ban on smoking in the apartment and house, keeping animals, fish, birds, refusal medicines to which an allergic reaction has been noted

2. Medical nutrition with the exclusion of obligate food allergens

3. Sanitation of foci of chronic infection of the upper respiratory tract in the patient and in those surrounding the sick child

4. Identification and treatment of chronic diseases of the digestive system (dyskinesia of the biliary system and cholecystitis, duodenogastric reflexes and gastroduodenitis), deworming, treatment of giardiasis, intestinal dysbacteriosis. The appointment of biologically active drugs (lacto-, coli-, bifidumbacterin, sour-milk bifidumbacterin) for 1-1.5 months, enzyme preparations for 2 weeks, enterosorbents (activated charcoal from 10 to 30 g per day, cholestyramine according to 4-8 g per day for 5-7 days and vazazan-r at the same dosage for 5-7 days at night; enterodez 10% solution up to 150-200 ml orally, in 3-4 doses during the day

5. Courses of vitamin B6 50-100 mg for 1-2 months.

6. Intal or ifiral inhalations 2-4 times a day for 2-4 months. It is also possible to use intal for a longer period (from 1 year to 3 years) if it maintains a stable remission.

7. Zaditen (ketotifen), a single dose of 0.025 mg / kg, 2 times a day or 0.125 ml / kg as a syrup 2 times a day, in the morning and in the evening, 6-9 months; astafen 1 mg twice daily with food for several weeks

8. Teopec - first 1/2 tablet 1-2 times a day, and then 1 tablet 2 times a day, orally after meals with water for 1-2 months. Do not chew or dissolve in water!!

9. Histoglobulin: a course of treatment of 5 injections with an interval of 3-4 days, starting with 0.5 ml, then 1 ml. Repeated courses in 2-3 months.

human placental blood 6 ml 2 times a month for 2 months.

11. Acupuncture 15-20 sessions daily / or every other day, 2-3 courses per year

12. Speleotherapy

13. Patients with hormone-dependent bronchial asthma are prescribed prednisolone in a maintenance dosage of 5-15 mg per day. Against the background of treatment with zaditen (ketotifen, astafen), it is sometimes possible to cancel corticosteroids or reduce their dosage

14. In atopic form of bronchial asthma 15% solution of dimephosphone 75-100 mg/kg (10-15 ml 3 times a day. Orally, for one month.)

15. Inhalations of 5% solution of unithiol (0.1 ml/kg) in combination with oil inhalations of vitamin E 2-3 mg/kg, 10-15 inhalations per course of treatment. Repeated prophylactic courses 2-3 times a year, 10 inhalations of each drug every other day (the best effect with medium-severe mixed and atopic forms of bronchial asthma)

16. Possible long-term (from several months to a year), continuous use of theophylline

17. Vilozen electrophoresis on the chest, 8-10 procedures daily. Repeated courses in autumn-winter-spring

18. Specific hyposensitization (SG-therapy) is carried out mainly by household and pollen allergens

19. Regular physical therapy, 2-3 times a day, for a long time

20. Various forms of massage (general, vibration, acupressure)

21. Sanatorium treatment in mountain-climatic conditions. Volunteers with bronchial asthma are not removed from the dispensary. They are subject to the supervision of the local doctor and the doctor of the adlergological office. During the rehabilitation period, an immunological examination of patients is carried out and, according to indications, immunocorrective therapy is prescribed.

Asthmatic bronchitis is a type of bronchial asthma. The development of asthmatic bronchitis is based on allergic edema of the bronchial mucosa and blockage of the airways with mucous secretions. In asthmatic bronchitis, an allergic reaction develops mainly in the bronchi of medium and large caliber, in contrast to bronchial asthma, in which small bronchi and bronchioles are involved in the pathological process. The peculiarities of clinical symptoms are associated with this: during exacerbation of asthmatic bronchitis, there are no typical attacks of suffocation (!), mixed-type dyspnea with a predominance of the expiratory component, with the participation of auxiliary muscles, wet frequent cough, remote wheezing.

The classification of asthmatic bronchitis is identical to that of bronchial asthma. Treatment and rehabilitation of patients is carried out according to the same program as for bronchial asthma.

1.7. Acute pneumonia is an acute inflammatory process in the lung tissue that occurs as an independent disease or as a manifestation or complication of a disease.

Classification of acute pneumonia

Focal (including focal-confluent)

Segmental

Croupous

Interstitial

2. Current

lingering

3. Manifestations (complications)

Respiratory failure

Cardiovascular insufficiency

Pulmonary edema

Destruction of lung tissue

Pneumothorax

Meningitis etc.

It is characterized by an acute onset of the disease with an increase in temperature to febrile figures. High temperature lasts for at least 3 days, accompanied by chills. Pneumonia can occur not only suddenly, but also against the background of a current respiratory viral infection. Cough - less often dry, more often - wet. There are violations of the general condition in the form of a decrease in appetite, changes in behavioral reactions (excitation or, conversely, apathy), sleep, a decrease in emotional tone, indicating pneumonic toxicosis. From the first days of the disease, shortness of breath appears in patients, in severe cases, groaning or grunting breathing is observed. When examining patients, a change in breathing over the affected area of the lung: hard or bronchial, very often weakened breathing. With percussion in the zone of the inflammatory process, a shortening of the percussion sound is observed. Auscultation of moist small bubbling rales over a limited area of the lung makes the diagnosis of pneumonia very likely, but in patients with acute pneumonia, rales may not be heard throughout the illness.

Infants and young children with pneumonia require immediate hospitalization. Duration of stay in the hospital 20-21 days, in complicated cases 1-1.5 months. Patients of preschool age and schoolchildren, at the request of their parents, can be treated at home, subject to all the recommendations of the local doctor.

Examination methods:

1. Radiography of the lungs in two projections, taking into account the localization of the inflammatory broncho-pulmonary process (right- or left-sided pneumonia)

2. Complete blood count.

1. Organization of a medical and protective regimen.

2. Treatment table 16 or 15 (depending on age). Additional introduction of liquid in the amount of 300-500 ml in the form of tea, berry and fruit decoctions, fruit drinks, juices, mineral water, oralit (oralit recipe: for 1 liter of water 3.5 g of sodium chloride, 2.5 g of sodium bicarbonate, 1, 6 g potassium chloride, 20-40 g glucose). With properly organized oral rehydration, in almost all cases, it is possible to refuse intravenous infusion therapy. In an uncomplicated course of pneumonia, it should be limited to parenteral administration (im) of one antibiotic, preferably a penicillin series (benzyl-penicillin 150 mg / kg, semi-synthetic penicillins - ampicillin, ampiox 150-200 mg / kg, carbenicillin 200 mg / kg).

The absence of a positive effect after 24-49 hours, namely: lowering the temperature to normal or subfebrile numbers, reducing or eliminating the symptoms of intoxication, improving the general condition and the appearance of appetite, as well as an increase in pulmonary changes require therapeutic correction in the form of prescribing a second antibiotic (in / in the introduction) or changing antibiotics with the appointment of cephalosporil 100 mg/kg, aminoglycosides (gentamicin 3-5 mg/kg), lincomycin 30-50 mg/kg, chloramphenicol 50 mg/kg, erythromycin 20 mg/kg. Enteral use of antibiotics is not recommended due to the risk of dysbactoria development!

4. Infusion therapy (in / in) includes the introduction of glucose-salt solutions: 1056 solution of glucose in a ratio of 1: 1 with saline, hemodez, reopoliglyukin (glucose 50 ml / kg, reopoliglyukin 10 ml / kg, gemodez 10-20 ml / kg ), plasma or albumin 5-10 ml/kg. The calculation of the infusion fluid is based on pathological losses, which in pneumonia are limited by high fever and shortness of breath, while the volume of fluid, as a rule, does not exceed 30 ml / kg.

5. Cardiotonic means; 0.065% solution of corglicon 0.1-0.15 ml per year of life or 0.05% solution of strophanthin 0.1 silt per year of life, i.v. You can use digoxin 0.007-0.01 mg / kg per day on the first day of the course of pneumonia complicated by pneumonic toxicosis

6. Corticosteroids (prednisolone) are used as a means of combating toxic-infectious shock, cerebral edema, secondary cardiopathy, pulmonary edema and microcirculation disorders. It is prescribed for severe condition of patients and willows at the rate of 4-6 mg/kg IV for 1-3 days

7. If you suspect a destructive form of pneumonia and the threat of DIC, prescribe: antiproteases (kontrykal 1000 units / kg, but more than 15 thousand), heparin 200-250 units / kg (under the control of a coagulogram)

8. Immunotherapy is indicated for severe, complicated course of staphylococcal pneumonia, Pseudomonas aeruginosa. proteic etiology. It is recommended to use immunoglobulin at the rate of 1-2 ml/kg IM, hyperimmune anti-staphylococcal immunoglobulin 100 mE daily for 3-5 days, hyperimmune plasma with high titers of the corresponding antitoxin at a dose of 5-15 ml/kg

9. Attention! Hemotransfusions (!) Are indicated for a long-term purulent-destructive process in a child with a hemoglobin content of 65 g / l

10. Oxygen therapy: the administration of humidified oxygen through a nasal catheter or in an oxygen tent DPK-1

11. Physiotherapy: SMT-phoresis on the chest No. 7-10, intraorgan electrophoresis of antibiotics No. 5-6 daily in acute inflammatory process, calcium electrophoresis No. 10, daily during the period of resolution of pneumonia

12. Symptomatic therapy, including a complex of vitamins, enzyme preparations, biologically active preparations, is prescribed after an improvement in general well-being, elimination of clinical symptoms of intoxication and respiratory failure. The duration of stay of patients in the hospital is 21-24 days, with a complicated form up to 1-1.5 months.

Rehabilitation. Rehabilitation activities are carried out within 3 months.

Children are removed from the register after a year. In the first month after discharge from the hospital, they are examined weekly, in the second or third month of observation once every 2 weeks, then monthly.

Repeated x-ray examination is recommended in cases where patients are discharged with residual pneumonia. In autumn-winter-spring time, inhalation therapy is carried out with the appointment of inhalations of St. John's wort (Novoimanin), chamomile, calendula, plantain, phytoncides (see Rehabilitation of recurrent bronchitis). Seasonal courses of prescribing vitamins and biologically active drugs. Chest massage No. 15-20.

Classes in the office of physiotherapy exercises for 1-1.5 months. Schoolchildren can continue their classes in sports sections after 1-1.5 months. after the control ECG.

Preventive vaccinations are carried out no earlier than after 2 months. after recovery (in cases of uncomplicated form), after 6 months. after suffering destructive pneumonia. If the course of pneumonia was accompanied by neurotoxicosis, preventive vaccinations are carried out after consulting a neurologist.

1.8. Chronic pneumonia is a chronic non-specific bronchopulmonary process, which is based on irreversible morphological changes in the form of bronchial deformation and pneumosclerosis in one or more segments and is accompanied by recurrent inflammation in the lung tissue and (or) in the bronchi. Chronic pneumonia with deformation of the bronchi (without their expansion) and with bronchiectasis is distinguished. The severity of the course of chronic pneumonia is determined by the volume and nature of bronchial lesions, the frequency and duration of exacerbation, and the presence of complications.

In children with chronic pneumonia, a history of acute pneumonia is revealed, often its complicated course or destructive form. Repeated pneumonia, increased incidence of SARS, bronchitis are noted.

Clinical symptoms of chronic pneumonia are determined by the localization and prevalence of the pathological process. Most often, the bronchopulmonary process is localized in the lower lobe of the left lung, then in the reed segments, then in the lower and middle lobes of the right lung, and only in some cases in the segments of the upper lobe. Exacerbation of chronic pneumonia proceeds, as a rule, according to the bronchitis type. The onset of exacerbation is gradual. The temperature rises, a wet cough intensifies, the amount of sputum increases, which acquires a mucopurulent or purulent character. The amount of sputum is small (20-50 silt), and only with the bronchiectasis variant of chronic pneumonia is there a large amount of sputum "mouthful" (up to 100-150 ml per day). Physical changes in the lungs are increasing in the form of the appearance of a large number of wet rales of various sizes or dry rales both in the zone of previously diagnosed chronic pneumonia and in places where they have not previously been heard. It is important to emphasize precisely the increase in the auscultatory picture in the lungs, since the constant presence of wet or dry rales in the area of the affected segment or segments is one of the most characteristic signs of chronic pneumonia. Mixed dyspnea (inspiratory-expiratory) intensifies, which, before exacerbation, was observed only during physical exertion. The exacerbation lasts from 2-3 to 4-6 weeks.

Exacerbation of chronic pneumonia may occur with symptoms of acute pneumonia. The onset of exacerbation is acute, with an increase in temperature to febrile numbers. The severity of the general condition, signs of intoxication, shortness of breath, cyanosis increase, cough intensifies. Wet, finely bubbling and crepitant rales are heard, first in the primary lesion zone, and then in neighboring areas, and in the unaffected lung. The period of exacerbation lasts from 3 weeks to 2-3 mods.

Currently, it is proposed to distinguish 2 variants of the course of chronic pneumonia. The first - "small" forms, in which the general condition of children, their physical development does not suffer. Exacerbations are rare, 1-2 times a year, with a short-term increase in temperature, a meager amount of sputum, and an increase in the physical picture. Outside of exacerbation, children feel quite satisfactorily; in the affected area, wheezing is heard only when deep breath and forced exhalation. The second option is bronchiectasis. It has been rare in recent years. With this option, exacerbation is observed 2-3 times a year. The cough is wet, with purulent sputum, almost constant. These children always show signs of intoxication. They lag behind in physical development. Physical symptoms in the form of weakened breathing, wet and dry rales in the affected area are observed almost constantly.

Examination methods:

1. X-ray of the lungs

2. Bronchoscopy

3. Complete blood count in dynamics

4. Bacteriological examination of the lavage fluid, i.e. bronchial washings during bronchoscopy with the determination of sensitivity to antibiotics

5. Immunogram

6. Consultation with an ENT specialist

1. Hospitalization of patients during an exacerbation

2. Mode depending on the general condition of the patient

3. Table 15 with an additional introduction of protein: meat, cottage cheese, eggs, cheese. Fruits and vegetables unlimited

4. Antibiotic therapy is carried out according to the same principle as in acute pneumonia and recurrent bronchitis. Duration of antibiotic therapy 7-12 days

5. Inhalation therapy (see. Recurrent bronchitis) is carried out in 3 stages

6. Mucolytic (secretolytic) and expectorant (secretomotor) drugs are prescribed in the same way. as in recurrent bronchitis

7. Physiotherapy: in case of exacerbation, ozokerite, paraffin applications, calcium-, magnesium-, copper-, iodine-electrophoresis, 10-12 procedures (2-55% solutions, galvanic current density 0.03-0.06 ml/cm3).

When the exacerbation subsides, high-frequency electrotherapy; microwaves - apparatus "Chamomile", 10 procedures, 7-12 W, duration of the procedure 8-10 minutes. apparatus "Luch-3", 9-10 procedures, 48 W, duration of the procedure 6-10 minutes. Inductothermy - apparatus IKV-4, 8-10 procedures, 160-200 mA, procedure duration 8-12 minutes.

8. Therapeutic bronchoscopy, course 2-6 bronchoscopy

9. Therapeutic exercise: postural drainage 2-3 times a day (Quincke's position: in the morning after waking up, hanging the torso from the bed with hands on the floor, 5-10 minutes, making coughing movements). Performing a handstand against the wall, 5-10 minutes, 1-2 times a day. Vibration massage.

Attention! These types of physical therapy are prescribed only after the elimination of the exacerbation (!) And during the rehabilitation period.

Rehabilitation

1. Examination by a pediatrician 2-3 times a year

2. Sanitation of foci of chronic infection in the upper respiratory tract

3. Immunological examination with immunotherapy (according to indications)

4. Treatment of concomitant diseases of the digestive system, the appointment of biologically active drugs in courses of 2-4 weeks, 2-3 times a year

5. Inhalation therapy in unfavorable seasons of the year - spring-autumn-winter and during epidemic outbreaks of SARS

6. Sanatorium treatment in local sanatoriums, in the Crimea, Anapa, Kislovodsk. Balneotherapy: mineral baths, chloride, sodium, carbonic, radon, sulfide. oxygen. Therapeutic mud in the form of applications on the chest (in the absence of respiratory and cardiovascular system disorders)

7. Physiotherapy exercises not earlier than a month after the exacerbation! Postural drainage and vibration massage 3-4 times a year. A set of measures is appointed by the methodologist of the exercise therapy cabinet

8. Hardening procedures, swimming, skiing, taking into account individual tolerance

9. A complex of vitamins and adaptogen preparations according to the program used in patients with recurrent bronchitis (see Rehabilitation of patients with recurrent bronchitis)

10. Consultation of a thoracic surgeon to determine the indication for surgical treatment. The decision on surgical intervention can be made after repeated X-ray and bronchological examination, a full course of conservative therapy and observation of the patient for at least a year.

The prognosis for most patients with chronic pneumonia is favorable, provided that conservative therapy is methodically carried out. Children are not removed from the dispensary register and are transferred to doctors of adolescent rooms.

For citation: Nonikov V.E. Expectorants in the treatment of broncho lung diseases// RMJ. 2006. No. 7. S. 554

Diseases of the upper (ARVI, pharyngitis, laryngitis, tracheitis) and lower respiratory tract (bronchitis, pneumonia, chronic obstructive pulmonary disease, bronchial asthma) account for one third of all outpatient visits to general practitioners. Cough is the most common symptom in bronchopulmonary pathology. It may be dry or accompanied by sputum. Sputum separation can be difficult for a number of reasons. An unproductive cough may be due to impaired consciousness, hypokinesia, muscle weakness, impaired drainage function of the bronchi (most often due to bronchial obstruction), and a decrease in the cough reflex. A decrease in the cough reflex may be a consequence of somatic pathology, but the possibility of drug suppression of the cough reflex by taking sedatives and / or hypnotics should also be taken into account. It should be borne in mind that cough receptors are predominantly localized in the trachea and large bronchi. There are no cough receptors in the distal sections of the bronchial tree and, therefore, even in the presence of sputum in the bronchi of small caliber, cough does not occur. Part of the sputum is evacuated from the respiratory tract without causing cough - due to the escalator function of the ciliated epithelium. It is essential that the function of the ciliated epithelium is impaired in a number of viral infections; chronic inflammatory processes; exposure to various toxic substances and fumes, which are usually the cause of chronic bronchitis/chronic obstructive pulmonary disease.

The other side of the problem is the properties of the sputum itself. Sputum can be liquid, and then it easily moves along the bronchial tree, reaches the cough receptors, causes a cough - and is easily coughed up. Viscous sputum is poorly displaced from the distal airways, it can be fixed on the bronchial mucosa, and significant efforts or repeated coughing are required to separate it. Such situations often occur in chronic obstructive pulmonary disease, when in the morning after a long bout of coughing, a meager amount of viscous sputum is separated. (“The mountain gave birth to a mouse” - in the figurative expression of my teacher, Boris Evgenievich Votchal, one of the founders of Russian pulmonology, whose “Essays on Clinical Pharmacology” were read by more than one generation of doctors). Viscous sputum can partially or completely block the segmental bronchi, creating obstructive atelectasis. With the resolution of such a clinical situation, sputum is coughed up in the form of casts of the bronchi.
The vast majority of patients report improvement after coughing up sputum. At the same time, surprisingly little attention has been paid to rational therapy expectorants. Unfortunately, there are official preparations of complex prescriptions related to expectorants - codterpine (codeine + terpinhydrate + sodium bicarbonate); neo-codione (codeine + ipecac); codeine + sodium bicarbonate + licorice root + thermopsis herb. These medicines are contained in the State Register of Medicines (2004) approved in Russia. It is difficult to predict what effect such a drug will cause in a patient: there will be stimulation of expectoration or, on the contrary, suppression of the cough reflex (codeine!) Will lead to the termination of sputum separation.
What drugs improve the drainage function of the bronchi and improve sputum production?
In the domestic literature, there are evidence-based recommendations for the use of expectorants, showing that the listed combination drugs lead to sputum stagnation in the respiratory tract.
Abroad, drugs that stimulate sputum separation are divided according to the mechanism of action, highlighting directly expectorant drugs and drug therapy providing an indirect expectorant effect (Table 1).
Direct expectorants are:
Drugs affecting mucus secretion
secretion hydrates - water, saline solutions;
normalizing the biochemical composition of mucus - ambroxol (Lazolvan), carbocysteine, bromhexine;
fluids that stimulate transepithelial secretion - balms, pinenes, terpenes;
directly stimulating bronchial glands - iodine salts;
stimulating secretion evacuation - ipecac, thermopsis, sodium, potassium and ammonium salts.
Means affecting the structure of mucus
secretion diluents - water, saline solutions;
mucolytics - cysteine, acetylcysteine, enzymes.
Means affecting mucociliary clearance
strengthening the function of the ciliated epithelium - sympathomimetics, cholinergic stimulants;
surfactant stimulant - ambroxol.
Means with a versatile action - mucosecretolytics, bronchosecretolytics, hydrating agents.
Thus, water and saline solutions taken orally or inhaled can be used to obtain a direct expectorant effect. The injected liquid performs two tasks - it increases the secretion of mucus and changes its structure (sputum viscosity decreases). Of course, drinking plenty of water should be dosed in heart failure.
Ambroxol (Lazolvan) and Bromhexine normalize the biochemical composition of mucus and facilitate its separation. By its nature, ambroxol is an active metabolite and the active principle of bromhexine, but unlike the latter, it has a number of additional positive properties. In particular, it has been proven that Lazolvan (Ambroxol) is able to stimulate the production of surfactant, which is an anti-atelectasis factor and ensures the stability of the alveoli during breathing.
The structure of mucus, in addition to water, is affected by mucolytics, of which acetylcysteine is the most common.
For many years, means of reflex action have been used - preparations of thermopsis, marshmallow, terpinhydrate. In recent years in clinical practice balms, pinenes, terpenes, iodine salts are relatively rarely used.
Most direct expectorants are symptomatic in nature.
Indirectly expectorant effect have:
Bronchodilators (b2-agonists, methylxanthines, anticholinergics)
Anti-inflammatory drugs (glucocorticosteroids, decongestants)
Antibacterial agents(antibiotics, antiviral agents)
Antiallergic drugs (antihistamines, cromolyn and other mast cell stabilizers)
Drugs that stimulate breathing and cough (aerosols of hypertonic solutions, cough receptor stimulants, respiratory analeptics).
Drugs that have an indirect expectorant effect (b2-agonists, methylxanthines, anticholinergics, glucocorticosteroids, antibiotics, antivirals, antihistamines, cromolyn and other mast cell stabilizers) are most widely used in the treatment of various bronchopulmonary diseases. First of all, these are bronchodilators (b2-agonists, anticholinergics, methylxanthines). Naturally, with a decrease in bronchial obstruction, sputum is separated more easily. In addition, b2-agonists stimulate the function of the ciliated epithelium. Anti-inflammatory drugs and antibiotics reduce inflammatory edema of the bronchial mucosa, improve bronchial drainage and, to a certain extent, reduce secretion production. Antiallergic drugs reduce bronchial obstruction and may reduce secretion production.
Drugs related to indirect expectorants form the basis of etiotropic (antibiotics, antiviral agents) and pathogenetic treatment of the most common diseases: pneumonia, bronchitis, COPD, bronchial asthma. From this group, aerosols of hypertonic solutions can be noted, which directly stimulate cough receptors and cause coughing.
When prescribing expectorants, the nature of the disease and the characteristics of its course are often not taken into account. So, it is almost standard to prescribe Bromhexine for coughing, but if the cough is dry, then taking the drug has no effect on the symptoms. On the other hand, the use of thermopsis, terpinhydrate for dry cough can increase the cough.
When prescribing expectorants, the following questions need to be addressed: what is the goal - to strengthen the cough reflex or reduce the viscosity of sputum and facilitate coughing? If it is necessary to stimulate cough receptors, then it is advisable to use thermopsis, marshmallow and other medicinal plants, terpinhydrate, sodium benzoate, etc. Coughing can be caused by inhalation of a hypertonic solution, but this manipulation usually has a one-time purpose.
If it is necessary to ensure a mucolytic effect and facilitate sputum separation, then the first step is to drink plenty of fluids (if this is possible due to the patient's condition and the nature of concomitant diseases). The second step is the choice of mucolytic drug. In Russia, ambroxol (Lazolvan), acetylcysteine, bromhexine are most commonly used. The formulas adopted in our country provide for the appointment of Ambroxol (Lazolvan) or acetylcysteine. Both drugs can be used orally, parenterally and inhaled. Most often, drugs are taken orally.
Lazolvan (Ambroxol) is prescribed for adults at a dose of 30 mg 3 times a day. In addition to the mucolytic effect, Lazolvan is able to enhance the activity of the ciliated epithelium, stimulates the formation of pulmonary surfactant. It is known about the anti-inflammatory and immunomodulatory effects of Lazolvan. Of particular interest are data on the potentiation of antibiotics by Ambroxol (Lazolvan). It has been shown that the concentration of antibiotics in the lung tissue is significantly higher with the simultaneous use of Lazolvan. In this regard, the antibiotic ambrodox is produced in the United States, which is a combination of doxycycline with ambroxol. Several years ago, as part of a multicenter work, we were convinced of the effectiveness of this drug and periodically use combinations of antibiotics with Lazolvan in the treatment of pneumonia and exacerbations of chronic bronchitis. It is also important in the treatment of patients with bronchopulmonary diseases that Ambroxol (Lazolvan) does not provoke bronchospastic syndrome.
Acetylcysteine is prescribed for adults at 200 mg 2-3 times a day in the form of granules, tablets or capsules. The drug should be used with caution in patients with pulmonary bleeding, liver disease, kidney disease, phenylketonuria. Sometimes the drug can provoke bronchospasm. In addition to the mucolytic effect, acetylcysteine has a strong antioxidant effect and is an effective antidote for paracetamol poisoning.
Thus, expectorants are widely used in pulmonological practice. When assigning them, it is important to take into account the features clinical manifestations diseases, the main direction of treatment (as a rule, the use of drugs with an indirect expectorant effect) and choose an expectorant drug that is most appropriate for the clinical situation (Lazolvan and others). A logical treatment program will ensure high efficiency of therapy.

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Section 1. DISEASES OF THE BRONCHOPULMONARY SYSTEM. TREATMENT, REHABILITATION

1. Bronchitis

Classification of bronchitis (1981)

Acute (simple) bronchitis

Acute obstructive bronchitis

Acute bronchiolitis

Recurrent bronchitis, obstructive and non-obstructive

With the flow:

exacerbation,

remission

1.1. Acute (simple) bronchitis- This is usually a manifestation of a respiratory viral infection. The general condition of the patients was slightly disturbed. Typical cough, fever for 2-3 days, may be more than 3 days (the duration of the temperature reaction is determined by the underlying viral disease). There are no percussion changes in the lungs.

Auscultatory-common (scattered) dry, coarse and medium bubbling wet rales. The duration of the disease is 2-3 weeks.

Examination methods: patients with acute bronchitis do not need X-ray and laboratory examinations in most cases. A chest x-ray and blood test are needed if pneumonia is suspected.

Drug therapy is aimed at reducing and alleviating cough. In order to reduce cough, they are prescribed:

libexin 26-60 mg per day, i.e. 1/4-1/2 tablets 3-4 times a day to swallow without chewing);
tusuprex 6-10 mg per day, i.e. 1/4-1/2 tablets 3-4 times a day or Tusuprex syrup 1/2-1 tsp. (in 1 tsp - 6 ml);
glauvent 10-25 mg, i.e. 1/1-1/2 tablets 2-3 times a day after meals.

Bromhexine and mucolytic drugs relieve cough, contribute to sputum thinning, improve the function of the ciliated epithelium, Bromhexine is recommended for children aged 3 to 6 years - at a dose of 2 mg, i.e. 1/4 tablet 3 times a day, from 6 to 14 years - 4 mg, i.e. 1/2 tablet 3 times a day. Bromhexine is not prescribed for children under the age of 3! Ammonia-anise drops and breast elixir have a mucolytic effect (to take as many drops as the child's age), percussion (to take from 1/2 tsp to 1 des.l 3 times a day) and chest preparations (No. 1 : marshmallow root, coltsfoot leaf, oregano herb - 2:2:1; No. 2: coltsfoot leaf, plantain, licorice root - 4:3:3; No. 3: sage herb, anise fruit, pine buds, marshmallow root, licorice root - 2:2:2:4:4). Prepared decoctions give 1/4-1/3 cup 3 times a day.

In the hospital, from the first days of illness, steam inhalations are prescribed (for children over 2 years old!) With a decoction of breast preparations or infusions of chamomile, calendula, mint, sage, St. , inhalations are carried out 3-4 times a day). You can use ready-made tinctures of mint, eucalyptus, calendula, plantain juice, kolanchoe from 15 drops to 1-3 ml per inhalation, depending on age. Thermal procedures: mustard plasters on the chest, warm baths.

1.2. Acute obstructive bronchitis is the most common form of acute bronchitis in young children. Obstructive bronchitis has all the clinical signs of acute bronchitis in combination with bronchial obstruction. Observed; prolonged exhalation, expiratory noise ("whistling" exhalation), wheezing on exhalation, participation in the act of breathing of auxiliary muscles. At the same time, there are no signs of severe respiratory failure. Cough dry, infrequent. The temperature is normal or subfebrile. The severity of the condition is due to respiratory disorders with mild symptoms of intoxication. The current is favorable. Respiratory disorders decrease within 2-3 days, wheezing wheezes are heard for a longer time.

Young children with bronchial obstruction syndromes must be hospitalized.

Examination methods:

General blood analysis
ENT specialist consultation
Allergy examination of children after 3 years of age for the purpose of early diagnosis of allergic bronchospasm
Consultation with a neurologist if there is a history of perinatal CNS injury.

Treatment:

1. Euphyllin 4-6 mg/kg IM (single dose), with a decrease in symptoms of bronchial obstruction, continue to give euphyllin 10-20 mg/kg per day evenly every 2 hours orally.

2. If eufillin is ineffective, administer a 0.05% solution of alupent (orciprenaline) 0.3-1 ml IM.

3. In the absence of effect and deterioration of the condition, administer prednisolone 2-3 mg/kg IV or IM.

Preventive vaccinations are carried out after 1 month. after obstructive bronchitis, subject to complete recovery.

Obstructive syndrome often develops suddenly, accompanied by a sonorous dry cough. The increase in respiratory disorders is accompanied by a sharp anxiety of the child, low-grade (with parainfluenza and respiratory syncytial infection) or febrile (with adenovirus infection) temperature. The severe and extremely serious condition of the patient is due to respiratory failure. Chest distention, a boxed shade of percussion sound is determined, a mass of small bubbling and crepitating rales is heard during auscultation of the lungs. Diffuse changes in the lungs against the background of severe obstruction with a very high probability (up to 90-95%) rule out pneumonia. Radiographically determined swelling of the lungs, increased bronchovascular pattern, possible microatelectasis. Complications of bronchiolitis can be reflex respiratory arrest, the development of pneumonia, repeated episodes of bronchial obstruction (in almost 50% of patients).

Examination methods:

Radiography of the lungs in two projections
General blood analysis
Determination of the acid-base state of the blood (KOS)

Treatment

Mandatory hospitalization for emergency care
oxygen inhalation. Humidified oxygen supply through nasal catheters, children over 1-1.6 years old in the oxygen tent DPC-1 - 40% oxygen with air
Removal of mucus from the respiratory tract
Infusion therapy in the form of intravenous drip infusions is indicated only taking into account hyperthermia and fluid loss during shortness of breath
Antibiotic therapy is indicated, since it is difficult to exclude pneumonia on the first day of the increase in the severity of the patient's condition. Semi-synthetic penicillins are prescribed, in particular, ampicillin 100 mg / kg per day in 2-3 injections (it should be noted that antibiotic therapy does not reduce the degree of obstruction!)
Eufillin 4-5 mg/kg IV or IM (single dose), but not more than 10 mg/kg per day (reduction in the severity of obstruction is observed only in 50% of patients!!)
If eufillin is ineffective, inject a 0.05% solution of adupent (orciprenaline) 0.3-0.5 ml / m. You can use inhalations of Alupent 1 silt for one inhalation, the duration of inhalation is 10 minutes.
Obstructive syndrome, which is not stopped for a long time by the administration of aminophylline, alupent, requires the appointment of corticosteroids: prednisolone 2-3 mg / kg parenterally (in / in or / m)
.Cardiotonic drugs for tachycardia!) - intravenous drip of a 0.05% solution of corglycone 0.1-0.6 ml every 6-8 hours.
Antihistamines are not indicated! Their drying, atropine-like action may exacerbate bronchial obstruction.
In severe cases of respiratory failure, mechanical ventilation is prescribed.

Positive skin tests, as well as attacks of obstructive boa virus infection, indicate the development of bronchial asthma.

Preventive vaccinations for patients with bronchiolitis. carried out no earlier than 1 month. subject to full recovery.

1.4. Recurrent bronchitis - bronchitis that recurs 3 times or more during the year with an exacerbation duration of at least 2 weeks, occurring without clinical signs bronchospasm, with a tendency to a protracted course. It is characterized by the absence of irreversible, sclerotic changes in the bronchopulmonary system. The onset of the disease can be in the first or second year of life. This age is of particular importance in the occurrence of relapses of bronchitis due to the weak differentiation of the epithelium of the respiratory tract and the immaturity of the immune system. However, the diagnosis can be made with certainty only in the third year of life. Recurrent bronchitis affects mainly children of early and preschool age.

Forecast. In the absence of adequate therapy, children get sick for years, especially those who fell ill at an early and preschool age. There may be a transformation of recurrent bronchitis into asthmatic and bronchial asthma. A favorable course of recurrent bronchitis is observed in children in whom it is not accompanied by bronchospasm.

Examination methods:

Blood test
Bacteriological examination of sputum
X-ray of the lungs (in the absence of an X-ray examination during periods of previous relapses of bronchitis and if pneumonia is suspected)
Bronchoscopy to diagnose the morphological form of endobronchitis (catarrhal, catarrhal-purulent, purulent)
Cytological examination of bronchial contents (smears-prints from the bronchi)
Examination of the function of external respiration; pneumotachotomy to determine the state of airway patency, spirography to assess the ventilation function of the lungs
Immunogram

Treatment

Patients with exacerbation of recurrent bronchitis are desirable to be hospitalized, but treatment is also possible on an outpatient basis.
It is necessary to create an optimal air regime with an air temperature of 18-20C and a humidity of at least 60%
Antibacterial therapy, including antibiotics, is prescribed if there are signs of bacterial inflammation, in particular, purulent sputum. Courses of antibiotic therapy (ampicillin 100 mg/kg, gentamicin Z-5 mg/kg, etc.) are prescribed for 7-10 days
Inhalation therapy is one of the most important types of therapy in the medical complex, prescribed to eliminate the violation of bronchial patency.

At the second stage, antiseptics and phytoncides are administered by inhalation. For this purpose, onion and garlic juice, decoctions of St. The duration of the second stage is 7-10 days.

At the third stage, oil inhalations are prescribed. Uses vegetable oils with a protective effect. The duration of the third stage is also 7-10 days.

Mucolytic (secretolytic) agents (see section acute simple bronchitis) are prescribed only at the first stage of inhalation therapy
Expectorant (secretory) means; decoctions and infusions of herbs (thermopsis, plantain, coltsfoot, thyme, wild rosemary, oregano), marshmallow root, licorice and elecampane, anise fruits, pine buds. Of these medicines are medicinal fees used to relieve coughs.
Physiotherapeutic procedures: microwaves on the chest (electromagnetic oscillations of ultra-high frequency of the centimeter range, SMV, the Luch-2 apparatus and the decimeter range, UHF, the Romashka apparatus.

Rehabilitation of patients with recurrent bronchitis is carried out according to the principle of improvement of frequently ill children:

1. Sanitation of foci of chronic infection in the upper respiratory tract: chronic tonsillitis, sinusitis, adenoiditis

2. Elimination of concomitant diseases of the digestive system: dyskinesia of the biliary system, intestinal dysbacteriosis, etc.

3. Correction of metabolic disorders is prescribed during the year. Approximate scheme:

August - riboxin and potassium orotate;
September - vitamins B1, B2, calcium pantetonate and lipoic acid;
October - Eleutherococcus tincture;

Respiratory diseases are often accompanied by a prolonged cough, poor expectoration, shortness of breath, and sometimes respiratory failure. There are many ways to heal, and it is most rational to use an integrated approach, combining conspiracies and medicinal herbs. Here are some recipes:

1. A cake made of mustard, honey, flour - 1:1:1. Warms up more than mustard plasters. Apply it for two hours in the middle of the chest. Top - compress paper and cover with heat. The cake can be used several times.
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2. Bronchitis, including which has been tormenting you for a long time, lilac heals well. Pick up lilac flowers, fill a full jar with them and pour vodka. Infuse for 10 days and treat it like this: pour a stack of this infusion into a glass of steeply brewed tea and drink in small sips before going to bed. Drink at night, after drinking do not go out into the cold. Usually such a medicine helps in 3 days.
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3. Inhalation of garlic with soda: peel 6 cloves of garlic, cut them. Pour 1 cup of water into a small saucepan and, as soon as the water boils, throw in the garlic and reduce the heat. Steam over low heat for no more than 5 minutes. Then put the saucepan on the table, cover yourself with a blanket, bend down closer to the saucepan so that the steam does not escape anywhere, and only then open the lid and throw in 1 teaspoon of soda. Inhalation is ready. It is not necessary to immediately inhale deeply, you can cough. When you get used to the steam, start breathing alternately: 2-3 times inhale through the nose - slowly exhale through the mouth, 2-3 times inhale through the mouth - exhale through the nose. Breathe while warm. Then wipe your face from sweat under the covers, put a warm scarf on your head and lie down in a warm bed. You can breathe the vapors of garlic with soda 2-3 times a day. Sputum leaves and the condition improves after 2-3 days, the temperature returns to normal.
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4. Take 500 grams of onions, pass through a meat grinder, add 5 tablespoons of honey, 2 cups of sugar, pour 1 liter of water. Boil all this over low heat for 2 hours. Strain. Pete 1 des. spoon 3 times a day 20 minutes before meals. This is for children, and for adults, 1 tablespoon 3 times a day. Treats chronic bronchitis, chronic whooping cough, cough.
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5. To an equal amount of aloe juice and honey, add unsalted, interior fat (mutton, goose, pork, beef - to choose from). Bring everything to a boil, mix, cool to a warm state. Give this composition to children to drink 1 tablespoon 3-4 times a day before meals. Store the mixture in the refrigerator.
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6. For bronchitis and asthmatic bronchitis: aloe juice 0.5 liters, honey - 1 kg, decoction aspen bark- 0.5 liters. It is better to take the spring bark, finely chop it, dip it into boiling water (700 ml), let it boil and steam over very low heat for 20 minutes, insist, wrapped in warmth, then strain the broth, which should be dark brown in color, bitter in taste. Mix all the ingredients well and put in a warm dark place for 2 weeks. But if you need it urgently, you can take it and take it right away. The first week, take 1 tablespoon 30 minutes before meals. Then 2 tablespoons and so on until recovery.
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7. During meals, eat an onion 3 times a day. Eat with anything. The property of onions is that it thins mucus well. While doing breathing exercises. Slowly inhale air through the nose, then sharply exhale the air through the mouth. Do this outside when you walk in the fresh air. You have to move, don't lie down. so that there is no blockage.
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8. At night, warm the oats in a bowl and pour them hot into two specially sewn bags. Before that, drink a glass of hot milk with a clove of garlic. Place bags with oats on the chest to warm the bronchi and under the left shoulder blade. Do at night.
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More tips:

1. Grate black radish and squeeze the juice through cheesecloth. It is good to mix a quart of this juice with one pound of liquid honey and drink. Dose: two tablespoons before meals and at bedtime in the evening.

2. This often stubborn disease is very well treated with pork "health", that is, internal fat from the intestines, which looks like a grid. This greasy mesh is placed in a dish and placed in a warm, but not hot, oven or on a very light fire so that the fat flows into the meshes. The melted fat is drained and placed in a cold place. Take one dessert spoon in a glass of hot milk and drink hot in sips ... For external rubbing into the chest, mix this fat with turpentine and rub it dry into the chest.

3. Cut the radish into small cubes, put in a saucepan and sprinkle with sugar. Bake in the oven for two hours. Strain, discard the radish pieces, and drain the liquid into a bottle. Dose: Two teaspoons three to four times daily before meals and at night before bed.
4. 5 cloves from a medium-sized head of garlic, cut into small pieces or crushed, boil well in a glass of unpasteurized milk and let children drink several times a day.

And here is another recipe for coughing, with goat fat:

For the treatment of chronic bronchitis and chronic cough, you can use such an effective folk remedy as a mixture of milk with goat fat (goat fat can be purchased on the market). For the treatment of patients with chronic bronchitis, a fresh mixture is always prepared. For this 300 ml. cow's milk (one mug) is brought to a boil, and then cooled slightly. To warm milk add 1 tablespoon of goat fat and 1 tablespoon of natural honey. The patient should drink the warm mixture in large sips and then wrap himself up and go to bed. Such a drink for cough and bronchitis is drunk 3-4 times a day throughout the entire period of illness and a few more days after. This folk remedy for chronic bronchitis not only heals the patient from the disease, but also perfectly restores his strength, undermined by the disease. Using this folk remedies even advanced cases of chronic bronchitis and colds can be treated.

For chronic obstructive bronchitis:

Aloe - 250 gr., a bottle of good Cahors, not candied honey.
Do not water aloe before cutting for 2 weeks, separating them from the stem, finely chop into glass jar and pour honey and Cahors. Stir, let it brew for 2 weeks. in a cool place.
The first 2-3 days, take 1 table. l. 3 p. in. from. Then you can increase the reception up to 5 times.

In equal parts, mix smarets (melted interior, pork or other fat), cocoa, Cahors, honey and aloe juice (the plant is not younger than 3 years old, do not water for 1 week before cutting, then keep in the refrigerator for 3-7 days and only then squeeze out the juice). Drink 1 table. l. mixture 3 times a day with a glass of warm milk.

Reception of funds is carried out regardless of the meal.

Conspiracies for coughing:

For persistent cough

If a person does not cough for a long time, then you need to wash him with charmed water for three evenings in a row. Water is spoken like this:

Zoryushka Maremyana, you are red and ruddy, take from me a cough-mayata, suffocation, carry it across the ocean-sea, into a wide expanse. Everyone will be there, everyone will be accepted. There the guests are baked and boiled, and my water is slandered. Just as the dawn Maremyana does not cough, does not sneeze, does not inhale and does not suffer from various ailments, so I would not be sick, not cough, not mourn. May it be so!

Another option, they read at dawn:

Two sisters live in God's heaven: the elder dawn Uliana, the younger Maremyana. I will go out into the open field, bow to the two sisters-dawns. Morning dawn Ulyana, evening dawn Maremyan, you, dawn-sisters, take my light, take the suffocation and cough out of me. Take them down for high mountain, deep river. There, your gift is waiting, waiting, tablecloths are spread on oak tables, pies with porridge are baked. There they will cough, suffocate, there they will live from now on. May it be so!

For asthma

The patient himself slanders on an oak branch. The branch must be from a mature tree. Day is Sunday. A month in the sky is waning. After they put a branch under their feet in bed and sleep with it. In the morning the patient himself takes the branch to the river. He stands with his back to the water and throws a branch over his head into the water with the words:

Swim along the water, not across or back. May it be so! .

And here is the slander on the branch

Little devils, brothers, quick kids. Hurry up and take my present. Izhno there is no breath for me, no rest. As the moon wanes in the sky, so the sickness wanes from me. As this branch floats away in the water, so the whole disease leaves me. Little devils, sit on the shuttle, otherwise it’s not a shuttle, but an oak branch. You ride on it, and I stay without illness. The word is not to break the case. Key, lock and broken oak. May it be so!