Combination drugs in the treatment of cough in acute respiratory viral infections occurring with bronchial obstruction

Shatalina S.I., Aksenova M.B., Kolosova N.G., Kasanave E.V., Aseeva E.V.

1) I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; 2) Scientific Research Clinical Institute of Childhood of the Ministry of Health of the Moscow Region, Mytishchi, Russia

Acute respiratory viral infections (ARVI) in children can proceed in various ways with various catarrhal symptoms due to the development of inflammation. But ARVIs are almost always accompanied by cough. And in children, especially young children, ARVIs are often aggravated by the development of bronchial obstruction. In half of the cases, episodes of bronchial obstruction against the background of ARVI recur within a year. In young children, due to physiological (thick bronchial secretion, insufficient smooth muscle function, weak cough reflex) and anatomical features (narrow airways), an unproductive «wet» cough is often observed. The main cause of pathological cough in acute respiratory infections is a violation of mucociliary clearance as a result of changes in the production and rheological properties of sputum due to the infectious process, which predispose to the formation of bronchial hyperreactivity. Inflammation of the respiratory organs in ARVI is also accompanied by compensatory increasing of bronchial secretion. The composition of tracheobronchial secretion also changes: an increase in the content of glycoproteins along with a decrease in the level of sialomucins leads to a decrease in the aqueous component of sputum and an increase in its viscosity, a violation of the ratio of gel/sol layers, which complicates the work of the ciliated epithelium. Medicinal cough management is primarily aimed at changing the viscosity, elasticity and adhesiveness of bronchial mucus to facilitate its expectoration, as well as eliminating smooth muscle spasm. Hyperproduction of viscous bronchial secretions often requires the administration of several mucoactive drugs with different mechanisms of action, since the nature of the cough (dry, wet) and the rheological properties of sputum (increased viscoelastic adhesive properties of secretions, impaired mucociliary clearance) may change during the treatment of an acute respiratory disease and the physician may encounter the problem of ineffective therapy with single-component drugs. To exclude polypharmacy, the use of combination drugs in cases of cough with a broncho-obstructive component is justified, which allows increasing patient compliance, ensuring maximum effectiveness of complex pharmacotherapy with the inclusion of all its components in a single dosage form. Studies conducted in patients with acute bronchitis with productive cough and bronchial obstruction syndrome have shown that the use of combination drugs containing bromhexine hydrochloride, guaifenesin and salbutamol sulfate is accompanied by a more rapid regression of cough.

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About the Authors

Svetlana I. Shatalina, Cand. Sci. (Med.), Teaching Assistant, Department of Pediatric Diseases, Filatov Clinical Institute of Child Health, I.M. Sechenov First Moscow State Medical University (Sechenov University); Senior Researcher, Research Clinical Institute of Childhood of the Ministry of Health of the Moscow Region, Russia; svetlanashatalina@mail.ru, ORCID: https://orcid.org/0000-0003-2085-0021 (corresponding author)
Marianna B. Aksenova, Cand. Sci. (Med.), Associate Professor, Department of Hospital Therapy No. 1, Sklifosovsky Institute of Clinical Medicine, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; axenovamarianna@mail.ru, ORCID: https://orcid.org/0000-0003-4802-6544
Natalia Georgievna Kolosova, Cand. Sci. (Med.), Associate Professor, Department of Pediatric Diseases, Filatov Clinical Institute of Child Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; kolosovan@mail.ru, ORCID: https://orcid.org/0000-0001-5071-9302
Elena V. Kasanave, Cand. Sci. (Med.), Teaching Assistant, Department of Pediatric Diseases, Filatov Clinical Institute of Child Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; lenavs@inbox.ru, ORCID: https://orcid.org/0000-0002-0496-4865
Elizaveta V. Aseeva, Cand. Sci. (Med.), Teaching Assistant, Department of Pediatric Diseases, Filatov Clinical Institute of Child Health, I.M. Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia; liza.romantseva@yandex.ru, ORCID: https://orcid.org/0000-0001-7140-6874

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