Producing phlegm: How To Get Rid Of Phlegm – Forbes Health

05.08.202309.06.2023 by alexxlab

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How To Get Rid Of Phlegm – Forbes Health

What Is Phlegm?
What Is the Difference Between Phlegm and Mucus?
Causes of Phlegm
How to Clear Phlegm
When to See a Doctor

Excess phlegm can build up in the throat and chest for a number of reasons, leading to bothersome symptoms, such as a sore throat, cough or difficulty breathing. While there are many potential causes, excess phlegm could result from a temporary respiratory infection—or be a sign of a more serious health problem like chronic obstructive pulmonary disease (COPD).

Luckily, there are several ways to get rid of phlegm. Read on to learn more about what phlegm is, what causes it to develop and how to ease the discomfort it can cause.

What Is Phlegm?

Phlegm—sometimes called sputum—is a thick, sticky substance that is produced by the body to help keep the airways and respiratory tract clear of irritants, according to Shawn Nasseri, M.D., a board-certified ear, nose and throat specialist in Beverly Hills, California. While phlegm serves an important purpose in protecting your lungs from damage, it can sometimes accumulate in excess amounts, leading to a sore throat, persistent cough and other unpleasant symptoms.

“Phlegm can be caused by respiratory infections (such as a cold, flu or sinusitis), allergies or an irritation in the nose, throat or lungs,” says Dr. Nasseri. “You don’t need to have a lung disease, such as lung cancer or cystic fibrosis, but they can cause phlegm as well.”

Oftentimes, phlegm has a green or yellow color, indicating that it may contain bacteria or other debris. “Phlegm turns yellow with increased white blood cells, which signal that the body is trying to fight an infection like bronchitis or pneumonia,” says Mahmud Kara, M.D., a board-certified internal medicine physician and founder of KaraMD, a line of supplements focused on digestive support, heart health and reducing inflammation.

To get rid of excess phlegm and restore normal breathing function, it’s essential to identify and address the underlying cause of your condition.

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What Is the Difference Between Phlegm and Mucus?

Phlegm and mucus are very similar and are often confused with one another. Phlegm, however, is a thicker substance that’s produced by the body in response to irritation or infection, while mucus is a thinner fluid that helps to keep the respiratory tract lubricated, says Dr. Nasseri. “Phlegm is formed more in the lower respiratory tract and lungs,” he adds.

Mucus, meanwhile, forms in the mucous membranes lining the airways and respiratory tract. This substance helps to trap dust, dirt and other foreign particles before they can enter the lungs. Mucus also keeps the airways moist, which helps prevent them from drying out and becoming irritated.

Causes of Phlegm

There is no single cause of phlegm. Rather, the substance is produced in response to a number of different underlying conditions.

Common causes of phlegm include:

Allergies: Allergic reactions cause the body to produce more mucus in an attempt to remove the allergens from the respiratory tract. This can lead to excess mucus production and difficulty breathing.
Reflux: Reflux of gastric fluids (stomach fluids) can occur with or without heartburn—also referred to as silent reflux—and can cause phlegm build up.
Asthma: An inflammatory disease of the respiratory system, asthma causes the airways to narrow and constrict, making it difficult to breathe. This can cause excess mucus production to protect the lungs from damage.
Chronic lung disease: Certain lung diseases, including COPD, cystic fibrosis and emphysema, can cause excess mucus production in the lungs.
Sinusitis: Infection or inflammation of the sinuses can lead to increased mucus production. This mucus may drain down the back of the throat. This draining is also known as postnasal drip.
Bronchitis: An inflammation of the bronchial tubes, bronchitis is often caused by a virus or bacteria. This condition can cause excess mucus production and difficulty breathing.
Smoking: Smoking irritates the respiratory system and can lead to higher levels of phlegm production.

How to Clear Phlegm

If you’re suffering from allergies, asthma or another condition that is causing excess mucus production, it’s important to seek medical treatment. However, in cases where phlegm results from a viral infection, such as the common cold, it will usually resolve on its own within seven to 10 days.

In the meantime, there are steps you can take to help clear your airways and get rid of phlegm.

Hydration

Drinking plenty of fluids helps to thin out mucus, making it easier to cough up and clear from the airways. Focus on drinking water, and avoid drinks that contain alcohol or caffeine, as these can make your condition worse.

Use a Humidifier

A humidifier will help to keep the air moist, which may reduce irritation in the respiratory tract and lead to less mucus production and coughing. A warm, steamy shower can also help to loosen phlegm if a humidifier is not available.

Use Saline Nasal Spray

Both Dr. Kara and Dr. Nasseri suggest using saline nasal sprays to help relieve congestion and clear the sinuses. This may also help to reduce excess phlegm production in the throat and clear the airways.

Keep Your Head Elevated at Night

Elevating the head of your bed or using extra pillows at night to elevate your head and chest can help to drain phlegm from the sinuses and prevent it from pooling in the back of your throat. This may help to reduce congestion and persistent coughing due to postnasal drip.

Stay Away from Irritants

Dr. Nasseri recommends staying away from irritants such as smoke, dust and pollen that can worsen your condition. Avoiding these triggers may help minimize phlegm production.

Perform Breathing Exercises

Practicing deep, controlled breaths can increase oxygen levels and improve overall lung function. It also promotes proper use of the diaphragm muscles that help you breathe. Airway clearance devices may help control increased phlegm production and ease symptoms as well.

Get Proper Treatment for Your Allergies

If you struggle with allergy-like symptoms, such as a runny nose, itchy eyes and excess mucus production, you may benefit from a personalized treatment plan.

Allergy testing can help to identify the substances that trigger your symptoms so you can avoid them in the future. Medications, such as antihistamines and nasal sprays, can also help to reduce mucus production and provide relief from your symptoms. Consider seeing an allergist for proper treatment.
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Stop Smoking

If you smoke, now is the time to quit. Smoking can worsen respiratory conditions and cause excess phlegm buildup. Nicotine, a chemical present in cigarettes, paralyzes cilia—thin, hairlike cells that help to move debris, such as phlegm, out of the airways—in the lungs. This paralyzation prevents the removal of phlegm. If you need help quitting smoking, talk to your doctor about nicotine replacement therapy or other smoking cessation aids.

When to See a Doctor

If you’re struggling to breathe or if your mucus is thick and green or yellow, you may have an infection that requires medical treatment. These symptoms can be a sign of a more serious condition, such as pneumonia.

If you’re coughing up blood or your phlegm contains red streaks, call your health care provider right away. Phlegm of this color may indicate a more serious condition, such as a lung infection. However, blood-colored phlegm could also result from excessive coughing. In either case, it’s important to get a proper diagnosis and treatment.

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Excess mucus production can also be a sign of an allergy or asthma. If you think you may have either of these conditions, it’s important to see a health care professional for proper care. They may request an allergy test or lung function tests to rule out these conditions.

“You should always consult a medical professional when you start to feel sick or different from how you feel on a normal basis, or before adding anything new to your health regimen,” says Dr. Kara. A quick visit with your care team can save you a lot of time and worry down the road.

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Phlegm or Mucus in Throat: Causes, Treatment, and More

When you breathe, allergens, viruses, dust, and other debris stick to your nasal mucus, which then passes out of your system. Sometimes, your body can make too much throat mucus, requiring frequent clearing.

Mucus protects your respiratory system with lubrication and filtration. It’s produced by mucous membranes that run from your nose to your lungs.

Keep reading to learn what causes excess mucus production in your throat and what you can do about it.

There are a number of health conditions that can trigger excess mucus production, such as:

acid reflux
allergies
asthma
infections, such as the common cold
lung diseases, such as chronic bronchitis, pneumonia, cystic fibrosis, and COPD (chronic obstructive pulmonary disease)

Excess mucus production can also result from certain lifestyle and environmental factors, such as:

a dry indoor environment
low consumption of water and other fluids
high consumption of fluids that can lead to fluid loss, such as coffee, tea, and alcohol
certain medications, such as certain birth control medications and ACE Inhibitors, for example lisinopril
smoking

If the overproduction of mucus becomes a regular and uncomfortable occurrence, consider consulting with your healthcare professional for a full diagnosis and a treatment plan.

Over-the-counter and prescription medications

Your doctor may recommend medication such as:

Over-the-counter (OTC) medicines: Expectorants, such as guaifenesin (Mucinex, Robitussin), can thin and loosen mucus so it will clear out of your throat and chest.
Prescription medications: Mucolytics, such as hypertonic saline (Nebusal) and dornase alfa (Pulmozyme), are mucus thinners that you inhale through a nebulizer. If your excess mucus is triggered by a bacterial infection, your doctor will most likely prescribe antibiotics.

Self-care steps

Your doctor may also suggest some self-care steps you can take to help reduce mucus, such as:

Gargle with warm salt water: This home remedy can help clear mucus from the back of your throat and may help kill germs.
Humidify the air: Moisture in the air can help keep your mucus thin.
Stay hydrated: Drinking enough liquids, especially water, can help loosen congestion and help your mucus flow. Warm liquids can be effective but avoid caffeinated beverages.
Elevate your head: Lying flat can make it feel like the mucus is collecting in the back of your throat.
Avoid decongestants: Although decongestants dry secretions, they may make it more difficult to reduce mucus.
Avoid irritants, fragrances, chemicals, and pollution: These can irritate mucous membranes, signaling the body to produce more mucus.
If you smoke, try to stop. Quitting smoking is helpful, especially with chronic lung diseases such as asthma or COPD.
Try certain foods: Garlic, radishes, and high fiber fruit like apples may help reduce mucus. However, avoid high fat or dairy foods, as that can worsen phlegm.

Make an appointment with your doctor if you have any of these symptoms:

Excess mucus has been present for more than 4 weeks.
Your mucus is getting thicker.
Your mucus is increasing in volume or changing color.
You have a fever.
You have chest pain.
You’re experiencing shortness of breath.
You’re coughing up blood.
You’re wheezing.

Was this helpful?

What’s the difference between mucus and phlegm?

Mucus is produced by the lower airways in response to inflammation. When it’s excess mucus that’s coughed up — it’s referred to as phlegm.

What’s the difference between mucus and mucous?

The answer is not medical: Mucus is a noun, and mucous is an adjective. For example, mucous membranes secrete mucus.

Should I be worried about phlegm in my throat?

Having phlegm or mucus doesn’t necessarily mean you have something serious. However, you could have something that needs to be medically treated, so it’s a good idea to see your doctor.

Is it normal to have phlegm every day?

Regular mucus production is normal. It’s the way your body gets rid of irritants in your throat and nasal passages. However, if you’re coughing it out and it doesn’t seem to resolve, it may be a sign of an infection or other condition.

Your body is always producing mucus. Overproduction of mucus in your throat is often the result of a minor illness that should be allowed to run its course.

Sometimes, however, excess mucus can be a sign of a more serious condition. See your healthcare provider if the:

overproduction of mucus is persistent and recurring
amount of mucus you’re producing increases dramatically
excess mucus is accompanied by other concerning symptoms

Read this article in Spanish.

Sputum: causes, types, treatment – article Mediflex Homeker

Sputum is a heterogeneous substance that is secreted by cells of the mucous membrane of the trachea and bronchi during pathological processes and disorders.

Normally, the human body secretes up to 100 ml of transparent mucus, which performs protective functions: it has bactericidal properties, moisturizes the mucous membrane, participates in metabolism and cleansing the respiratory tract from infectious agents, dust and foreign particles. This secretion does not have a strong odor and is not very viscous.

If the body is healthy, then the mucus is naturally evacuated by the vibration of the cilia of the epithelium from the bottom up to the throat for excretion. The resulting mucus does not cause coughing or discomfort, and is easily swallowed along with saliva.

With pathologies and disorders in the functioning of the body, the volume of sputum secreted may increase. A cough reflex occurs due to irritation of the mucous membrane to evacuate accumulated mucus in the lumen of the trachea and bronchi to facilitate breathing.

Sputum may be difficult to expectorate and cough may be absent, as occurs in inflammatory diseases of the nose. If sputum is not excreted from the body and accumulates in the respiratory system, this is fraught with the creation of conditions for the reproduction of viruses and bacteria, which leads to various complications.

Sputum is a diagnostic factor for pathologies of the nose and sinuses, respiratory tract, digestive system, allergies, inhalation of irritants.

Causes of sputum

Excessive mucus can be caused by infectious, inflammatory, environmental, and other factors. Among the causes of sputum formation are present:

Diseases of the nasopharynx. This includes rhinitis, sinusitis, laryngitis, pharyngitis, viral epiglottitis. Sputum flows down the back of the throat from the nose and sinuses, can make breathing difficult, cause a hoarse voice.
Pathologies affecting the lungs and bronchi. This group of causes of sputum formation includes bronchitis, bronchial asthma, tuberculosis, inflammation and lung cancer, abscess, lung gangrene, pneumonia, bronchitis or mixed COPD, bronchiectasis, etc. This also includes pulmonary mycoses – candidiasis, aspergillosis, zygomycosis, and also specific diseases such as pulmonary syphilis.
Allergic reactions. The accumulation of mucus occurs in the nose and throat as a response to an irritating allergen.
Exposure to nicotine and toxic tar. Smokers have a protective response of the body to the irritating effect of resins, which, when smoked, settle on the walls of the pharynx in the form of a sticky substance that dries up the mucous membranes. Phlegm in this case performs the function of moisturizing the throat.
Pathologies of the gastrointestinal tract. With gastroesophageal reflux and the ejection of acid from the stomach into the esophagus, the formation of excess sputum after eating has been established.
Psychosomatic disorders or neurotic sputum. The main cause of sputum in this case is neurosis, which leads to a constant sensation of a lump in the throat.
Steroid exposure. The use of steroid inhalants for asthmatics can lead to the side effect of increased mucus secretion.
Hereditary diseases and disorders such as cystic fibrosis and Kartagener’s syndrome. With such pathologies, abundant sputum production is observed due to congenital mutations of the genes responsible for the functioning of the glands and the immobility of the cilia of the epithelium.
Hormonal changes. These include, for example, hypothyroidism and Hashimoto’s disease. Violations in the production of hormones can lead to severe damage to the thyroid gland, disruption of other organs and metabolic processes. One of the consequences of hormonal pathologies is the accumulation and secretion of sputum.
Congenital anatomical defects, such as a deviated septum, can also lead to accumulation and difficulty in clearing sputum from the body.
Inhalation of polluted air due to poor ecology or work in a hazardous industry is fraught with increased sputum production as a protective reaction to exposure to toxic substances, and disturbances in the respiratory system lead to its accumulation and weak discharge.

Regardless of the cause, sputum requires close attention. This is an alarming symptom, with which you should contact a medical specialist for diagnosis and consultation.

Types of sputum

Depending on the cause of formation, the composition of sputum also varies, which directly affects its color, smell, consistency, and degree of transparency. A description of sputum is essential for the correct diagnosis of its formation.

The following types of sputum are distinguished:

Serous. It is characterized by the absence of smell, the presence of abundant foam and a watery structure. Colorless or has a pinkish tinge. It is observed in acute left ventricular failure, accompanied by pulmonary edema.
Green or yellow-green. Such sputum has in its composition pus, consisting of dead cells, proteins, bacteria, remnants of damaged tissues. Occurs during inflammatory processes of the respiratory system due to bacterial infections. It has a viscous consistency and often smells of rot.
Dark yellow or brown. Occurs in smokers and stains from cigarette tar. It can also stain from drinking coffee and chocolate.
Black. May indicate a fungal infection or be associated with prolonged exposure to polluted air.
White or transparent. It often indicates a reaction to allergens or adverse factors, but can also occur due to asthma, GERD, COPD, and the initial stage of lung cancer before blood vessels are affected.
Red or pink (hemoptysis). Such sputum indicates the presence of blood in its composition. It can be a symptom of various pathologies – pharyngitis, bronchitis, lung cancer, tuberculosis, as well as erosion processes in the respiratory tract, etc. A rusty tint can be caused by pneumococci in pneumonia.
Mucous, watery. A mucous liquid secret signals the onset of inflammation in the airways in various diseases, and can also form as an allergic reaction. Has white or transparent color.
Thick, viscous. Viscous bronchial secretion is associated with a wide range of bronchopulmonary pathologies. It has a thick consistency, light or yellowish color. Such sputum can be secreted during an exacerbation of chronic diseases.
Lumpy. Sputum with lumps is characteristic of mycosis and cystic fibrosis. In cystic fibrosis, the secretion secreted has a dense and thick consistency, which leads to the formation of lumps inside the bronchioles. This is fraught with segmental atelectasis of the lung.
Fetid. A strong unpleasant odor indicates stagnant processes in the cavity formations of the lungs and the formation of pus. It has a semi-liquid consistency.

The type of sputum plays an important role in the diagnosis and determines the plan of diagnostic and therapeutic procedures.

Diagnosis of diseases that produce sputum

Diagnosis of diseases that cause sputum production is carried out by medical specialists – general practitioners or pulmonologists. Diagnostics includes a number of activities:

Patient interview. In this case, it is important to find out how long ago the symptoms occurred, the patient’s living and working conditions, to establish or exclude the connection with smoking and the environment. The survey also includes obtaining data on the color, smell, profuseness of sputum, how often and easily it is separated, how long the cough is.
Physical examination with auscultation reveals the presence of rales in the lungs and their character – moist, dry, wheezing. This, in turn, gives reason to assume infiltration of the lung tissue, pneumonia, bronchial obstruction.
Imaging techniques include lung x-ray, chest CT and MRI, pleural x-ray and ultrasound.
Endoscopic methods involve bronchoscopy to examine the lining of the bronchi and trachea. A biopsy of the bronchial wall, fibrogastroscopy to rule out GERD, and rhinoscopy to rule out diseases of the nasopharynx may be indicated.
Laboratory tests involve the study of peripheral blood to obtain data on inflammatory processes. Microscopic examination of sputum is also carried out to assess its properties and study its composition, and bacterial culture to detect the causative agent of the infection and its sensitivity to antibiotics.
Also, in some cases, specific tests may be indicated – spirometry, body plethysmography, allergy diagnostics, genetic tests, Mantoux test, diaskin and quantiferon tests, etc. root cause of mucus.
How to get rid of sputum
It should be remembered that therapy requires the underlying disease that causes sputum. It is the elimination of the cause that caused sputum that will allow you to get rid of the most excess secret.
Therapy depends on the nature of the pathological process or disorder, which is established during the diagnosis, as well as on the stage of the course of the disease, comorbidities, complications and characteristics of the patient. All treatment measures must be prescribed by a doctor.
For better sputum discharge, you should drink more warm fluid to thin the sputum and better evacuate it. It is also important to humidify the air to prevent the larynx from drying out and the mucus to thicken. Avoid exposure to toxic irritants – paint fumes, tobacco smoke, chemicals. Reducing alcohol and caffeine intake will be helpful. If the cause of sputum production is gastroesophageal reflux, foods that increase the production of gastric juice should be excluded from the diet.
Conservative therapy involves the use of drugs that are selected strictly by the medical specialist conducting the treatment. As a rule, such drugs belong to the groups of mucolytics, mucoregulators, expectorants, bronchodilators. With an established bacterial infection, antibiotics are indicated, for fungal diseases – antifungal agents, for tuberculosis – combinations of anti-tuberculosis drugs. Malignant tumors require the use of antitumor agents.
Inhalations with aerosols of medicines, essential oils, nasal lavage with special solutions for pathologies of the nasopharynx are also useful.
Common recommendation for exercise therapy, breathing exercises, chest percussion and postural drainage.
Surgical treatment includes segmental resections, lobectomy, bilobectomy and pulmonectomy. These operations are indicated for patients with abundant purulent sputum and lung tumors. With pyothorax, drainage of the pleural cavity is performed.
Instrumental methods to improve sputum evacuation and removal are also common today. To do this, expectorators are used – high-tech devices that help liquefy and move sputum into large airways for coughing. To do this, such devices create alternately positive and negative airway pressure, intermittently supply small volumes of air at high speed (percussion), or have a vibrational effect on the chest through special belts and vests.
After using the expectorant, the aspirator is used, another innovative tool for removing (suctioning) sputum from the respiratory tract by creating a vacuum. Sputum to be removed may accumulate in the throat, nasal and oral cavities, and lower respiratory tract. For its suction together with an aspirator, catheters of various diameters are used.
1. Bisenova N.M., Ergalieva A.S. Microbial spectrum of sputum of patients with progressive respiratory diseases // Clinical Medicine of Kazakhstan. 2014. No. 3 (33). pp. 17-21.
2. Bisenova N.M., Mitus N.M., Tuleubaeva E.A., Ergalieva A.S., Kuanyshbekova A.B., Kamaeva A.A., Taishikova R.T. Comparative analysis of sputum microflora of patients with respiratory infections // Clinical Medicine of Kazakhstan. 2011. No. 3, 4 (22, 23). pp. 333-336.
3. Laboratory service in tuberculosis control programs / WHO guidelines. 1998.
4. Laptev A.N. Purulent-necrotic lung destruction // Medical panorama. 2008. No. 13.S.21-26.
5. Matveykov G.P., Vechersky G.A., Goncharik I.I. Handbook of differential diagnosis of internal diseases. 1990.
Modern aspects of mucoactive therapy in immunological practice
GIT — gastrointestinal tract
CO – mucous membrane
HB – chronic bronchitis
COPD – chronic obstructive pulmonary disease
In most inflammatory diseases of the respiratory system, the airways are involved in the pathological process. Regardless of the main mechanisms of development and progression, lung diseases have common features in the form of changes in bronchial secretion, ultimately leading to mucostasis, sometimes significantly aggravating the course of any respiratory disease [1, 2]. Mucostasis, as a manifestation of insufficiency of mucociliary clearance – the main mechanism for removing mucus from the airways, can be observed both in acute respiratory diseases (acute respiratory diseases, bronchitis, pneumonia) and in chronic diseases (chronic bronchitis – CB, chronic obstructive pulmonary disease – COPD). , bronchial asthma, chronic forms of pulmonary tuberculosis, cystic fibrosis, all diseases in the “honeycomb lung” stage, etc.) [3, 4].
The formation of tracheobronchial secretion is an important protective mechanism that is disrupted when the mucous membrane (SO) of the respiratory tract is damaged by various infectious, chemical, physical and other factors. The excretion of sputum is provided by the movement of the cilia of the ciliated epithelium and the cough reflex. The source of the formation of tracheobronchial mucus is the bronchial glands, goblet cells, the epithelium of the terminal bronchioles and alveoli. The number of cells and glands that produce the secret increases in the direction from the alveoli to the large bronchi. The ciliated epithelium of the respiratory tract ensures the constant movement of this secret in the direction of the oral cavity, ensuring the evacuation of cellular debris, foreign particles and pathological agents. The tracheobronchial secret is one of the first lines of defense of the body against the effects of inhaled gases, dust, and microorganisms [1].
The function of the ciliated epithelium is negatively affected by many factors: toxins of viruses and bacteria, mediators of allergic inflammation, tobacco smoke, inhalation of pure oxygen, ammonia, formaldehyde, hot air. In these cases, the coordination of the movement of cilia, the bioenergetics of cells and the effectiveness of the ciliary impulse are disturbed.
In addition to the coordinated work of the cilia, the effectiveness of mucociliary clearance requires appropriate rheological parameters of the secretion, primarily its viscosity and elasticity. The viscosity and elasticity of the secret depend on the amount of water and its constituent glycoproteins – mucins. Secretion mucins are divided into two subtypes: acidic mucins (sialo- and sulfomucins) and neutral mucins (fucomucins). With inflammation, the secretory function of the bronchial glands and goblet cells increases significantly, the content of cell decay products, metabolites of vital activity and decay of microorganisms, and exudate in the bronchial secret increases. The ratio of fuco- and sialomucins increases, which leads to an increase in the viscosity of the mucus. The latter inevitably leads to its stagnation, which contributes to the growth of bacteria. Under these conditions, the ciliated epithelium works with an excessive load, but it is not able to provide the necessary transport of mucus. Prolonged overload leads to depletion of the functionality of the mucociliary apparatus, dystrophy and atrophy of the ciliated epithelium. Bacterial enzymes and lysosomal proteases of destroyed cells can secondarily modify sialomucins and lead to the loss of their ability to form fibrous structures, which makes the secret liquid and can cause it to drain along the bronchial wall due to loss of elasticity.
Thus, the result of any irritative, infectious or allergic inflammation of the bronchial mucosa is a change in the amount and rheological properties of sputum, a violation of the drainage function of the bronchi [4].
Under different pathological conditions, the viscosity and elasticity of the secret can change in different ways, which necessitates an individual approach to the patient and the choice, taking into account the characteristics of secretory disorders, of one or another drug that can affect the secretory function of CO or the secret itself.
So, at the beginning of an acute inflammatory process, accompanied by a dry cough, drugs that stimulate secretion are indicated; with an unproductive wet cough – drugs that dilute sputum; with the appearance of a productive wet cough – mucoregulators that normalize mucus formation and the composition of the secret. Therefore, the normalization of mucus formation and the evacuation of bronchial secretions in most diseases of the respiratory system is of great importance.
The most important physiological process of removing sputum from the airways is coughing. However, in violation of mucus formation in the bronchi and trachea – the phenomena of mucostasis – cough becomes ineffective, paroxysmal, painful. An ineffective cough can cause hemoptysis, spontaneous pneumothorax, urinary incontinence, pulmonary hypertension, anxiety, the formation of hernias of the anterior abdominal wall and diaphragm, rib fractures and other complications. In addition, mucostasis leads to impaired ventilation, manifested by obstructive syndrome and shortness of breath. All these consequences of mucostasis are factors that aggravate the course of the underlying disease.
In many clinical situations, the improvement of mucus formation occurs as a result of the use of the main means of treating each specific disease: antibiotics, glucocorticosteroids, bronchodilators, etc. However, often the main means are not enough to quickly and completely eliminate mucostasis. In such situations, in addition to the main funds, mucolytic (secretolytic) agents are prescribed that improve the processes of mucus formation and sputum evacuation. In practice, doctors of various schools (classical medicine, homeopathy, oriental medicine, various branches of the so-called traditional medicine) use more than a hundred drugs with mucolytic properties (different classifications of these drugs are used). In principle, this large group of drugs is difficult to classify because of its heterogeneity. Conventionally, all drugs are divided according to their source of origin: herbal or synthetic, or according to the main mechanisms of their action: expectorants, sputum thinners, sputum viscosity reducers, stimulating secretion with new properties [5].
Bronchial mucus facilitators are generally divided into the following groups:
1. Preparations that stimulate expectoration. They cause irritation of the receptors of the stomach and reflexively increase the secretion of the bronchial glands.
2. Mucolytics. They depolymerize mucopolysaccharide and mucoprotein fibers in sputum by breaking the disulfide bonds of sputum proteins.
3. Mucoregulators. Means that regulate secretion production by glandular cells, acting directly on the glandular cell.
4. Mucohydrants. Drugs that promote hydration of the secretion.
5. Bronchoroids. Drugs that enhance transepithelial secretion of water.
6. Combination preparations combining several drugs with different mechanisms of action to facilitate the clearance of sputum from the airways.
In 2010, Italian authors in 4 classification categories (expectorants, mucoregulators, mucolytics, mucokinetics) detailed the mechanisms of action and the results of the use of 7 individual drugs and 5 groups of other drugs included in these categories [6].
It should be noted that there are very few combination drugs that can affect several mechanisms of mucostasis at once. Currently, in the treatment of respiratory diseases, fixed combinations of drugs acting on individual pathogenetic links of diseases are increasingly being used. It is the diversity and interrelation of mucostasis mechanisms that determine the expediency of using fixed combinations of drugs. However, the fixed combination in accordance with modern requirements must comply with certain standards (BMA and the Royal Pharmaceutical Society of Great Britain, British National Formulary, London):
1. The preparation must contain no more than 3 active ingredients from different pharmacological groups and no more than one active ingredient from each pharmacological group.
2. Each active ingredient must be present at an effective and safe concentration and be conducive to the treatment for which the product is being used.
3. Possible adverse reactions of components must be taken into account.
One of the few fixed combined drugs that eliminate mucostasis and meet modern requirements is ascoril.
Ascoril syrup contains salbutamol sulfate, bromhexine hydrochloride, guaifenesin and menthol.
Salbutamol sulfate – β ₂ is a short-acting agonist with a pronounced bronchodilatory and antispasmodic effect. It eliminates and prevents bronchospasm, reduces bronchial resistance. In some chronic respiratory diseases (bronchial asthma, COPD, bronchiectasis, cystic fibrosis), along with mucostasis, bronchial obstruction is pronounced, which significantly affects the speed and quality of sputum production. Viscous sputum exacerbates bronchial obstruction, which in turn prevents the free separation of sputum. To cut this “Gordian knot” successfully allows a combination of broncho- and mucolytic properties of β ₂ – agonists. In addition to the bronchodilatory effect, salbutamol is able to directly affect mucociliary transport, stimulating β ₂ receptors contained in mucosecreting cells, and thereby lead to an increase in bronchial secretion. In addition, they affect the ciliary apparatus of the bronchial epithelium, increasing their fluctuations, which improves sputum evacuation.
Oral salbutamol is known to have slightly different pharmacokinetic properties than its aerosol. When taken orally, the absorption of salbutamol is high, food intake reduces its rate, but does not affect bioavailability: 10% of salbutamol binds to plasma proteins. The drug crosses the placenta. The bioavailability of salbutamol taken orally is 50% (!). In this regard, ascoril should be used with caution in patients taking methylxanthines, monoamine oxidase inhibitors and tricyclic antidepressants (the likelihood of tachyarrhythmia, a drop in blood pressure). It is not recommended to take it simultaneously with non-selective β-blockers.
Another active ingredient in ascoril is guaifenesin. It is he who gives ascoril unique properties that distinguish it from other combined mucoregulatory drugs.
The basis for the production of guaifenesin (guaifenesin) is the natural substance guaiacol, discovered in 1912, which is obtained from the bark of the guaiac tree.
Guaifenesin stimulates bronchial CO secretory cells that produce neutral polysaccharides, depolymerizes acid mucopolysaccharides, reduces viscosity and increases sputum volume, activates the bronchial ciliary apparatus, facilitates the removal of sputum and promotes the transition of an unproductive cough into a productive one. The duration of action at a single dose is 3.5-4 hours. The drug is rapidly absorbed from the gastrointestinal tract (GIT), penetrates into tissues containing acid mucopolysaccharides. Metabolism is carried out in the liver. Excreted by the lungs (with sputum) and kidneys as inactive metabolites. Guaifenesin not only has expectorant properties, but also has an anxiolytic effect (suppression of anxiety-neurotic disorders).
The third component of ascoril is bromhexine, a mucolytic agent that has an expectorant and antitussive effect. Bromhexine is a “classic”, long-known mucolytic drug, is a derivative of the alkaloid vasicin. The mucolytic effect is associated with the depolymerization of mucoprotein and mucopolysaccharide fibers. Stimulates the synthesis of neutral polysaccharides and the release of lysosomal enzymes. Increases the serous component of bronchial secretion; activates the cilia of the ciliated epithelium, reduces the viscosity of sputum, increases its volume and improves discharge. One of the unique properties of bromhexine is the stimulation of the synthesis of endogenous surfactant, it also promotes the penetration of antibiotics into the lung tissue. Such unique qualities of bromhexine often make it the drug of choice for the treatment of pneumonia, bronchiectasis. When taken orally, almost completely (99%) is absorbed from the gastrointestinal tract within 30 minutes. Bioavailability is low (the effect of the primary passage through the liver). Penetrates through the placental and blood-brain barriers. In the liver, it undergoes demethylation and oxidation, and is metabolized to the pharmacologically active ambroxol. T _1/2 is 15 hours (due to slow reverse diffusion from tissues). Excreted by the kidneys. In chronic renal failure, excretion of metabolites is impaired. With repeated use, it can accumulate.
The fourth component of ascoril syrup is menthol. It contains essential oils that have a soothing, mild antispasmodic and antiseptic effect.
Thus, due to its multifunctionality and safety, ascoril is a modern, highly effective drug for the treatment of patients with disorders of mucoregulation processes, which is confirmed by data from controlled studies and materials from an analytical review of the Cochrane Collaboration [6–17]. The safety of ascoril allows it to be widely used in outpatient practice. The personal experience of the authors of the article recommends to allocate a contingent of “coughing” patients in whom the use of ascoril is especially effective: patients with acute bronchitis of a protracted course; HB; COPD patients who do not need antibiotic therapy, but suffer from an excruciating cough, combined with panic attacks. The use of ascoril in them leads to a significant reduction in symptoms and an improvement in the general condition.