Production of phlegm: Phlegm or Mucus in Throat: Causes, Treatment, and More

07.07.202305.07.2023 by alexxlab

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

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Medically reviewed by Lauren Castiello, MS, AGNP-C — By Scott Frothingham — Updated on May 10, 2023

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.

Last medically reviewed on May 10, 2023

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Allinson JP, et al. (2016). The presence of chronic mucus hypersecretion across adult life in relation to chronic obstructive pulmonary disease development.
ncbi.nlm.nih.gov/pmc/articles/PMC4824943/
Byer S. (2015). Congestion relief.
alsworldwide.org/research-and-trials/article/congestion-relief
Cystic Fibrosis Foundation. (n.d.). Mucus thinners.
cff.org/Life-With-CF/Treatments-and-Therapies/Medications/Mucus-Thinners/
Gupta R, et al. (2023). Mucolytic medications.
ncbi.nlm.nih.gov/books/NBK559163/
Li X, et al. (2020). Recent advances in the development of novel drug candidates for regulating the secretion of pulmonary mucus.
europepmc.org/backend/ptpmcrender.fcgi?accid=PMC7327140&blobtype=pdf

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May 10, 2023

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Jan 7, 2020

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Medically reviewed by Lauren Castiello, MS, AGNP-C — By Scott Frothingham — Updated on May 10, 2023

How to Get Rid of Mucus in Chest: 8 Tips

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1. Drink liquids

Drink lots of fluids. It sounds cliché, but you likely hear this advice often because it works.

Liquids help thin out mucus. Warm liquids can help clear out mucus in the chest and nose. This can relieve congestion, giving you a small respite from your symptoms.

2. Gargle with salt water

Research shows that gargling warm salt water can help relieve the symptoms of a cold, which can include excess mucus.

Try to mix a cup of warm, filtered, or bottled water with half to three-quarters teaspoon (tsp) of salt. Take a sip and tilt your head slightly back and gargle for 30-60 seconds. Alternatively, use saline solution in spray or neti pot form.

3. Elevate your head

Try to keep your head upright, especially at night. This will help the mucus drain out faster. You can do this by propping up a few pillows under your head.

4. Use a humidifier

Steam can also help loosen mucus and clear up congestion. You can pick up a humidifier at your local drugstore. You may find it beneficial to use it at night near your bed. This can help ease congestion while you’re sleeping.

Depending on your needs, you can make your own steam room or humidifier at home in the following ways:

Breath in steam in the shower
Lean over a bowl of hot water, placing a hand towel over your head to help trap the steam around your face.

5. Take honey

Honey has been used as a natural remedy throughout history and is known for its anti-inflammatory properties. There is some evidence it may be particularly helpful in relieving nighttime coughs in children.

One 2018 meta-analysis of six randomized studies also found evidence to suggest that honey may be more effective than no treatment, a placebo, and diphenhydramine (Benadryl).

However, it wasn’t necessarily more effective than the common cough suppressant Dextromethorphan (Mucinex, Robitussin, and others).

6. Use essential oils

Certain essential oils may help loosen mucus in the chest. A 2020 meta-analysis of seven studies suggest essential oils may help relieve some symptoms of respiratory illnesses, though the results of the studies were mixed.

Peppermint oil and eucalyptus oil are also used as natural decongestants.

You can make use of essential oil in one of two ways:

Diffuse it: Pick up a diffuser from your local drugstore, and add a couple of drops of the oil to a hot bath to release the scent into the air.
Breathe it in: Fill a bowl with hot water and a few drops of essential oil. Lean over the bowl and cover your head with a hand towel to help trap the steam. Breathe in the steam for 5 to 10 minutes.
Apply topically: Mix 12 drops of carrier oil for every 1 or 2 drops of essential oil. Do a skin patch test first. If there’s no irritation in 24 hours, you can apply it directly to your chest.

While research suggests there are health benefits, the FDA doesn’t monitor or regulate the purity or quality of essential oils. It’s important to talk with a healthcare professional before you begin using essential oils and be sure to research the quality of a brand’s products. Always do a patch test before trying a new essential oil.

7. Take a decongestant

Decongestants are available in liquid, tablet, or nasal spray form at your local drugstore. Common OTC options include:

oxymetazoline (Vicks Sinex): This is a nasal spray that shouldn’t be used for longer than three days.
pseudoephedrine (Sudafed): People with certain conditions may need to avoid taking Sudafed.

Follow the directions on the packaging. A decongestant can speed up your heart rate and make it harder to fall asleep. You may find it better to take it during the day.

8. Slather on a vapor rub

Vapor rubs contain decongestive ingredients, but they’re applied topically instead of ingested.

You can usually rub it onto your chest every night until the symptoms stop. Be sure to follow the instructions on the packaging.

In one older 2010 study, researchers studied children who received either vapor rub treatment, petrolatum ointment, or no medication. Vapor rub scored the highest in providing relief from cough and congestion.

Another 2017 study found that people with a cold who used Vicks VapoRub could sleep better at night, though the study didn’t determine whether this is definitely due to the relief of symptoms like a cough.

9.

Avoid smoking

Smoking can actually increase mucus in your airway, so it’s a good idea to avoid it.

10. Eat certain foods

Try adding more onion, garlic, lemon, or cayenne pepper to your food.

A 2018 survey suggests they may help relieve symptoms of colds and coughs, which includes reducing mucus. Spicy foods containing capsaicin might also provide temporary relief of sinus congestion by stimulating the flow of mucus.

If you find that the mucus lasts for more than 3 to 4 days or that your condition gets worse quickly, your doctor may suggest a prescription decongestant, which is stronger than an OTC decongestant

They may also prescribe a prescription nasal spray to help open up your nasal passageway.

Talk with your doctor about how long you should use them. Typically, if you use decongestant nasal sprays for more than 3 days in a row, you may end up stuffed up again.

Learn about the types of decongestants.

If your symptoms persist, make an appointment to see your doctor. This is especially true if you have a fever, chest pain, or trouble breathing.

It’s also important to see a doctor if:

the congestion worsens and lasts longer than 3 or 4 days
mucus changes from a runny substance to a thicker texture
mucus has a green or yellow color, as this may indicate an infection

In most cases, mucus and related congestion will clear up within 7 to 9 days.

Is mucus good or bad for the body?

You need some mucus to moisturize your mucous membranes and filter out allergens and microorganisms from your nose and mouth. However, too much mucus usually indicates a respiratory illness like a cold, allergies, or asthma.

What causes mucus in the throat?

Your body produces mucus to cover the moist surfaces of your body, like your lungs, sinuses, or mouth. When your body is fighting a cold or reacting to an allergen, the body will make more mucus.

Why won’t the mucus in my throat go away?

If your excess mucus isn’t going away, it means your body is still fighting an infection or you are still being exposed to something irritating like an allergen. Your doctor can determine the cause and suggest treatment.

There are a number of home remedies that may help relieve chest congestion, such as gargling with salt water, using essential oils, or taking an OTC decongestant.

That said, if symptoms don’t improve, you may need prescription medication that will depend o the cause.

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 phlegm 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 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 in the bronchial secretion of cell decay products, metabolites of vital activity and decay of microorganisms, and exudate 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, hernia 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 in 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 combination 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.