medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2023-089medsovet-7419Research ArticleРАЦИОНАЛЬНАЯ ФАРМАКОТЕРАПИЯRATIONAL PHARMACOTHERAPYМесто противокашлевых препаратов при лечении острых респираторных вирусных инфекций и гриппаRole of antitussive agents in the treatment of acute respiratory viral infections and influenzahttps://orcid.org/0000-0003-0078-4071ФесенкоО. В.FesenkoO. V.

Фесенко Оксана Вадимовна - доктор медицинских наук, профессор  кафедры  пульмонологии.

125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Oxana V. Fesenko - Dr. Sci. (Med.), Professor  of Pulmonology  Department, Russian  Medical Academy  of Continuous  Professional  Education.

2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

ofessenko@mail.ruРоссийская медицинская академия непрерывного профессионального образованияРоссияRussian Medical Academy of Continuous Professional EducationRussian Federation20231104202304109115Copyright © Фесенко О.В., 20232023Фесенко О.В.Fesenko O.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/7419

Острый кашель, спровоцированный вирусной инфекцией  верхних дыхательных путей, является во всем мире наиболее распространенным  симптомом среди детей и взрослых. Он обусловливает серьезные  экономические  и социальные проблемы как для отдельных пациентов и их семей, так и для системы здравоохранения в целом. До сих пор не существует эффективного  фармакологического  средства, способного  повлиять на все  основные  патофизиологические  механизмы, лежащие в основе острого кашля при острых респираторных вирусных инфекциях. Этим обстоятельством отчасти объясняется увеличение  числа случаев  затяжного течения  острых респираторных  инфекций, когда кашель принимает  черты подострого  или постинфекционного. В целях  оптимизации  лечения  кашля активно  исследуется  патофизиология  этого симптома. Вирусная инфекция  провоцирует  острый кашель вследствие  различных раздражителей,  главным из которых является секрет дыхательных путей, непосредственно воздействующий на рефлексогенные  участки слизистой оболочки. Играют важную роль также медиаторы воспаления, влияющие на периферические сенсорные окончания, локализованные в дыхательных путях. Медиаторы воспаления  провоцируют и постинфекционную гиперреактивность  бронхов  − важный компонент патогенеза  постинфекционного кашля. Также в последнее  время исследователи  все больший интерес уделяют роли произвольного или осознанного компонента кашля, который реализуется благодаря кортикальному ответу на афферентную информацию из рецепторов, расположенных в верхних дыхательных путях. Эта гипотеза объясняет неэффективность  противокашлевых  препаратов   центрального  действия  при  сухом  кашле, обусловленном   вирусной  инфекцией, и расширяет  возможности  применения  противокашлевых  средств  периферического действия, представителем  которых является леводропропизин.  Помимо воздействия на нервные окончания, препарат также оказывает влияние на медиаторы воспаления,  что усиливает  его  способность  разрывать  «порочный  круг» этого симптома, предотвращать  развитие постинфекционного кашля и способствовать реабилитации  бронхиального дерева. Эффективность и безопасность леводропропизина продемонстрирована в клинических исследованиях  как у детей, так и у взрослых.

Viral upper respiratory infection  (VURI)-associated acute cough is the most common symptom worldwide among children and adults. It causes  serious  economic  and  social  problems  both  for individual  patients, patients’  families, and  the  health  care system as a whole. There is still no effective pharmacological agent  capable  of interfering  with all the main pathophysiological mechanisms involved in VURI-associated acute  cough. This circumstance partly explains  the increased prevalence of the prolonged course of acute  respiratory  infections, when the cough takes on the features  of subacute or post-infectious course. The pathophysiology of this symptom is being actively investigated to optimize  the treatment of cough. A viral infection  provokes an acute  cough  induced  by various irritative  stimuli, the  main one  being  secretions from the  respiratory  tract, which directly acts on reflexogenic areas  of the mucosa. Inflammatory mediators also play an important role, acting  on the peripheral sensory terminations of airways. Inflammatory mediators also induce post-infectious bronchial hyperreactivity, which is an important component of the pathogenesis of post-infectious cough. Recently, researchers are becoming increasingly interested in the  role of the  voluntary  or conscious  cough  component, which is implemented due  to the  cortical  response to afferent information  from the receptors of the upper respiratory tract.This hypothesis  explains the ineffectiveness of central antitussive agents  in patients with viral infection-associated dry cough  and  expands  the  possibilities  of peripheral antitussive agents represented by levodropropizine. In addition  to the  action  on nerve endings, the  agent  also affects  inflammatory  mediators, which enhances its ability to break the “vicious circle” of this symptom, prevents the development of post-infectious cough and promotes rehabilitation of the  bronchial  tree. The efficacy and safety of levodropropizine has been  demonstrated in clinical trials in both children and adults.

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The authors declare that there are no conflicts of interest present.