Modern approaches to the prescription of mucolytics and expectorants in the daily pediatric practice

The article presents the clinical evidence of safety and efficacy of mucolytics and expectorants in the treatment of both productive and non-productive coughs in respiratory infections in childhood in all stages of the infectious-inflammatory process. The authors set a goal to study the efficacy and safety of mucolytics and expectorants in children with respiratory infection in the pediatric practice. Materials and methods. A total of 96 children undergoing inpatient treatment for various variants of acute respiratory infection were examined. The average age of the patients was 7.6 ± 0.9 years old (from 3 to 14 years old). All patients were divided into 3 groups. Primary outcomes. Using the investigational drugs in children with various forms of acute respiratory infection made it possible to quickly reduce the intensity and frequency of cough by Day 3-5 from the onset of the disease and therapy, and transform cough into productive wet cough. The study showed rapid positive dynamics in cases, when acetylcysteine was prescribed from the first days of the disease, with a consistent cough therapy using herbal products. Both investigational drugs showed no adverse drug effects during the study. The results of the analysis brings us to the conclusion that a multimodal approach to cough treatment provides a comprehensive effect, which potentiates the treatment effect and allows us to recommend them in everyday pediatric practice as effective symptomatic agents to treat inflammatory diseases of the respiratory tract. This method helps to prevent polypharmacy, minimizing the drug load on the child.

1. Kazyukova T.V., Pankratov I.V., Aleev A.S., Dudina T.A. Family prophylaxis of influenza and acute respiratory infections during the seasonal flu outbreaks. RMZH = RMJ. 2011;19(2):118-123. (In Russ). Available at: https://www.rmj.ru/articles/infektsiya/Semeynaya_profilaktika_grippa_i_ostryh_respiratornyh_infekciy_v_period_podyema_sezonnoy_zabolevaemosti/.

2. Hay A.J., McCauley J.W. The WHO global influenza surveillance and response system (GISRS)—A future perspective. Influenza Other Respir Viruses. 2018;12(5):551–557. doi: 10.1111/irv.12565.

3. Tereshchenko S.YU. Long-term cough in children: issues of diagnosis and therapy. Consilium medicum. 2010;(4):18-27. (In Russ.) Available at: https://con-med.ru/magazines/pediatry/pediatry04-2010/dlitelnyy_kashel_u_detey_voprosy_diagnostiki_i_terapii_obzor/.

4. Zakharova I.N., Dmitrieva Yu.A. Cough in children: differential diagnosis and management. Consilium medicum. 2010;(1):37. (In Russ.) Available at: https://con-med.ru/magazines/pediatry/pediatry-01-2010/kashel_u_detey_differentsialnaya_diagnostika_i_taktika_lecheniya_/.

5. Blokhin B.M. An Actual Approach to the Problem of Cough in Acute Respiratory Infections in Children. Voprosy sovremennoj pediatrii = Current Pediatrics. 2016;15(1):100104. (In Russ.) doi: 10.15690/vsp.v15i1.1506.

6. Vishneva E., Torshkhoeva R., Alekseeva A., Volkov K. THE MEDICAL APPROACH TO THE PATIENT WITH COUGH. Pediatricheskaya farmakologiya = Pediatric pharmacology. 2011;8(3):9497. (In Russ) Available at: https://pf.spr-journal.ru/jour/issue/view/41.

7. Zakharova I.N. Korovina N.A., Ovsyannikova E.M. Role of expectorants in cough therapy. RMZH = RMJ. (In Russ). 2011;(2):113-115. Available at: https://www.rmj.ru/articles/pediatriya/Roly_otharkivayuschih_preparatov_v_terapii_kashlya/

8. Zaytseva O.V., Zaytseva S.V., Lokshina E.E. Specificities of cough therapy in children. Voprosy sovremennoj pediatri = Current Pediatrics. 2015;10(1):68-74. (In Russ.) Available at: https://elibrary.ru/item.asp?id=23398547.

9. Svistushkin V.M., Nikiforova G.N., Pshonkina D.M., Karpovа O.Yu. The relevance of the application mukoactive preparations in patients with inflammatory pathology of ent organs. Meditsinskiy sovet = Medical Council. 2018;(20):65-69. (In Russ.) doi: 10.21518/2079701X-2018-20-65-69.

10. Simonova O.I. Simple Answers to Complex Questions about Mucolytics for Children. Voprosy sovremennoj pediatri = Current Pediatrics. (In Russ.). 2015;14(4):509-513. doi: 10.15690/vsp.v14.i4.1391.

11. Samuni Y., Goldstein S., Dean O., Berk M. The chemistry and biological activities of N-acetylcysteine. Biochimica et Biophysica Acta. 2013;1830:4117-4129. Available at: https://www.ncbi.nlm.nih.gov/pubmed/23618697.

12. Lokshina E.E., Zaytseva S.V., Zaytseva O.V.. New possibilities of mucolytic therapy in children with acute respiratory diseases. Voprosy prakticheskoy pediatrii = Clinical Practice in Pediatrics. 2011;6(1):67-72. (In Russ.) Available at: https://elibrary.ru/item.asp?id=16734977.

13. Duijvestijn Y.C.M., Mourdi N. Smuchny J. Pons G., Chalumeau M Acetylcysteine and carbocysteine for acute upper and low respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease (Review). Cochrane Database Syst. Rev. 2010;(9):1-22. Available at: https://www.ncbi.nlm.nih.gov/pubmed/19160217.

14. Barnes P.J., Adcock I.M., Ito K. Histone acetylation and deacetylation: importance in inflammatory lung diseases. Eur Respir J. 2005;25(3):552-563. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15738302.

15. Pikuza O.I., Zakirova A.M. Role of acetylcysteine in the treatment of bronchopulmonary pathology in children. RMZH = RMJ. 2009;(2):82-84. (In Russ.). Available at: https://elibrary.ru/item.asp?id=17885140.

16. Simonova O.I. Mucolytics for children: difficult issues, key solutions. Voprosy sovremennoj pediatrii = Current Pediatrics. 2014;13(1):26-32. (In Russ.) https://doi.org/10.15690/vsp.v13i1.909.

17. Zakirova A.M., Moroz T.B, Rashitov L.F., Fetisova T.G. Plant exctract based medication «abisil» administration experirence in children with acute bronchitis. Vestnik sovremennoy klinicheskoy meditsiny = The Bulletin of Contemporary Clinical Medicine. 2017;10(2):34-39. (In Russ.) Available at: http://vskmjournal.org/images/Files/Issues_Archive/2017/Issue_2/VSKM_2017_N_2_p34-39.pdf.

18. Chernikov V.V. Application of vegetable drugs for treating cough in children. Pediatričeskaa farmakologia = Pediatric pharmacology. (In Russ.) 2012;9(6):105-109. doi: 10.15690/pf.v9i6.527.

19. Pikuza O.I., Zakirova A.M. Modern approaches to cough therapy in medical practice. RMZH = RMJ. (In Russ.). 2017;25(18):1312-1316. Available at: https://www.rmj.ru/articles/bolezni_dykhatelnykh_putey/Sovremennye_podhody_k_terapii_kashlya_vo_vrachebnoy_praktike/.

20. Chalumeau M., Duijvestijn Y.C.M. Acetylcysteine and carbocysteine for acute upper and lower respiratory tract infections in paediatric patients without chronic broncho-pulmonary disease. Cochr Database Syst Rev. 2013;(5):CD003124. doi:10.1002/14651858.CD003124.pub4.