Features of cough therapy in children

This article discusses the problem of cough in children as one of the symptoms of a complicated course of acute respiratory infection. The data on the peculiarities of the course of cough in children depending on the cause, the level of damage, and age are presented. Virulence of infectious agents, immune status, and the child’s constitution may influence the development of local inflammation covering the tonsils, adenoids, pharynx, larynx. The study of respiratory problems in children remains relevant due to the need to improve therapy tactics and rehabilitation after an infection. Acute upper respiratory tract infections affect about 23 million children annually, which is 52% of the total morbidity of children and adolescents aged 0-17 years. Various therapeutic options are discussed. Thus, central drugs have a direct antitussive effect and cause inhibition of the cough center: narcotic antitussive drugs, such as codeine-containing drugs; non-narcotic antitussive drugs (glaucine hydrochloride, butamirate citrate, etc.). Peripheral medications reduce the sensitivity of cough afferent receptors and act on the mucosa of the airways. There are drugs of combined action, as well as bronchodilators, mucoactive drugs, and chest cough sets. Particular attention is paid to the multicomponent drug, which has a complex anti-inflammatory, antitussive and antimicrobial action in cough. The results of various foreign and domestic studies on the efficacy and safety of this drug are given. The necessity of early treatment is emphasized to improve the quality of life of patients and to prevent the formation of chronic bronchial processes. It is concluded that for the treatment of children it is necessary to choose the best drugs. It should be drugs that have proven efficacy and safety, and most importantly - they should be registered for use in the Russian Federation.

Clinic and semiotics of digestive lesions with coronavirus SARS-CoV-2

The article presents the results of the analysis of clinical features of gastroenterological manifestations of a new coronavirus infection (COVID-19) caused by the pathogen SARS-CoV-2. Taking into account the stage-by-stage system assessment of the experience of treating 1,180 patients in a multi-specialty hospital transformed into an infectious hospital, the most characteristic clinical manifestations of digestive damage by SARS-CoV-2 coronavirus are described. The article focuses on verification of changes in the digestive system, both at the stage of primary examination, and during etiotropic (in combination with hydroxychloroquine and azithromycin, interferon-alpha drugs), pathogenetic (in combination with corticosteroids, heparin drugs, according to indications - an interleukin-6 inhibitor) and symptomatic (antipyretics, antiemetics and antitussive drugs) therapy, carried out in accordance with Temporary guidelines of the Ministry of health of the Russian Federation “Prevention, diagnosis and treatment of new coronavirus infection Covid-19”. Directions for the development of algorithms for clinical and laboratory, instrumental and radiological diagnostics of changes in the digestive system in patients with COVID-19 are justified.

Intra-Arterial, but Not Intrathecal, Baclofen and Codeine Attenuates Cough in the Cat

Centrally-acting antitussive drugs are thought to act solely in the brainstem. However, the role of the spinal cord in the mechanism of action of these drugs is unknown. The purpose of this study was to determine if antitussive drugs act in the spinal cord to reduce the magnitude of tracheobronchial (TB) cough-related expiratory activity. Experiments were conducted in anesthetized, spontaneously breathing cats (n = 22). Electromyograms (EMG) were recorded from the parasternal (PS) and transversus abdominis (TA) or rectus abdominis muscles. Mechanical stimulation of the trachea or larynx was used to elicit TB cough. Baclofen (10 and 100 μg/kg, GABA-B receptor agonist) or codeine (30 μg/kg, opioid receptor agonist) was administered into the intrathecal (i.t.) space and also into brainstem circulation via the vertebral artery. Cumulative doses of i.t. baclofen or codeine had no effect on PS, abdominal muscle EMGs or cough number during the TB cough. Subsequent intra-arterial (i.a.) administration of baclofen or codeine significantly reduced magnitude of abdominal and PS muscles during TB cough. Furthermore, TB cough number was significantly suppressed by i.a. baclofen. The influence of these drugs on other behaviors that activate abdominal motor pathways was also assessed. The abdominal EMG response to noxious pinch of the tail was suppressed by i.t. baclofen, suggesting that the doses of baclofen that were employed were sufficient to affect spinal pathways. However, the abdominal EMG response to expiratory threshold loading was unaffected by i.t. administration of either baclofen or codeine. These results indicate that neither baclofen nor codeine suppress cough via a spinal action and support the concept that the antitussive effect of these drugs is restricted to the brainstem.

CLINICAL AND PHARMACOLOGICAL FEATURES OF APPLICATION WITH AN OVERVIEW OF THE COUNTRIES ON THE MARKET AN TIT UIS H DRUGS

Cough is one of the most common clinical manifestations of acute infectious diseases of the upper and lower respiratory tract. Patients complaining of coughing represent one of the most numerous groups in the practice of a doctor. In most cases, an acute cough usually resolves on its own and rarely requires additional medical intervention. Chronic cough can be a manifestation of a variety of pulmonary and extra pulmonary diseases. A long course of chronic cough can lead to both somatic disorders and psychological and social difficulties. Since cough can be caused by many factors, it is often difficult to identify its true cause. Often, in order to establish the true cause of a cough, the doctor has to repeatedly examine the patient and conduct several trial courses of treatment. The article discusses the classification, mechanism, causes, types of cough, the effect of the use of various drugs on the appearance of cough, complications arising from a prolonged, debilitating cough, as well as approaches to the diagnosis and treatment of cough. The classification of antitussive drugs of central, peripheral and mixed action, indications for their use is presented. The clinical and pharmacological features of the use of certain antitussive drugs available on the market are described and recommendations for their use in clinical practice are given. The use of approaches based on in-depth knowledge of the physician about the clinical pharmacology of antitussive drugs can contribute to competent «cough management», increasing the patient's quality of life.

Chronic cough: differential diagnosis and treatment

Cough is one of the most common symptoms and is present in diseases of the respiratory, cardiovascular, digestive, endocrine and other systems. Cough is a reflex act, therefore it is caused by stimulation of cough receptors due to pathological influences. The diagnosis takes into account the nature of the cough, its duration, the results of laboratory and instrumental examination methods. The most attention is required to diagnose chronic cough and exclude life-threatening causes. Symptoms of anxiety are hemoptysis, prolonged resistant cough, prolonged intoxication syndrome, weight loss, etc. In diagnostically unclear cases, the examination schedule must include computed tomography of the chest, magnetic resonance imaging and bronchoscopy. A dry, painful intense cough can lead to the development of complications: a decrease in the quality of life, hemorrhages, pneumothorax, etc., therefore, requires symptomatic treatment. A common cause of unproductive cough is viral diseases, whooping cough, diseases leading to overactive cough receptors. The variety of coughs determines a differentiated approach to its therapy. The main efforts should be directed to the treatment of the underlying disease. In the case of a productive cough, mucoactive drugs are used. To stop unproductive cough, antitussive drugs of central and peripheral action are used. The recommendations of the European Respiratory Society present the results of clinical trials assessing the efficacy and safety of antitussive drugs with morphine-like action. The study identified side effects that limit their use. One of the most effective and safe drugs is a non-opioid drug with a central action Sinekod. The effectiveness and safety of the drug is confirmed by clinical studies.

The Prospect for Potent Sodium Voltage-Gated Channel Blockers to Relieve an Excessive Cough

An excessive, irritable, productive or non-productive coughing associated with airway inflammation belongs to pathological cough. Increased activation of airway vagal nociceptors in pathological conditions results from dysregulation of the neural pathway that controls cough. A variety of mediators associated with airway inflammation overstimulate these vagal airway fibers including C-fibers leading to hypersensitivity and hyperreactivity. Because current antitussives have limited efficacy and unwanted side effects there is a continual demand for the development of a novel more effective antitussives for a new efficacious and safe cough treatment. Therefore, inhibiting the activity of these vagal C-fibers represents a rational approach to the development of effective antitussive drugs. This may be achieved by blocking inflammatory mediator receptors or by blocking the generator potential associated with the specific ion channels. Because voltage-gated sodium channels (NaVs) are absolutely required for action potentials initiation and conduction irrespective of the stimulus, NaVs become a promising neural target. There is evidence that NaV1.7, 1.8 and 1.9 subtypes are predominantly expressed in airway cough-triggering nerves. The advantage of blocking these NaVs is suppressing C-fiber irrespective to stimuli, but the disadvantage is that by suppressing the nerves is may also block beneficial sensations and neuronal reflex behavior. The concept is that new antitussive drugs would have the benefit of targeting peripheral airway nociceptors without inhibiting the protective cough reflex.