Хронический продуктивный кашель считается маркером заболеваний нижних дыхательных путей, таких как хронический бронхит, хроническая обструктивная болезнь легких, бронхиальная астма, бронхоэктатическая болезнь. В патогенезе хронического бронхита ярко просматриваются симптомы нарушения мукоцилиарного клиренса (вязкость бронхиального секрета, затруднения экспекторации, нарушение активности реснитчатого эпителия). В то же время доказано, что в патогенезе хронического кашля играет большую роль гиперсенситивный компонент, развивающийся вследствие повышенной чувствительности периферических и центральных компонентов кашлевого рефлекса. Лечение кашля, развившегося в результате мультифакторного патогенеза, представляет большие проблемы, так, возникает необходимость в назначении и мукоактивных препаратов, и препаратов, непосредственно воздействующих на повышенную чувствительность к кашлю (противокашлевых препаратов). Однако известный нам препарат – фиксированная комбинация сальбутамола, бромгексина, гвайфенезина (Аскорил) – показал свою эффективность при лечении продуктивного кашля у больных с хроническими респираторными заболеваниями, позволив решить все поставленные задачи.
Chronic productive cough is considered a marker of lower respiratory tract disorders such as chronic bronchitis, chronic obstructive pulmonary disease, bronchial asthma, and bronchiectasis. Chronic bronchitis pathogenesis includes prominent symptoms of muco-ciliary clearance disturbance (bronchial mucous viscosity, expectorations disorders, ciliated epithelium activity disorders). In the meantime it was shown that in chronic cough pathogenesis hypersensitive component that develops in consequence of increased sensitivity of peripheral and central components of coughing reflex plays an essential role. Treatment of cough that developed as a result of multifactorial pathogenesis is of concern. For example it requires using mucoactive therapy and medications that directly influence increased sensitivity to cough ( anti-tussive medications). A well known medication that is a fixed combination of salbutamol, bromhexine, and guaiphenesine (Ascoril) has shown its effectiveness in treatment of productive cough in patients with chronic respiratory disorders allowing solve all formulated problems.
1. Шварц Л.С. Кашель. В кн.: Большая медицинская энциклопедия. Т. 12. 2-е изд. М.: Большая советская энциклопедия, 1959. [Shvarts L.S. Kashel'. V kn.: Bol'shaia meditsinskaia entsiklopediia. T. 12. 2-e izd. M.: Bol'shaia sovetskaia entsiklopediia, 1959 (in Russian).] 2. Ohar JA, Donohue JF, Spangenthal S. The Role of Guaifenesin in the Management of Chronic Mucus Hypersecretion Associated with Stable Chronic Bronchitis: A Comprehensive Review. Chronic Obstr Pulm Dis 2019; 6 (4). DOI: 10.15326/jcopdf.6.4.2019.0139 3. Вотчал Б.Е. Очерки клинической фармакологии. М.: Государственное издательство медицинской литературы. [Votchal B.E. Essays on clinical pharmacology. Moscow: State publishing house of medical literature (in Russian).] 4. Barnes PJ. Airway NANC nerves and neuropeptides. In: Barnes PJ, Rodger IW, Thomson XC eds. Asthma. Basic Mechanisms and Clinical Management. London: Academic Rress, 1992; p. 359–89. 5. Mazzone SB, Farrell MJ. Heterogeneity of cough neurobiology: clinical implications. Pulm Pharmacol Ther 2019; 55: 62–6. 6. Morice AH, Jakes AD, Faruqi S et al. A worldwide survey of chronic cough: a manifestation of enhancedsomatosensory response. Eur Respir J 2014; 44: 1149–55. 7. Millqvist E. The airway sensory hyperreactivity syndrome. Pulm Pharmacol Ther 2011; 24: 263–6. 8. O’Connell F, Thomas VE, Studham JM et al. Capsaicin cough sensitivity increases during upper respiratory infection. Respir Med 1996; 90: 279–86. 9. Dicpinigaitis PV, Bhat R, Rhoton WA et al. Effect of viral upper respiratory tract infection on the urge-to-cough sensation. Respir Med 2011; 105: 615–8. 10. Morice AH, Millqvist E, Belvisi MG, et al. Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. Eur Respir J 2014; 44: 1132–48. 11. Morice AH, Millqvist E, Bieksiene K et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020; 55: 1901136. DOI: 10.1183/13993003.01136-2019 12. Dicpinigaitis PV, Gayle YE. Effect of Guaifenesin on Cough Reflex Sensitivity. Chest 2003; 124: 2178–81. 13. Chung KF, Canning B, McGarvey L. Eight International London Cough Symposium 2014: Cough hypersensitivity syndrome as the basis for chronic cough. Pulm Pharmacol Ther 2015; 35: 76–80. DOI: 10.1016/j.pupt.2015.08.009 14. Mazzone SB, Chung KF, McGarvey L. The heterogeneity of chronic cough: a case for endotypes of cough hypersensitivity. Lancet Respir Med 2018; 6: 636–46. 15. Morice AH, Kantar A, Dicpinigaitis PV et al. Treating acute cough: wet versus dry – have we got the paradigm wrong? ERJ Open Res 2015; 1 (2): 00055-2015. DOI: 10.1183/23120541.00055-2015 16. Dicpinigaitis PV, Morice AH, Birring SS et al. Antitussive Drugs – Past, Present, and Future. Pharmacol Rev 2014; 66: 468–512. http://dx.doi.org/10.1124/pr.111.005116 17. Клячкина И.Л., Синопальников А.И. Амброксол в программе лечения хронических бронхолегочных заболеваний. Практическая пульмонология. 2018; 2: 83–92. [Kliachkina I.L., Sinopal'nikov A.I. Ambroksol v programme lecheniia khronicheskikh bronkholegochnykh zabolevanii. Prakticheskaia pul'monologiia. 2018; 2: 83–92 (in Russian).] 18. Albrecht HH, Dicpinigaitis PV, Guenin EP. Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections. Multidiscip Respir Med 2017; 12: 31. DOI: 10.1186/s40248-017-0113-4 19. Seagrave J, Albrecht H, Park YS et al. Effect of guaifenesin on mucin production, rheology, and mucociliary transport in differentiated human airway epithelial cells. Exp Lung Res 2011; 37: 606–14. DOI: 10.3109/01902148.2011.623116 20. Jayaram S, Desai A. Efficacy and safety of Ascoril expectorant and other cough formula in the treatment of cough management in paediatric and adult patients – a randomised double-blind comparative trial. J Indian Med Assoc 2000; 98: 68–70. 21. Ainapure SS, Desai A, Korde K. Efficacy and safety of Ascoril in the management of cough – National Study Group report. J Indian Med Assoc 2001; 99: 111, 114. 22. Федосеев Г.Б., Орлова Н.Ю., Шалюга Л.В. Применение препарата «АСКОРИЛ» в амбулаторной практике. Новые Санкт-Петербургские врачебные ведомости. 2002; 1 (19): 69–70. [Fedoseev G.B., Orlova N.Iu., Shaliuga L.V. Primenenie preparata "ASKORIL' v ambulatornoi praktike. Novye Sankt-Peterburgskie vrachebnye vedomosti. 2002; 1 (19): 69–70 (in Russian).] 23. Федосеев Г.Б., Зинакова М.К., Ровкина Е.И., Щукина Т.В. Клинические аспекты применения Аскорила в пульмонологической клинике. Новые Санкт-Петербургские врачебные ведомости. 2002; 2 (20): 64–7. [Fedoseev G.B., Zinakova M.K., Rovkina E.I., Shchukina T.V. Klinicheskie aspekty primeneniia Askorila v pul'monologicheskoi klinike. Novye Sankt-Peterburgskie vrachebnye vedomosti. 2002; 2 (20): 64–7 (in Russian).] 24. Корж А.Н., Краснокутский С.В., Васькив Н.Н. Применение препарата «Аскорил» в лечении больных хроническим обструктивным заболеванием легких. Consilium Medicum Ukraina. 2007; 1 (4): 15–7. [Korzh A.N., Krasnokutskii S.V., Vas'kiv N.N. Primenenie preparata "Askoril' v lechenii bol'nykh khronicheskim obstruktivnym zabolevaniem legkikh. Consilium Medicum Ukraina. 2007; 1 (4): 15–7 (in Russian).] 25. Клячкина И.Л. Лечение кашля при острых респираторных вирусных инфекциях у пациентов группы риска. ВМЖ. 2009; 7: 40–5. [Klyachkina I.L. Lechenie kashlia pri ostrykh respiratornykh virusnykh infektsiiakh u patsientov gruppy riska. VMZh. 2009; 7: 40–5 (in Russian).] 26. Клячкина И.Л., Дмитриев Ю.К. Лечение нетяжелых обострений хронической обструктивной болезни легких. Клиническая медицина. 2012; 3: 69–73. [Klyachkina I.L., Dmitriev Iu.K. Lechenie netiazhelykh obostrenii khronicheskoi obstruktivnoi bolezni legkikh. Klinicheskaia meditsina. 2012; 3: 69–73 (in Russian).] 27. Prabhu Shankar S, Chandrashekharan S, Bolmall CS, Baliga V. Efficacy, safety and tolerability of salbutamol + guaiphenesin + bromhexine (Ascoril) expectorant versus expectorants containing salbutamol and either guaiphenesin or bromhexine in productive cough: a randomised controlled comparative study. J Indian Med Assoc 2010; 108: 313–20. 28. Григорьева Н.Ю. Оценка клинической эффективности и безопасности комбинированного препарата Аскорил у больных c коморбидной бронхолегочной и сердечно-сосудистой патологией. РМЖ. 2013; 29: 1475–9. [Grigor'eva N.Iu. Otsenka klinicheskoi effektivnosti i bezopasnosti kombinirovannogo preparata Askoril u bol'nykh c komorbidnoi bronkholegochnoi i serdechno-sosudistoi patologiei. RMZh. 2013; 29: 1475–9 (in Russian).] 29. Нургажин Т.С., Гуляев А.Е., Ермекбаева Б.А. и др. Результаты международного многоцентрового неинтервенционного исследования эффективности и безопасности аскорила экспекторанта при лечении кашля, проведенного в Республике Казахстан и Республике Узбекистан. Клин. медицина. 2013; 6: 50–5. [Nurgazhin T.S., Guliaev A.E., Ermekbaeva B.A. i dr. Rezul'taty mezhdunarodnogo mnogotsentrovogo neinterventsionnogo issledovaniia effektivnosti i bezopasnosti askorila ekspektoranta pri lechenii kashlia, provedennogo v Respublike Kazakhstan i Respublike Uzbekistan. Klin. meditsina. 2013; 6: 50–5 (in Russian).]
________________________________________________
1. Shvarts L.S. Kashel'. V kn.: Bol'shaia meditsinskaia entsiklopediia. T. 12. 2-e izd. M.: Bol'shaia sovetskaia entsiklopediia, 1959 (in Russian). 2. Ohar JA, Donohue JF, Spangenthal S. The Role of Guaifenesin in the Management of Chronic Mucus Hypersecretion Associated with Stable Chronic Bronchitis: A Comprehensive Review. Chronic Obstr Pulm Dis 2019; 6 (4). DOI: 10.15326/jcopdf.6.4.2019.0139 3. Votchal B.E. Essays on clinical pharmacology. Moscow: State publishing house of medical literature (in Russian). 4. Barnes PJ. Airway NANC nerves and neuropeptides. In: Barnes PJ, Rodger IW, Thomson XC eds. Asthma. Basic Mechanisms and Clinical Management. London: Academic Rress, 1992; p. 359–89. 5. Mazzone SB, Farrell MJ. Heterogeneity of cough neurobiology: clinical implications. Pulm Pharmacol Ther 2019; 55: 62–6. 6. Morice AH, Jakes AD, Faruqi S et al. A worldwide survey of chronic cough: a manifestation of enhancedsomatosensory response. Eur Respir J 2014; 44: 1149–55. 7. Millqvist E. The airway sensory hyperreactivity syndrome. Pulm Pharmacol Ther 2011; 24: 263–6. 8. O’Connell F, Thomas VE, Studham JM et al. Capsaicin cough sensitivity increases during upper respiratory infection. Respir Med 1996; 90: 279–86. 9. Dicpinigaitis PV, Bhat R, Rhoton WA et al. Effect of viral upper respiratory tract infection on the urge-to-cough sensation. Respir Med 2011; 105: 615–8. 10. Morice AH, Millqvist E, Belvisi MG, et al. Expert opinion on the cough hypersensitivity syndrome in respiratory medicine. Eur Respir J 2014; 44: 1132–48. 11. Morice AH, Millqvist E, Bieksiene K et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020; 55: 1901136. DOI: 10.1183/13993003.01136-2019 12. Dicpinigaitis PV, Gayle YE. Effect of Guaifenesin on Cough Reflex Sensitivity. Chest 2003; 124: 2178–81. 13. Chung KF, Canning B, McGarvey L. Eight International London Cough Symposium 2014: Cough hypersensitivity syndrome as the basis for chronic cough. Pulm Pharmacol Ther 2015; 35: 76–80. DOI: 10.1016/j.pupt.2015.08.009 14. Mazzone SB, Chung KF, McGarvey L. The heterogeneity of chronic cough: a case for endotypes of cough hypersensitivity. Lancet Respir Med 2018; 6: 636–46. 15. Morice AH, Kantar A, Dicpinigaitis PV et al. Treating acute cough: wet versus dry – have we got the paradigm wrong? ERJ Open Res 2015; 1 (2): 00055-2015. DOI: 10.1183/23120541.00055-2015 16. Dicpinigaitis PV, Morice AH, Birring SS et al. Antitussive Drugs – Past, Present, and Future. Pharmacol Rev 2014; 66: 468–512. http://dx.doi.org/10.1124/pr.111.005116 17. Kliachkina I.L., Sinopal'nikov A.I. Ambroksol v programme lecheniia khronicheskikh bronkholegochnykh zabolevanii. Prakticheskaia pul'monologiia. 2018; 2: 83–92 (in Russian). 18. Albrecht HH, Dicpinigaitis PV, Guenin EP. Role of guaifenesin in the management of chronic bronchitis and upper respiratory tract infections. Multidiscip Respir Med 2017; 12: 31. DOI: 10.1186/s40248-017-0113-4 19. Seagrave J, Albrecht H, Park YS et al. Effect of guaifenesin on mucin production, rheology, and mucociliary transport in differentiated human airway epithelial cells. Exp Lung Res 2011; 37: 606–14. DOI: 10.3109/01902148.2011.623116 20. Jayaram S, Desai A. Efficacy and safety of Ascoril expectorant and other cough formula in the treatment of cough management in paediatric and adult patients – a randomised double-blind comparative trial. J Indian Med Assoc 2000; 98: 68–70. 21. Ainapure SS, Desai A, Korde K. Efficacy and safety of Ascoril in the management of cough – National Study Group report. J Indian Med Assoc 2001; 99: 111, 114. 22. Fedoseev G.B., Orlova N.Iu., Shaliuga L.V. Primenenie preparata "ASKORIL' v ambulatornoi praktike. Novye Sankt-Peterburgskie vrachebnye vedomosti. 2002; 1 (19): 69–70 (in Russian). 23. Fedoseev G.B., Zinakova M.K., Rovkina E.I., Shchukina T.V. Klinicheskie aspekty primeneniia Askorila v pul'monologicheskoi klinike. Novye Sankt-Peterburgskie vrachebnye vedomosti. 2002; 2 (20): 64–7 (in Russian). 24. Korzh A.N., Krasnokutskii S.V., Vas'kiv N.N. Primenenie preparata "Askoril' v lechenii bol'nykh khronicheskim obstruktivnym zabolevaniem legkikh. Consilium Medicum Ukraina. 2007; 1 (4): 15–7 (in Russian). 25. Klyachkina I.L. Lechenie kashlia pri ostrykh respiratornykh virusnykh infektsiiakh u patsientov gruppy riska. VMZh. 2009; 7: 40–5 (in Russian). 26. Klyachkina I.L., Dmitriev Iu.K. Lechenie netiazhelykh obostrenii khronicheskoi obstruktivnoi bolezni legkikh. Klinicheskaia meditsina. 2012; 3: 69–73 (in Russian). 27. Prabhu Shankar S, Chandrashekharan S, Bolmall CS, Baliga V. Efficacy, safety and tolerability of salbutamol + guaiphenesin + bromhexine (Ascoril) expectorant versus expectorants containing salbutamol and either guaiphenesin or bromhexine in productive cough: a randomised controlled comparative study. J Indian Med Assoc 2010; 108: 313–20. 28. Grigor'eva N.Iu. Otsenka klinicheskoi effektivnosti i bezopasnosti kombinirovannogo preparata Askoril u bol'nykh c komorbidnoi bronkholegochnoi i serdechno-sosudistoi patologiei. RMZh. 2013; 29: 1475–9 (in Russian). 29. Nurgazhin T.S., Guliaev A.E., Ermekbaeva B.A. i dr. Rezul'taty mezhdunarodnogo mnogotsentrovogo neinterventsionnogo issledovaniia effektivnosti i bezopasnosti askorila ekspektoranta pri lechenii kashlia, provedennogo v Respublike Kazakhstan i Respublike Uzbekistan. Klin. meditsina. 2013; 6: 50–5 (in Russian).
Авторы
И.Л. Клячкина*
ФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава России, Москва, Россия *formozailk2012@yandex.ru
________________________________________________
Irina L. Klyachkina*
Russian Medical Academy of Continuous Professional Education, Moscow, Russia *formozailk2012@yandex.ru