Expectorant drugs 

Expectorants are drugs reducing he sputum viscosity and facilitating its removal. By the mechanism of action they are divided into:
Expectorants of reflex action;
Expectorants of direct action.

Expectorants of reflex action 

They are prescribed for p/o use. They irritate the gastric receptors and induce reflex changes in bronchi: 

• They stimulate secretion of the bronchial glands (sputum is more viscous);
• They increase the activity of ciliated epithelium in bronchi (moving epithelial cilia promote the removal of sputum).
• In large doses they can trigger vomiting reflex.

One uses: infusion of bush pea herbs, dry and fluid form of bush pea extract, infusion of ipecacuanha roots. 
Bush pea herbs (Herba Thermopsidis) – 0,6-1g for 200ml of water. 1 table spoon 6 times a day.

Cough tablets – Таблетки от кашля (tabulettae contra tussim) contain 0,01 g of bush pea herbs in the form of fine powder and 0,25 g of sodium hydrocarbonate. They are prescribed 1 tablet 3 times a day. 
Dry extract of bush pea – экстракт термопсиса сухой (extraction Thermopsidis siccum) – a mix of dry extract of bush pea and milk sugar; 
Dry mixture for cough for adults – cухая микстура от кашля для взрослых (mixtura sicca contra tussim pro adultis) consists of the mix of dry extract of bush pea, licorice roots, sodium hydrocarbonate, sodium benzoate and ammonium chloride with anise oil and sugar. It is taken in the form of water solution.

Althaea roots (Radices Althaeae) are used in the from of powder, infusion, extract and syrup as an axpectorant and anti-inflamatory drug. It is included into breast teas (species pectoralis), which serve as a base for infusions, and into the composition of dry mixture for cough for children (mixtura sicca contra tussim pro infantibus). 
Mucaltin tablets contain the mix of polysaccharides out of Althaea officinalis herbs. It is used as an expectorant in case of acute and chronic diseases of respiratory tracts.

Licorice root (Radices Glycyrrhizae, Radix Liquiritiae) contains licuraside, glycyrrhizic acid (6% minimum), flavonoids, mucous substances. It has an anti-inflammatory and spasmodic action.
It is included into the composition of breast teas and dry mixture for cough in children. 
Thick extract of licorice roots (extractum Glycyrrhizae spissum) is included into the composition of breast elixir. The drugs of licorice roots are used as expectorants. Besides, they also exert a moderate anti-inflammatory action. 
Glycyram exerts an anti-inflammatory action and a moderate expectorant one.

Milkwort roots (Radices Polygalae) contain saponins, used in the form of decoction as an axpectorant. Пертуссин (Pertussinum) consists of 12 parts of brotherwort extract and  caraway extract, 1 part of potassium bromide, 82 parts of sugar syrup, 5 parts of 80% alcohol. It is used as an expectorant in case of bronchitis and other diseases of respiratory tracts. It is also prescribed to children in case of pertussis.
Terpin hydratе (Terpinum hydratum) is prescribed for p/o use as an expectorant at chronic brinchitis. It is not recommended to use in case of gastric and duodenal diseases.
Sodium benzoate is included into the composition fo powders and mixtures as an expectorant. 

Mucolytic drugs

They act directly on sputum making it less viscous and in this way making its removal easier.

Acetylcysteine (ACC, Fluimucil) thins sputum, increases its volume and facilitates its removal. It breaks intra- and intermolecular disulfide junctions of acidic mucopolysaccharide of sputum, with depolymerization of mucoproteins and decrease in viscosity in a number of cases it increases the amount of sputum. It affects the synthesis of glycoproteids in bronchial epithelium. It decreases the adhesion of bacteria on epithelial cells of bronchial mucous tunic. The drug stimulates mucous cells of bronchi, the secretion of which lyses fibrin. It also has some anti-inflammatory properties.

Acetylcysteine (Acetylcysteinum), Мукосольвин, Mucomyst, ACC, Fluimucil are produce for p/o use in the form of effervescent tablets 0,1; 0,2; 0,6 g (N 20-50). Granules for the preparation of 2%   solution in satchels of 0,2-0,6 g. For inhalations: amp.20% - 5 and 10ml. For injections – amp. 5% - 10ml and 10% 2 and 3ml. 

P/o use – 0,4-0,6 g/day. 1-2 times a day. Inhalations: 20%- 2-5ml, 3-4 times a day. Intra-tracheally – 1ml 10% solution every hour. For the lavage of bronchi in bronchoscopy - 5-10% solution. Injections i/m, i/v 10%-3ml once a day. Locally for the lavage of acoustic and nasal meatuses – 10% - 1,5-3ml.

The drugs of proteolytic enzymes are used as mucolytics in case of excessive sputum. They thin bronchial secretion and facilitate the removal of sputum at chronic non-specific pulmonary diseases.  

• Trypsin (Tripsinum), Chymotrypsin (Chymotrypsinum) Dosage form: powder in vials and ampoules - 0,005, and 0,01 g. Prescription:  5-10mg in 3 ml of isotonic solution of sodium chloride for inhalations. The course of treatment – 10-15 days. 
• Deoxyribonuclease (Desoxyribonucleasum), Dornase alfa. Dosage form: powder in vials and ampoules - 0,005, 0,01, 0,025 and 0,05 g. Prescription: 2mg in 1ml of solution for inhalations 3 times a day in the course of 5-7 days.

Drugs with mucolytic and expectorant ptoperties

Ambroxol – a mucolytic stimulating prenatal development of lungs (increases the synthesis, secretion of surfactant and blocks its disintegration). It has secretomotor, secretolytic and expectorant actions; increases the amount of mucous secretion; normalizes the disturbed balance between serous and mucous components of sputum. Activating hydrolysing enzymes, it decreases the viscosity of sputum. It increases the motor activity of the ciliated epithelium and mucociliary transport. 
Dosage forms: 0,03g tablets. 75mg extended-release tablets, 0,75% solution for inhalations.

Bromhexine (Bromhexinum). Bisolvon, Mucovin, Flegamin. Mucolytic (secretolytic) drug exerting an expectorant and weak antitussive action. It decreases the viscosity of sputum (depolymerize mucoprotein and mucopolysaccharide fibers, increases the serous component of brinchial secretion); activates ciliated epithelium, increases the volume of sputum and facilitates its removal. It stimulates the production of endogenous surfactant providing stability of alveolocytes in the process of breathing. The onset of action is 24-48 hours. The course of treatment – 4 days – 4 weeks. 
Indications: acute and chronic bronchitis, bronchial asthma, pulmonary TB, pneumonia.
Contraindications: pregnancy, lactation.
Produced in: tablets, dragee of 0,004g and 0,008g. For p/o use and inhalations - 0,2% in 100 ml vials. For injections - 0,2% in 2 ml ampoules.