Benylin expectorant versus actifed expectorant in the treatment of acute cough.
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Adult↗
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[Expectoration and expectorants].
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Bronchi↗
[Expectoration disorders in patients with chronic obstructive lung diseases].
The paper is concerned with an analysis of the original data and the conception regarding the pathogenesis of expectoration alterations and correction in patients with chronic obstructive pulmonary diseases (COPD). Expectoration defects in COPD are suggested to be classified according to duration of respiratory tract clearing from sputum. The disorders of the first and second degree amenable to correction by oral and inhalation expectorants are referred to compensation stage, those of the third degree resistant to the correction to decompensation stage. Efficiency of current expectorants is comparatively assessed as well as mechanisms of their actions. An approach to expectorants administration should be differential basing on the severity of relevant impairment and aimed at adequate maintenance or recovery of the sputum discharge in COPD patients.
Ciliary Motility Disorders↗
Methods for clinical assessment of expectorants: a critical review.
The purpose of the paper is to discuss some aspects of the methods that are most appropriate for the clinical assessment of new expectorants. Expectorants are drugs devised to help in the removal of bronchial secretions. The evaluation of these drugs is aimed at demonstrating, in controlled trials, their efficacy, safety and, if possible, mechanism of action. Unfortunately, there is no universally accepted assessment technique available. Evaluation of symptoms with the use of self-reported measures is imprecise. Studies of quality of life can assist as a means of assessing the usefulness of this class of drug for patients. Lung function tests evaluate only the possible indirect effects of expectorants; the changes observed are often minor and they do not correlate with other methods of evaluation. Mucociliary clearance studies evaluate bronchial drainage by mucociliary transport and cough. They are a useful pharmacological approach but they cannot replace therapeutic trials. In vitro and ex vivo studies of bronchial secretion, while improving knowledge of the mechanisms of bronchial secretion, fail to predict the modifications of bronchial drainage produced in vivo by cough or mucociliary transport. To be considered efficient, expectorants should not only ease the removal of bronchial secretions, but also improve the patient's condition for the duration of treatment.
Animals↗
[Metabolism of 4-carbomethoxythiazolidine chlorohydrate to cysteine through human expectorate and lung homogenates, and its action on glycoproteins of mucus].
A study has been carried out on the formation of -SH groups and of cysteine and cystine from 4-carbomethoxythiazolidin HCl through human expectorate mucus and lung homogenates. Both the expectorate and the homogenate, revealed to be able to metabolize TCM to cysteine releasing free -SH groups. The speed of cysteine formation is higher for the homogenate, but also the expectorate revealed to be very effective for the metabolization to cysteine. Furthermore it has been demonstrated that the TCM, incubated with human expectorate in presence and in absence of lung homogenate, can modify the chemical-physical characteristics of the mucus, rendering it more soluble and less viscous, i.e. displaying a mucolytic activity. These results account for the in-vitro experimental base to the observation that the product has a mucolytic activity whether administered by os or by aerosol.
Cysteine↗
Liver, lung and kidney homogenates used as an activation system in mutagenicity studies of airborne particles and of expectorate and urine samples from exposed workers in a coke plant.
A comparison was made between lung and kidney homogenates on the one hand and liver S9 from rats on the other hand in order to compare their ability to activate promutagens. The Salmonella reversion assay was used on extracts of airborne particles from the top of coke oven batteries, and of expectorate and urine samples from exposed workers in the same coke plant. The contents of benzo[a]anthracene and benzo[a]pyrene in the different test solutions were measured by high-resolution gas chromatography/mass spectrometry. Both mutagens were detected in the filter extract and in the expectorates from the exposed workers but not in the expectorates from the control groups or in the urine samples. The liver S9 gave significantly higher mutagenicity than lung and kidney activation with both filter samples and expectorate and urine samples.
Adult↗
Effect of exercise and physiotherapy in aiding sputum expectoration in adults with cystic fibrosis.
The role of exercise in aiding sputum expectoration in patients with cystic fibrosis and the comparative roles of exercise and physiotherapy in sputum expectoration were assessed in two studies. In the first study 19 adult patients undertook a two month programme of home exercise using a cycle ergometer. In the 12 patients completing the study peak work capacity, maximum oxygen consumption, and maximum minute ventilation had increased significantly by the end of the exercise programme; the increase in daily sputum weight (from 24 to 37 g) was not significant (p = 0.055). In the second study (with 10 patients) more sputum was expectorated during and after physiotherapy than during and after exercise (9.8 v 4.0 g). Exercise may have a role in aiding sputum expectoration in patients with cystic fibrosis but should not be considered as a replacement for physiotherapy.
Adolescent↗
Indium-111 labelled granulocyte scanning to detect inflammation in the lungs of patients with chronic sputum expectoration.
Thirty eight patients with chronic sputum expectoration underwent indium-111 labelled granulocyte lung scanning and measurement of whole body loss of indium-111 labelled granulocytes. Twenty four patients had radiologically proved bronchiectasis and 14 had mucus hypersecretion without radiological evidence of bronchiectasis. None was having an acute exacerbation at the time of the scan. The median 24 hour volume of sputum expectorated was 17 (range 2-175) ml. The 24 hour volume of purulent sputum was 5 (0-142) ml; six patients expectorated mucoid sputum only. Twenty one of the 38 patients had a positive granulocyte lung scan. All nine patients expectorating more than 20 ml purulent sputum in 24 hours had positive lung scans and all had lost more than 19% of the indium-111 from the body after five to seven days. Of the six patients with mucoid sputum, only one had a positive scan and these subjects lost only 6-11% of the indium-111 in five to seven days. The percentage loss of indium-111 from the body correlated with 24 hour purulent sputum volume (r = 0.41, n = 38, p less than 0.001) and total elastolytic activity in 24 hour sputum (r = 0.54, n = 14, p less than 0.01). The loss of indium-111 was not related to the extent of bronchiectasis when purulent sputum volume was allowed for. Indium-111 labelled granulocyte scanning provides a sensitive and objective method for detecting inflammation in the lungs and should help to improve understanding of chronic bronchial sepsis and possibly treatment in selected cases.
Adult↗
[Pharmacological studies on expectorants (author's transl)].
Perry and Boyd's method described in 1941 appears to be the most suitable for evaluating the efficacy of expectorants. In this method, changes in volume of respiratory tract fluid (RTF) collected by postural drainage from animals breathing air kept at a constant temperature and humidity are used as criteria. We attempted to improve on the method and to establish the optimum experimental conditions for rabbits. Accordingly, an air conditioning apparatus and tracheal cannula were re-designed and basic experimental conditions essential for quantitative collection of RTF were studied. Using this method, the effects of drugs on the volume of respiratory tract fluid (VRTF) were determined. Bromhexine and emetine as expectorants increased VRTF, and the former showed far more remarkable effects. Codeine and dextromethorphan as antitussives, isoproterenol, clorprenaline and C-78 as bronchodilators decreased VTRF. On the other hand, fominoben and eprazinone as antitussives increased VRTF. Our findings with application of this new approach indicate that this method is applicable for evaluating not only the efficacy of expectorants which increase VRTF but also that of other drugs which decrease VRTF.
Animals↗
Testing for mutagens in an aluminium plant. The results of Salmonella typhimurium tests on expectorates from exposed workers.
Methanol extracts of hydrolyzed expectorate samples from workers in a Söderberg potroom were evaluated by the Salmonella reversion assay. The expectorates from exposed workers--mostly from smokers, but also to a certain extent from nonsmokers--were mutagenic; however, the control samples from both smokers and nonsmokers were not. The positive results produced by the expectorate samples from the exposed smokers suggest a synergistic relationship between exposure to air pollution of the working atmosphere and smoking.
Aluminum↗
Mutagenicity of expectorate from workers in a coke plant.
Methanol extracts of hydrolyzed expectorate samples from workers in a coke plant were tested with the Salmonella reversion assay. The expectorates from exposed smokers (but also to a certain extent from exposed non-smokers) were mutagenic; however, the control samples from both smokers and non-smokers were not. The positive results produced by the expectorate samples from exposed smokers suggest a synergistic relationship between exposure to air pollution in the working atmosphere and smoking.
Air Pollutants, Occupational↗
[Expectoration and inhalation therapy].
We analysed sputum properties based on certain clinical information such as sputum volume, its gross appearance, the diagnosis, and difficulty in expectoration. We also compared sputum properties, clinical information and the effects of inhalation drugs on sputum in vitro, and on this basis evaluated the indications and limitations of inhalation therapy. It appears that inhalation therapy is limited by sputum properties, because the properties of large amounts of sputum, purulent sputum, and sputum expectorated with great difficulty are apparently different from those of other types of sputum. The effect of inhalation drugs on sputum was studied in vitro. Distilled water and normal saline showed as mucolytic agents. Bromhexine was acids in solution. The acidity caused the sputum to gel and reduced its mucolytic effect. Tyloxapole was alkaline in solution. The alkalinity decreased the mucociliary transport rate (MTR). Acetylcysteine had a marked mucolytic effect and decreased the MTR. There was a particular desire to develop drugs which improved MTR, because MTR is impaired by large amounts of sputum and sputum expectorated with great difficulty as well as in the case of sputum from diffuse panbronchiolitis patients.
Administration, Inhalation↗
[Pulmonary complication after resection of lung cancer--difficulty in expectoration and cough dynamics].
From January 1975 to December 1986, 415 patients were operated for primary lung cancer. Postoperative pulmonary complications were observed in 83 patients and among them 48 patients (57.8%) suffered from difficulty in expectoration. Postoperative expectoration mostly depends on the ability of coughing. To evaluate cough dynamics, expiratory flow-rate and volume at voluntary maximal cough were measured. The more expiratory flow rate and volume a cough has, the more effective it is for expectoration. In those patients with decreased FEV1.0, or respiratory muscle weakness because of emaciation and aging, or severe pain in the wound, the cough dynamics was decreased. By cleaning retained secretions in the respiratory tract, postoperative pulmonary complications would be prevented. However in cases where the decrease in postoperative cough dynamics is predictable, application of limited resection should be considered as well.
Aged↗
[The effect of systemic N-acetylcysteine on postoperative expectoration. A prospective, randomized double-blind study].
A material of 110 consecutive patients submitted to elective upper abdominal laparotomy participated in a randomized double-blind investigation of the effect of N-acetylcysteine (Mucomyst) administered systemically in the recommended dosage on postoperative expectoration. As an effect variable the quantity of expectorate and the viscosity as assessed subjectively by the physiotherapists in the department on a visual analog scale was employed. N-acetyl-cysteine was not found to have any effect on the postoperative expectoration as assessed by the quantity and the viscosity.
Clinical Trials as Topic↗
The value of provoked expectoration in obtaining sputum samples for cytologic investigation. A prospective, consecutive and controlled investigation of 134 patients.
A prospective controlled investigation in 134 consecutive outpatients compared the cytologic adequacy of sputum samples obtained by spontaneous and provoked expectoration. Inhalation of nebulized 10% sodium chloride was used for provoked expectoration. A significantly higher number of adequate samples was produced after provocation, as judged by the presence of alveolar macrophages (X2 = 5.63; p less than 0.02). The improvement in sample adequacy was limited to the nonsmokers and ex-smokers in the study. This result, together with the relatively high cost of cytologic sputum examinations, indicates that provoked expectoration should at least be applied to the collection of sputum samples from nonsmokers and ex-smokers.
Humans↗
Expectoration of bronchogenic carcinoma.
A case of expectoration of primary squamous cell bronchogenic carcinoma is reported. Only two previous cases of expectoration of grossly visible fragments of primary bronchogenic carcinoma have been reported. Interestingly enough these were also squamous cell carcinomas. Patients suspected of having pulmonary neoplasm should be instructed to save any grossly visible expectorated tissue fragments.
Carcinoma, Bronchogenic↗
Expectoration disturbances and bronchial obstruction.
UNLABELLED: Two methods for the efficacy evaluation of the respiratory tract clearance by cough, measuring the time of expectoration (Texp) of sputum mixed with hem-containing indicators after their inhalation were used in patients with bronchial obstruction. In the first method, the patients studied inhaled their own hemoglobin (Hb) and in the second one they inhaled a finely pulverized powder of hem-containing substances which were obtained from donor erythrocyte mass. 195 subjects were examined: 44 with intrinsic bronchial asthma (BA), 71 with obstructive bronchitis (OB) and 22 with purulent obstructive bronchitis (POB). Patients expectorating not less than 30 ml/day of sputum were selected. The control group consisted of 18 patients with non-obstructive bronchitis (NOB) and 40 healthy volunteers, nonsmokers. The sputum for analysis after the inhalation of the indicator in healthy persons was collected during coughing stimulated by inhaling a hypertonic solution (15% NaCl+1% NaHCO3). It was found that Texp depends on the form of illness (means +/- SEM): (1) with Hb technique, BA: 41.5 +/- 3.4 h; OB: 59.3 +/- 5.7 h and POB: 128.8 +/- 15.3 h and (2) with the powdered indicator technique, BA: 53.4 +/- 7.6 h; OB: 68.8 +/- 6.6 h and POB: 101.1 +/- 11.8 h. CONTROL GROUP: in patients with NOB, Texp measured with the Hb technique was 31.4 +/- 4.3 h and with the powdered indicator 30.0 +/- 10.3 h. In healthy volunteers, the presence of hem-containing substances in sputum after 36 h was not found.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
The effect of an expectorant on the tracheal mucosa. A scanning-electron microscopic study.
The effect of an intravenous expectorant agent, i.e. Bisolvon, on the secretory activity of the tracheal mucosa of the dog was studied with the scanning electron microscope. A marked increase in the production of tracheal secretion was observed 15 and 30 min following the injection. Both the goblet cells in the epithelium and the seromucinous glands in the tunica propria contributed to the formation of the secretion. 60 min after the injection, the submucosal glands were shrunken or empty. The rapid secretory response to the expectorant, Bisolvon, confirmed the active and important role of the tracheal mucociliary clearance mechanism for the protection of the lower respiratory tract.
Animals↗