Approaches to the Treatment of Cough in Acute Bronchitis in an Outpatient Setting

Abstract

The objective: to determine the therapeutic efficacy and dynamics of clinical and instrumental indicators on the background of comprehensive treatment of patients with acute bronchitis with the use of the drug Ascoril in an outpatient setting.

Materials and methods. To establish the diagnosis and prescribe basic treatment, the recommendations of the Unified Clinical Protocol of Primary Care for Adults and Children “Acute Respiratory Infections” were used – Order of the Ministry of Health of Ukraine dated 11.02.2016 № 85. Using the BSS scale (Bronchitis Severity Score). The study involved 40 patients with acute bronchitis aged 23–48 years. Patients were divided into two groups using the “closed envelopes” method. Patients in group I (n = 30) were prescribed a combined drug Asсoril (manufactured by Glenmark Pharmaceuticals Ltd.), which contains salbutamol 2 mg, bromhexine 8 mg, guaifenesin 100 mg (1 tablet 3 times per day). Ten patients of group II (comparison) were prescribed a combined mucolytic drug containing ambroxol hydrochloride 30 mg and acetylcysteine 200 mg (1 tablet 3 times a day). Patients took the drugs for 7 days. Observations were performed on the first and eighth day. A diary was recommended for all patients for 2–7 days. On the first and eighth day were conducted on the background of clinical and instrumental studies: of FEV1, PSV, SpO2, evaluated the maintenance of the diary.

Results. It is established that the classic manifestation of acute bronchitis is a combination of catarrhal and inflammatory syndromes. According to the indicators of the scale of severity of bronchitis (BSS), the most pronounced sign was cough, and the most regressive signs – chest pain when coughing (0.72 ± 0.21 – group I and 0.56 – group II in the acute period, up to 0.00 –during convalescence in both groups); wheezing on auscultation and difficulty breathing. It was determined that the most stable on the BSS scale is a symptom of cough (a significant decrease in group I from 2.84 ± 0.11 – in the acute period, up to 1.22 ± 0.16 – in the period of convalescence and from 2.67 ± 0.15 to 1.94 ± 0.12, respectively – in group II). It was found that in group I (against the background of complex therapy with Ascoril) the dynamics of the cough symptom had a significant difference from this indicator in the second group of comparison on the 8th day of control. Therefore, the reduction of cough as the main symptom of acute bronchitis was significantly faster with Ascoril. During the therapy with the drug Ascoril it was recorded a significant decrease (p <0.001) from 9.58 ± 0.12 to 3.96 ± 0.42 of the total score on the BSS scale in the convalescence period compared to the acute period. This indicator was significantly better compared to the result in group II – from 9.47 ± 0.75 to 6.05 ± 0.56 (p <0.05). Observed the absence of symptoms of intoxication, improvement of general condition, increased strength and energy for homework, and hence the quality of life on a modified questionnaire “SF-36 Health Status Surve”, which during convalescence was more pronounced in group I, which can be explained by synergistic action of the components that are part of the combined drug Ascoril. The results of treatment according to the adapted integrated IMOS scale were assessed as a significant improvement in 20% of patients and a moderate improvement in 80 % of group I on the third day of treatment, while in group II a slight improvement was observed in 60 % of patients and 40 without changes, indicating a faster localization of symptoms of acute bronchitis on the background of complex therapy with Ascoril. The effect of Ascoril on the number of cough attacks in group I patients was effective, as the frequency of attacks on the 8th day of control was 75.92 % lower compared to the first day respectively. During the follow-up, no side effects and adverse reactions were registered in patients of both groups on the background of the use of drugs.

Conclusion. A short, 7-day follow-up of complex therapy with Ascoril (group I) and a preparation containing a combination of ambroxol hydrochloride and acetylcysteine (comparison group II) showed a comparative effect of the drugs on the components of acute bronchitis (BSS scale). At the same time, promoting a faster effect on the cough symptom on the third day when using the drug Ascoril compared with the other group. All components of the drug Ascoril created a synergistic effect, improving mucociliary clearance, regulating the secretion of bronchial mucus and its rheological properties, reducing excessive bronchial tone. As a result, there was a rapid clearing of the bronchi from the altered bronchial secretion, reduction or cessation of cough, improvement of bronchial patency and general condition of the patients.