Modern approaches to pharmacotherapy of acute bronchitis. The benefits of herbal medicine
Bronchitis is an inflammatory disease of the lungs without
the formation of infiltrative changes in their parenchyma. Bronchitis can be both a manifestation of ARVI and its complication due to the addition of secondary bacterial microflora in the background or after suffering ARVI. The incidence of acute bronchitis in Russia averages 75–250 per 1000 children per year, that is, 2 orders of magnitude higher than pneumonia. Most often in children, bronchitis occurs in the age category of 1-3 years.
Viruses are thought to be the root cause of approximately 90% of cases of acute bronchitis. Despite this, in a prospective study aimed at studying the etiology and outcomes of lower respiratory tract infections in adults, viruses were isolated in only about a quarter of patients with this disease.
Moreover, data on the role of bacteria in the etiology and pathogenesis of acute bronchitis remain contradictory: bacterial strains are isolated from sputum in a minority of patients with acute bronchitis, and bronchial biopsy does not show bacterial invasion at all.
The primary role of viruses in the etiology of acute bronchitis is also confirmed by the ambiguous generalized results of the use of antibiotics for its treatment. According to the results of the Cochrane community meta-analysis of 11 clinical trials (n = 3841) devoted to the study of the effectiveness of antibiotics in acute bronchitis, there were no advantages (clinical improvement) compared with placebo (risk ratio [RR] 1.07, 95% confidence interval [CI] 0.99–1.15).
Treatment of acute bronchitis
According to the clinical recommendations of the Ministry of Health of the Russian Federation for the treatment of acute bronchitis in children, the use of antibiotics is not recommended (strength of recommendation 1; level of evidence A), as well as the use of antihistamines, electrical procedures (strength of recommendation 1; level of evidence C), mustard, burning plasters, cans (strength of recommendation 1; level of evidence C).
At the same time, the use of mucolytic and expectorant agents is recommended for viscous, difficult to separate sputum, without a specific specification of the classes of such agents and international nonproprietary names. Ambroxol hydrochloride, acetylcysteine and carbocysteine are given as examples only in this manual. The role of herbal medicine in the treatment of cough is difficult to overestimate. The most effective and safest agents used for this purpose are drugs that include extracts of thyme grass, ivy leaves and primrose roots. Thyme herb has a secretolytic, expectorant, bronchospasmolytic, antibacterial and anti-inflammatory property, while ivy leaves and primrose root have an expectorant and antispasmodic effect on the respiratory tract.
Focus on herbal medicine
One of the most studied and effective herbal medicines for the treatment of acute bronchitis is the original combined herbal preparations Bronchipret® (a combination of thyme and ivy leaves) in the syrup dosage form and Bronchipret® TP (a combination of thyme and primrose root) in the dosage form “ film-coated tablets. ”
Preparations are made in Germany by the phytopharmaceutical company Bionorika CE. The high quality of medicines is ensured by the original phytoniring concept (from the English Phytoneering: phyton – plant and engineering – engineering, development, technology) used in their production. This concept implies a symbiosis of a chemical-pharmaceutical study of the effects of plant active substances and their further implementation using innovative technological processes and modern production methods, as well as the subsequent clinical study of their use in compliance with the principles of evidence-based medicine.
The effectiveness of Bronchipret® and Bronchipret® TP in the pharmacotherapy of acute bronchitis has been proven in numerous clinical studies, the most significant of which are considered in this review.
Review of clinical trials of the efficacy and safety of Bronchipret® and Bronchipret® TP
The pharmacotherapy of acute bronchitis with a productive cough in adults was studied in 2 studies performed according to the “gold standard” of evidence-based medicine: the study design was a randomized, double-blind, placebo-controlled.
The first study examined the effectiveness of Bronchipret® Syrup. This study involved 360 patients. In the main group, patients (n = 182, average age – 43.4 ± 17.7 years, 47.8% of men) received Bronchipret® syrup, in the control group (n = 178, average age – 41.5 ± 17.3 years, 45.5% of men) patients received placebo. The duration of therapy for each patient was 11 days, during which time each of them visited the doctor 3 times. The authors showed that the effectiveness of Bronchipret® was superior to placebo.