International name:

Dosage form:

Pharmacological action: Berodual is a combination drug with a pronounced bronchodilator effect due to the action of the constituents fenoterol and ipratropium...

Indications:

Berodual N

International name: Fenoterol + Ipratropium bromide (Fenoterol + Ipratropium bromide)

Dosage form: dosed aerosol for inhalation, solution for inhalation

Pharmacological action: Berodual N is a combination drug with a pronounced bronchodilator effect due to the action of the constituents fenoterol and ipratropium...

Indications: COPD, bronchial asthma (treatment and prevention of acute asthma attacks). Preparation of the respiratory tract for aerosol administration of drugs (antibiotics, mucolytic drugs, corticosteroids, etc.).

Vagos

International name:

Dosage form:

Pharmacological action:

Indications:

Ipravent

International name: Ipratropium bromide

Dosage form: dosed aerosol for inhalation, capsules with powder for inhalation, solution for inhalation

Pharmacological action: A bronchodilator that blocks m-cholinergic receptors of the smooth muscles of the tracheobronchial tree (mainly at the level of large and...

Indications: COPD (with or without emphysema), bronchial asthma (mild to moderate severity), especially with concomitant cardiovascular diseases. Bronchospasm...

Itrop

International name: Ipratropium bromide

Dosage form: injection solution, film-coated tablets

Pharmacological action: A bronchodilator that blocks muscarinic receptors of the smooth muscles of the tracheobronchial tree (mainly at the level of large...

Indications: Sinus bradycardia caused by the influence of n.vagus, bradyarrhythmia, SA block, AV block II degree, atrial fibrillation arrhythmia (bradysystolic form).

Combivent

International name: Salbutamol + Ipratropium bromide (Salbutamol + Ipratropium bromide)

Dosage form: solution for inhalation

Pharmacological action: Combined bronchodilator drug. Ipratropium bromide blocks m-cholinergic receptors of the smooth muscles of the tracheobronchial tree (mainly...

Indications: Bronchospastic syndrome (including with COPD and bronchial asthma, against the background of acute respiratory infections, during surgical operations).

Arutropid

International name: Ipratropium bromide

Dosage form: dosed aerosol for inhalation, capsules with powder for inhalation, solution for inhalation

Pharmacological action: A bronchodilator that blocks m-cholinergic receptors of the smooth muscles of the tracheobronchial tree (mainly at the level of large and...

Indications: COPD (with or without emphysema), bronchial asthma (mild to moderate severity), especially with concomitant cardiovascular diseases. Bronchospasm...

Atrovent

International name: Ipratropium bromide

Dosage form: dosed aerosol for inhalation, capsules with powder for inhalation, solution for inhalation

Pharmacological action: A bronchodilator that blocks m-cholinergic receptors of the smooth muscles of the tracheobronchial tree (mainly at the level of large and...

Indications: COPD (with or without emphysema), bronchial asthma (mild to moderate severity), especially with concomitant cardiovascular diseases. Bronchospasm...

Atrovent N

International name: Ipratropium bromide

Dosage form: dosed aerosol for inhalation, capsules with powder for inhalation, solution for inhalation

Pharmacological action: A bronchodilator that blocks m-cholinergic receptors of the smooth muscles of the tracheobronchial tree (mainly at the level of large and...

Indications: COPD (with or without emphysema), bronchial asthma (mild to moderate severity), especially with concomitant cardiovascular diseases. Bronchospasm...

Formula: C20H30BrNO3, chemical name: (endo,syn)-(±)-3-(3-Hydroxy-1-oxo-2-phenylpropoxy)-8-methyl-8-(1-methylethyl)-8-azoniabicyclo-octane bromide.
Pharmacological group: vegetotropic agents / anticholinergic agents / m-anticholinergics.
Pharmacological action: bronchodilator, m-anticholinergic.

Pharmacological properties

Ipratropium bromide has a blocking effect on m-cholinergic receptors in the smooth muscles of the trachea and bronchi. Ipratropium bromide is a competitive antagonist of acetylcholine, as it is structurally similar to it. Being a derivative of quaternary nitrogen, ipratropium bromide is slightly soluble in fats, and therefore does not penetrate biological membranes well. The bioavailability of ipratropium bromide is very low; inhalation of about 500 doses is required to develop a systemic effect (tachycardia); only 10% of the substance used reaches the alveoli and small bronchioles, the rest settles in the oral cavity or pharynx and is swallowed. Ipratropium bromide is almost not absorbed in the gastrointestinal tract and is excreted in feces. A small portion of the absorbed portion is metabolized to eight weak or inactive anticholinergic metabolites, which are subsequently excreted in the urine.
5 - 10 minutes after inhalation, a bronchodilator effect develops, which lasts for 5 - 6 hours. Ipratropium bromide expands mainly the medium and large bronchi, reduces the production of bronchial mucus. Ipratropium bromide prevents constriction of the bronchi, which can occur as a result of inhalation of cold air, cigarette smoke, and the action of various bronchoconstrictors. When used systemically, ipratropium bromide improves atrioventricular conduction and causes an increase in heart rate; does not affect the central nervous system, unlike atropine.

Indications

Inhalation: bronchial asthma (moderate and mild severity), especially with concomitant pathology of the circulatory system; chronic obstructive pulmonary disease (pulmonary emphysema, chronic obstructive bronchitis); bronchospasm, hypersecretion of the bronchial glands during surgical operations, against the background of colds; for preparing the respiratory tract before the administration of aerosols of glucocorticoids, mucolytic drugs, antibiotics, cromoglycic acid; tests for reversibility of bronchial obstruction.
Intranasally: chronic rhinitis with hypersecretion.
Orally and intravenously: bradyarrhythmias with sinoatrial block; sinus bradycardia, which is caused primarily by the action of the vagus nerve; bradysystolic form of atrial fibrillation; atrioventricular block of the second degree.

Method of administration of ipratropium bromide and dose

Inhalation: 4 times a day, 2 doses of aerosol (40 mcg) (if necessary, up to 12 inhalations are possible). Solution for inhalation: patients over 14 years of age: via nebulizer 3 - 4 times a day 0.1 - 0.5 mg; patients 6 – 14 years old: via nebulizer 3 – 4 times a day 0.1 – 0.25 mg; patients under 6 years of age: under the supervision of a physician, 3–4 times a day, 0.1–0.25 mg. For systemic use, the dosage and mode of use of ipratropium bromide are established individually, depending on the indications, age and dosage form used.
Patients with cystic fibrosis have an increased risk of developing gastrointestinal motility disorders. It is not recommended to use ipratropium bromide for emergency relief of an attack of suffocation, since the bronchodilator effect appears later than that of beta-agonists. The effectiveness and safety of intranasal use of ipratropium bromide in patients under 12 years of age has not been established. The patient must be informed that if the condition worsens or inhalations are not effective enough, then they need to consult a doctor to change the treatment plan. If shortness of breath occurs suddenly and rapidly progresses, the patient should also urgently consult a doctor. If any of the symptoms of angle-closure glaucoma appear (discomfort, pain in the eye, blurred vision, the appearance of colored spots and a halo before the eyes in combination with corneal and conjunctival hyperemia), you should immediately consult an ophthalmologist. Given that ipratropium bromide can affect visual acuity, when taking it, care must be taken when driving vehicles and other potentially hazardous activities.

Contraindications for use

Hypersensitivity (including to atropine and its derivatives), pregnancy (1st trimester); for systemic use (optional): prostatic hyperplasia, increased intraocular pressure, mechanical stenosis of the gastrointestinal tract, megacolon, tachycardia.

Restrictions on use

For inhalations: urinary tract obstruction (including prostate hyperplasia), closed-angle glaucoma, breastfeeding, pregnancy (2nd and 3rd trimesters), age up to 6 years.

Use during pregnancy and breastfeeding

The use of ipratropium bromide is contraindicated in the 1st trimester of pregnancy; During breastfeeding and in the 2nd and 3rd trimesters of pregnancy, the use of ipratropium bromide is possible if the expected effects of treatment for the mother exceed the possible risk to the child and fetus.

Side effects of ipratropium bromide

For inhalation use. The most common adverse reactions: nausea, headache, dry mouth. Effects that are associated with anticholinergic effects: palpitations, tachycardia, impaired accommodation, impaired gastrointestinal motility, decreased secretion of sweat glands, urinary retention (in patients with obstructive lesions of the urinary tract, the possibility of developing urinary retention increases). From the respiratory system: cough, paradoxical bronchospasm; allergic reactions: itching, skin rash, urticaria, oropharyngeal edema, angioedema, anaphylaxis. There are reports of the development of complications from the organ of vision (increased intraocular pressure, pupil dilation, eye pain, closed-angle glaucoma) when ipratropium bromide aerosol gets into the eyes.
For intranasal use: allergic reactions, irritation and dryness of the nasal mucosa.
For systemic use: dry mouth, constipation, anorexia, impaired accommodation, urination disorders, increased intraocular pressure, decreased secretion of sweat glands, extrasystole.

Interaction of ipratropium bromide with other substances

Ipratropium bromide enhances the bronchodilator effect of xanthine derivatives (theophylline) and beta-agonists. The anticholinergic effect of ipratropium bromide is enhanced by antiparkinsonian, anticholinergic drugs, tricyclic antidepressants, and quinidine. When ipratropium bromide is used together with other anticholinergic drugs, an additive effect develops. When using ipratropium bromide together with salbutamol, there is a risk of developing increased intraocular pressure and acute angle-closure glaucoma, especially in predisposed patients.

Overdose

In case of an overdose of ipratropium bromide, anticholinergic reactions are enhanced (including dry mouth, increased heart rate, impaired accommodation). Required: symptomatic treatment.

Trade names of drugs with the active substance ipratropium bromide

Combined drugs:
Ipratropium bromide + Fenoterol: Berodual®, Berodual® N;
Ipratropium bromide + Salbutamol: Ipramol Steri-Neb, Combivent;
Ipratropium bromide + Xylometazoline: Xymelin® Extra.

Medicines with low or unproven effectiveness in the symptomatic treatment of colds, nasal congestion and/or frequent sneezing

Scientific research results show that nasal drops and sprays with corticosteroids, while highly effective in many cases of prolonged runny nose/nasal congestion associated with allergic rhinitis, chronic sinusitis, or vasomotor rhinitis, have only modest effectiveness in acute infectious rhinitis. On average, 14 people must use these medications for 15 days for one person to experience significant relief from nasal breathing.

Antihistamine medications in tablet form may only be effective in people whose symptoms of a cold infection have developed against the background of allergic rhinitis.

Acute bacterial sinusitis (sinusitis, frontal sinusitis, ethmoiditis, sphenoiditis)

What is sinusitis?

The term "sinusitis" is used in medicine to describe the condition of people who have inflammation of the right or left maxillary sinus, or both sinuses at the same time.

The maxillary sinuses are small, air-filled cavities that are located on the right and left sides of the nose, in the thickness of the bone of the upper jaw. They communicate with the nasal cavity through small holes located on the walls of the right and left nasal passages.

The inside of the maxillary sinuses is covered with a mucous membrane similar to the mucous membrane of the nose.

In addition to the maxillary sinuses, in the thickness of the skull bones there are several more smaller sinuses, which also communicate with the nasal cavity through small openings:

• two frontal sinuses (they are located deep in the forehead, in the area of ​​the right and left eyebrows);
• network of ethmoid bone sinuses (they are located in the central part of the nose);
• one sphenoid sinus (it is located in the thickness of the sphenoid bone at the base of the skull).

As we explained above, for most people, acute viral respiratory tract infections (i.e. colds) cause inflammation of only the nasal passages. In relatively rare cases (5-10%), a viral infection spreads to the mucous membrane of one or more paranasal sinuses and causes inflammation. In medicine this condition is called acute viral sinusitis or rhino-sinusitis.

In the vast majority of cases, viral sinusitis ends with complete recovery within 7-14 days.

Much less frequently, in 0.5-2% of sick people, after the viral infection has stopped, a bacterial infection develops inside the sinuses. In medicine this condition is called acute bacterial sinusitis. Unlike a viral infection, which is not dangerous and does not require any special treatment, a bacterial sinus infection can cause serious complications. For this reason, when its symptoms appear, an ill child or adult needs additional observation, and, in some cases, special treatment.

Of all the forms of sinusitis, inflammation of the maxillary sinuses (sinusitis) is observed most often. Inflammation of the frontal sinuses (frontitis), ethmoid sinuses (ethmoiditis) or sphenoid sinus (sphenoiditis) is much less common.

What are the symptoms and signs of acute bacterial sinusitis (sinusitis)?

Acute bacterial sinusitis (and other forms of bacterial sinusitis) is characterized by the following symptoms, provided that they have been present for at least 10 days*, without signs of improvement, or have intensified after a short-term improvement in the condition of the sick person: purulent runny nose, i.e. discharge of opaque (yellowish, brown, greenish) mucus from the nose or a feeling of mucus running down the throat; more or less severe nasal congestion; sensation of pain and/or pressure in the face, on the sides of the nose, in the area around the eyes, in the forehead or throughout the head**; symptoms may be more severe on the right or left side or may be bilateral. *A runny nose (discharge of cloudy, colored mucus from the nose) or fever that lasts less than 10 days and gradually gets better is not a sign of a bacterial infection. The color of the mucus that is released during a runny nose is determined by the presence of immune system cells (neutrophils) in it, and not bacteria, and therefore short-term release of colored mucus is also possible during a viral infection. Fever can be a sign of a bacterial infection only if the disease immediately begins with a high temperature (39 C or higher) and is accompanied by purulent nasal discharge for 3-4 days. ** Sinusitis can cause pain or a feeling of pressure in the face, on the right or left side of the nose. Frontitis can cause severe headaches localized in the forehead, above the eye sockets. Sphenoiditis usually causes a dull pain in the back of the head, which may radiate to the forehead and behind the orbits. However, observations of large groups of people in whom the diagnosis of bacterial sinusitis was confirmed by objective examinations showed that the localization of pain does not always indicate which of the paranasal sinuses was affected by inflammation. Additional symptoms of acute bacterial sinusitis (and other forms of acute sinusitis) may include: cough associated with irritation of the throat by flowing mucus (this symptom is characteristic mainly of children); feeling of weakness, weakness; dullness of smell or complete loss of the ability to distinguish odors; pain in the upper jaw or teeth; a feeling of fullness or pressure in the ears.

As mentioned above, in rare cases, bacterial sinusitis can cause dangerous complications.

In this regard, all people whose symptoms of acute sinusitis (or other form of sinusitis) have been present for more than 10 days, or who have become worse after a short-term improvement, are recommended to consult an ENT doctor for examination and, if necessary, treatment with antibiotics.

What complications and consequences can cause bacterial sinusitis (sinusitis)?

In the vast majority of cases, acute bacterial sinusitis (and other forms of sinusitis) result in complete recovery and do not cause any dangerous complications or consequences.

Only in rare cases, the infection spreads from the paranasal sinuses to the eye socket or cranial cavity and causes inflammation of the tissues of the eye, brain or cranial nerves. This poses an immediate danger to the life of the sick person and, without adequate treatment, can lead to death or serious consequences.

Diagnosis and treatment of acute bacterial sinusitis in adults and children. How can a doctor help?

As we said above, all people who have symptoms of acute sinusitis for more than 10 days or whose symptoms of the disease not only do not subside, but gradually intensify, are recommended to consult an ENT doctor.

The doctor will need to examine the sick person to make sure there are no signs of a dangerous infection.

The above symptoms of acute sinusitis are highly specific diagnostic criteria. This means that only by the presence of these symptoms for a specified period of time, the doctor can make a diagnosis with great accuracy acute bacterial sinusitis.

Carrying out any additional examinations is recommended only in cases where, during the examination, the doctor detects signs of a dangerous development of infection. In such situations, the doctor may suggest a CT (computed tomography) or MRI (magnetic resonance imaging) scan of the head.

Both of these examinations make it possible to accurately assess the condition of the paranasal sinuses and adjacent structures and identify signs of the spread of infection. However, the results of these examinations do not allow one to distinguish viral from bacterial sinusitis. In CT and MRI images, viral and bacterial inflammation manifest themselves in the same changes.

X-rays of the paranasal sinuses are not recommended, due to the fact that, in this case, this examination method does not allow assessing the extent of the infection.

How quickly should antibiotic treatment help with acute bacterial sinusitis (sinusitis)? What to do if treatment doesn't help?

In the first 2-3 days after starting antibiotic treatment, the condition of the sick person should begin to gradually improve. If the sick person initially had a fever, it should begin to subside. Significant relief of symptoms may occur within 7 to 10 days. Full recovery (disappearance of symptoms) may take 14 days or more.

If within 48-72 hours after starting antibiotic treatment, the sick child or adult does not get better, you need to contact the ENT doctor again to review the treatment plan.

If a person has only taken symptomatic treatment to begin with, the doctor will have to recommend starting treatment with Amoxicillin.

If a person has been taking Amoxicillin from the very beginning, the doctor may prescribe Amoxicillin in combination with clavulanic acid for 10 days.

If the child or adult has already taken Amoxicillin with clavulanic acid, the doctor may recommend treatment with Doxycycline, a fluoroquinolone antibiotic (Levofloxacin or Moxifloxacin), a combination of Clindamycin with Cefixime (or Cefpodoxime), or a combination of Linezolid with Cefixime.

In what cases is it necessary to perform a puncture (puncture) of the paranasal sinuses for sinusitis?

Considering the high effectiveness of available drug treatment and the fact that in most cases bacterial sinusitis occurs without serious complications, at present, puncture of the paranasal sinuses is considered justified only in the following situations:

1. If, despite prolonged treatment with antibiotics, the symptoms of sinusitis (sinusitis) do not stop or increase. In this case, performing a puncture (puncture) allows the doctor to collect material to determine the sensitivity of microbes to antibiotics. Currently, for this purpose, puncture of the paranasal sinuses is increasingly being replaced by a less invasive, but quite effective in this regard, endoscopic examination of the nose.
2. If a sick person shows signs of a dangerous infection. In this case, using a puncture, the doctor can remove the accumulated fluid from the inflamed sinus and inject antibiotics into it.

Persistent (chronic) runny nose, persistent nasal congestion and/or frequent sneezing in children and adults

This section will explain treatment and diagnostic options for people who have one or more of the following symptoms:

• Frequent or constant runny nose in the form of clear or purulent mucous discharge from the nose or phlegm dripping into the throat;
• Constant or periodic nasal congestion (difficulty breathing through the nose);
• Frequent sneezing;
• Feeling of pain/pressure in the face, on the sides of the nose.

As will be discussed below, these symptoms, in various combinations, may be associated with the following diseases and conditions:

1. Allergic rhinitis;
2. Chronic sinusitis (chronic sinusitis);
3. Vasomotor rhinitis associated with such phenomena as:
   • Irritation of the nasal mucosa by various chemicals at home or in the workplace;
   • Increased sensitivity of the nasal mucosa to cold air, changes in weather conditions, strong odors or polluted air;
4. Changes in the reactivity of the nasal mucosa that occur in some people as they age
5. Side effects of some medications:
   • Nasal sprays (drops) containing vasoconstrictors;
   • Medicines for high blood pressure;
   • Birth control pills;
6. Non-allergic rhinitis with eosinophilic syndrome;
7. Deviation of the nasal septum;
8. Increased size of adenoids (in children).

We will start with recommendations regarding medications for symptomatic treatment prolonged runny nose, nasal congestion and/or frequent sneezing in children and adults, the appropriateness of which is supported by scientific evidence.

As will be shown in the sections devoted to specific diseases and conditions that provoke chronic runny nose, nasal congestion and frequent sneezing, in most cases, it is recommended to solve these problems. symptomatic treatment.

Diagnostic examinations and tests, at least initially, may not be helpful to patients because their results often do not change the treatment plan. In many cases, even after an accurate diagnosis, the most effective, safe and cheap, and, therefore, the most acceptable, for most patients, treatment option for problems that provoke prolonged runny nose and nasal congestion may remain symptomatic medications.

Testing for persistent runny nose/stuffy nose/sneezing may be appropriate (1) if symptomatic treatment does not resolve the problem, or (2) if the physician and patient have good reason to believe that the test results may influence subsequent treatment. More detailed recommendations on this matter will be presented below, in the section on diagnostics, as well as in sections regarding solutions to each specific problem.

Means for the symptomatic treatment of prolonged (chronic) runny nose, persistent nasal congestion and/or frequent sneezing in children and adults

Currently available scientific evidence supports the use of the following agents for the symptomatic treatment of persistent runny nose/stuffy nose and/or frequent sneezing:

1. Regular rinsing of the nose with an aqueous saline solution;
2. Corticosteroid nasal drops or sprays;
3. Nasal drops or sprays with antihistamines;
4. Antihistamines in tablet form;
5. Nasal drops or sprays with Ipratropium bromide;

• Effective in eliminating runny nose, nasal congestion, sneezing and other symptoms;
• Possible side effects and safety of treatment;
• Possibility of combination with other treatment methods;
• Recommendations for proper use;

We believe that based on these data, readers will be able to make an informed decision regarding which treatment will be most appropriate for their case.

Rinsing the nose with saline solution for chronic runny nose and nasal congestion

Regular saline nasal rinsing is the first-line treatment (that is, one of the most effective, safe, and cost-effective treatment options) for many cases of persistent runny nose and/or nasal congestion associated with chronic sinusitis, allergic rhinitis, or vasomotor rhinitis.

The effectiveness of this method of treatment is supported by the results of a number of scientific studies, and, at this time, there is no reason to believe that rinsing the nose with an aqueous saline solution, even for a long time, could provoke any serious side effects (including during pregnancy or children).

Compared to other symptomatic medications, nasal irrigation is less effective in relieving nasal congestion and does not relieve a profuse runny nose. However, if necessary, it can be combined with all other means.

What solutions can be used to rinse the nose?

To rinse the nose, you can use regular saline solution (it is sold in large bottles at the pharmacy), or a solution prepared at home according to the following recipe: dissolve 2 teaspoons of table salt and 2 teaspoons of baking soda in 1 liter of warm water.

It is not recommended to use more concentrated solutions, as they are not more effective and may irritate the nasal mucosa more.

How to rinse your nose with saline solution?

To rinse your nose, you need to use a saline solution at room temperature.

First, you need to draw 250 ml of the solution into a large syringe or into some other vessel suitable for this purpose: a rubber bulb, a plastic bottle with a thin tip, or a kettle with a long spout (there are special kettles for rinsing the nose on sale).

Further actions need to be carried out over the sink:

• Leaning over the sink, you need to turn your head to the side so that the nostril you are going to rinse first is on top.
• After this, you need to carefully insert the tip of the syringe (bulb or other vessel that you will use) into the nostril and begin to slowly inject the saline solution into the nasal passage.
• The solution will need to flow down the entire nasal passage and out through the other nostril or through the mouth.
• Having finished rinsing (i.e. having used all 250 ml of solution), you can lightly blow your nose.
• After this, you need to draw a new portion of the solution, turn your head in the opposite direction and repeat the procedure for the second nostril.
• Washing should be done 2 times a day.

At first, rinsing causes a strong burning sensation in the nose, however, with subsequent repetitions, this feeling goes away and the procedure becomes quite tolerable.

Nasal drops and sprays with corticosteroids for chronic runny nose and nasal congestion

Research results indicate that, when used systematically, nasal drops or sprays with corticosteroids (glucocorticoids) are one of the most effective means for the symptomatic relief of nasal congestion, as well as runny nose, frequent sneezing and nasal itching associated with:

• allergic rhinitis,
• chronic sinusitis (with and without polyps),
• vasomotor rhinitis,
• non-allergic rhinitis with eosinophilic syndrome,
• drug-induced rhinitis associated with prolonged use of drops or sprays for the common cold with vasoconstrictors.

Currently, drugs containing the following active substances are produced:

• Triamcinolone acetonide;
• Budesonide;
• Flunisolide;
• Fluticasone propionate;
• Fluticasone furoate;
• Mometasone furoate;
• Cyclesonide;
• Beclamethasone dipropionate.

Clinical studies that compared drugs with different active substances from this group showed that they all have comparable effectiveness. In this regard, if you are not satisfied with something about a medicine with one active substance (price, smell, taste in the mouth after use, form: spray or drops, etc.), you can try another medicine, with a different active substance substance.

The effect of nasal drops and sprays with corticosteroid drugs develops slowly, on average, during the first 5-36 hours after the first use. Therefore, these medications are not suitable for cases where you need to quickly relieve a runny nose, nasal congestion, sneezing or itchy nose. Much more suitable means for this purpose are the antihistamines described below in the form of nasal sprays and tablets, as well as drops and sprays with vasoconstrictors and Ipratropium bromide.

On the other hand, when used systematically, corticosteroid nasal drops and sprays provide reliable control of nasal congestion and runny nose.

For allergic rhinitis, the maximum effect develops within 1 week of regular use of these drugs.

For chronic sinusitis and vasomotor rhinitis, the effectiveness of treatment can be finally assessed after 3 months of systematic use of these medications.

If necessary, nasal drops and sprays with corticosteroid drugs can be combined with other drugs. In particular, combining these medications with regular saline nasal rinses increases the effectiveness of treatment in relieving runny nose and nasal congestion associated with chronic sinusitis.

If, after several months of proper use, these remedies cannot effectively eliminate nasal congestion, itchy nose, sneezing or runny nose, they can be combined with nasal drops and sprays with antihistamines.

What side effects can these medications cause?

When used correctly, corticosteroid nasal drops and sprays rarely cause any serious side effects.

The most common side effects from these medications are related to irritation of the nasal mucosa and include: a feeling of dryness in the nose, a burning or tingling sensation in the nose after using the medication, and possibly streaks of blood in the mucus that comes from the nose.

On average, 4-8% of people who regularly use these medications experience minor nosebleeds, but in studies, this side effect appeared with the same frequency in the group of patients taking placebo Placebo

.

The chance of nosebleeds and other side effects can be reduced by properly applying the medication to the nose:

1. Shake the container with the medicine well;
2. Tilt your head forward, looking at the floor;
3. After administration, you do not need to inhale the medicine deeply or tilt your head back. If any remaining medication comes out of your nose, you can blot it with a handkerchief. After applying the medicine, you can wash your face to completely remove its residue from the skin.

In rare cases, with prolonged use of nasal drops and sprays with corticosteroids, perforation is possible, i.e. the appearance of a hole in the nasal septum. It may result in frequent nosebleeds.

It is reliably known that careless use ointments and creams for skin with corticosteroids can cause skin atrophy (see. Recommendations for the safe use of ointments and creams containing corticosteroid hormones). However, observations of people who used nasal drops and sprays with corticosteroids for a long time (from 1 to 5 years) showed that such treatment does not cause atrophy of the nasal mucosa.

The use of corticosteroids for the nose does not affect the functioning of the endocrine system or metabolism. In particular, these drugs do not alter the production of natural corticosteroid hormones in the adrenal glands and do not contribute to excess weight, diabetes, or high blood pressure (unlike long-term treatment with corticosteroids in the form of tablets or injections).

Observations of people who use nasal drops (sprays) with corticosteroids show that these drugs do not affect the condition of the eyes (unlike eye drops, which can contribute to increased intraocular pressure and the development of cataracts). However, if you would like to use nasal medications for a long time, be sure to ask your doctor if you need to measure your intraocular pressure periodically.

The effects of corticosteroid nasal drops and sprays on growth in children have been studied in several studies. It was found that the use of the drugs Budesonide and Beclamethasone propionate can cause a slight slowdown in the child's growth (the slowdown in growth was assessed in comparison with the predicted growth rates that the child should have achieved at the end of the year of observation).

At the same time, it was found that the drugs Fluticasone propionate, Mometasone furoate and Triamcenolone acetonide do not have any effect on growth. In this regard, at the moment, these medications are recommended first for the treatment of allergic rhinitis, vasomotor rhinitis or chronic sinusitis in children.

Antihistamines in tablet form for chronic runny nose and sneezing

If the most pronounced and unpleasant symptoms are a runny nose (production of watery mucus), sneezing and itchy nose, second-generation antihistamines in tablet form can be very effective symptomatic remedies.

Currently, medications are produced containing such active substances as:

• Cetirizine,
• Levocetirizine,
• Fexofenadine,
• Loratadine,
• Desloratadine.

Compared to older drugs (diphenhydramine, chlorpheniramine, hydroxyzine), these drugs do not cause (or cause, but to a much lesser extent) drowsiness and decreased alertness.

The most common side effects of antihistamine tablets are:

• Headache (12%),
• Drowsiness (8%),
• Feeling tired (4%),
• Dry mouth (3%).

The effectiveness of these drugs has been proven in a number of studies involving patients with allergic rhinitis. The results of these studies indicate that antihistamine tablets are slightly less effective than corticosteroid nasal drops and sprays in relieving nasal congestion, but may be a very suitable solution for many people with mild to moderate runny nose, sneezing or itching in the nose.

The effect of treatment becomes noticeable within the first hours after taking the medicine. The maximum positive effect develops with systematic and long-term use of these medications (for several weeks).

For allergic rhinitis, different antihistamines have different biological properties and may demonstrate different effectiveness in different people. For this reason, if one medicine does not help or causes unpleasant side effects, it may be the right decision to try another drug.

If a person is already taking chronic treatment with corticosteroid drops or sprays, adding antihistamines in tablet form usually does not increase the effectiveness of the treatment.

On the other hand, if a person has started treatment with antihistamine tablets and the treatment does not control the symptoms of allergic rhinitis well (for example, does not relieve nasal congestion), the effectiveness of the treatment can be increased by adding corticosteroid nasal drops or sprays.

Antihistamines in the form of nasal drops or sprays for chronic runny nose, sneezing and nasal congestion

Research has shown that antihistamine nasal drops and sprays are highly effective symptomatic treatments against runny nose, sneezing, nasal itching and congestion associated with allergic rhinitis, chronic sinusitis and vasomotor rhinitis.

Antihistamine sprays can be combined with saline nasal rinses and corticosteroid nasal medications. The superiority of combination treatment, compared with treatment with either agent alone, has been demonstrated in studies of people with severe symptoms of allergic rhinitis, vasomotor rhinitis and chronic sinusitis.

Currently, nasal drops and sprays containing antihistamines such as Azelastine and Olopatadine are available. Different products containing these active substances have comparable effectiveness.

Possible side effects from using antihistamine nasal drops and sprays may include a burning sensation in the nose, an unpleasant bitter taste in the mouth (after using the medication), and headache. Drowsiness is observed with a frequency of 0.4-3% (and almost the same frequency in the group of people taking placebo Placebo- any substance that does not have the properties of a medicine, but looks like a medicine.
Placebos are used in studies examining the effectiveness of drugs in the treatment of certain diseases: one group of patients is given the real drug, and the other group is given a placebo, while the patients in the second group are sure that they are receiving the real drug.
Comparison of treatment results in both groups allows us to determine which of the treatment effects are directly related to the effect of the drug.). Minor nosebleeds may also occur. The likelihood of this and other side effects can be reduced by administering the medication correctly:

1. Shake the container with the medicine well.
2. Bend your head forward, looking at the floor.
3. Place the tip of the medication bottle into your nostril. The bottle should be held with your left hand for the right nostril and with your right hand for the left nostril.
4. It is necessary to point the tip towards the outside of the nasal cavity, since contact with the drug on the nasal septum often causes irritation and bleeding.
5. After administration, you do not need to inhale the medicine deeply or tilt your head back. If any remaining medication comes out of your nose, you can blot it away with a handkerchief.

The advantages of antihistamine sprays (compared to antihistamine tablets) are:

• They are less likely to cause side effects (in particular, there is no risk of decreased alertness, which can be important for people working with complex equipment or when driving a car).
• They are more effective in relieving nasal congestion.
• They help people with allergic rhinitis who have not been helped by antihistamine tablets.
• Their effect begins very quickly - after 15-20 minutes (compared to 150 minutes in the case of drugs in tablet form).

Ipratropium bromide for frequent or chronic runny nose

Nasal drops and sprays with Ipratropium bromide block the glands that produce mucus in the nose. Preparations containing this active substance can be very effective in the symptomatic treatment of a runny nose, but they do little to eliminate nasal congestion.

The use of nasal sprays with Ipratropium bromide (0.03%) may be the optimal solution in situations in which a runny nose appears in the form of copious liquid discharge from the nose:

• runny nose, which some people experience in cold weather;
• runny nose when in contact with strong-smelling substances or smoke;
• runny nose, typical for older people;
• severe runny nose with allergic rhinitis, etc.

For very severe runny nose, you can use more concentrated products containing 0.06% Ipratropium bromide.

The main side effect of Ipratropium bromide drugs is a feeling of dryness in the nasal cavity.

If necessary, Ipratropium bromide can be combined with other symptomatic drugs if they do not eliminate the runny nose well enough.

Medicines that should not be used to treat a long-lasting runny nose or should only be used for a short period of time

For long-term symptomatic treatment of runny nose and nasal congestion, it is not recommended to use vasoconstrictor drugs in the form of nasal drops or sprays. As already mentioned above (see. Symptomatic treatment of colds and nasal congestion, at home, in children and adults) the safety and effectiveness of these drugs have not been sufficiently studied at the moment, especially in children.

In addition, there is reason to believe that with prolonged use, these medications not only do not eliminate nasal congestion, but may also worsen it.

Diagnostic capabilities for prolonged runny nose and nasal congestion

As mentioned above, unlike many other problems in which the solution begins with an examination to make an accurate diagnosis, with prolonged (chronic) runny nose/nasal congestion, in many cases, a more appropriate solution is to begin symptomatic treatment, without conducting examinations.

Examinations and analyzes become appropriate in the following situations:

• If symptomatic treatment with the above drugs does not help eliminate a runny nose or nasal congestion (within several months of correct use);
• If the doctor and patient have reason to believe that the examination results may affect the subsequent treatment algorithm.

Below we describe the main examinations and tests, the advisability of which for chronic runny nose and/or nasal congestion is supported by scientific evidence:

1. Allergen tests;
2. Endoscopic examination of the nose;
3. Computed tomography of the nose and paranasal sinuses.

For each examination, we will show how the results may influence your treatment plan.

Allergen tests

Testing for common airborne allergens can help determine whether persistent runny noses, nasal congestion and/or frequent sneezing may be associated with substances such as pollen, mite particles in house dust, mold spores, pet dander, etc.

In cases where the analysis shows that a person does have an increased sensitivity to certain allergens, the doctor and patient can assume that the cause of the problem is allergic rhinitis and, in addition to symptomatic remedies, they can choose two new treatment options:

(1) A person can try to eliminate from his environment an allergen to which he is hypersensitive. As will be discussed below in the section on allergic rhinitis, for some people, adequate allergen elimination measures can significantly relieve runny nose and nasal congestion.

The problem here is that eliminating some allergens (such as house dust mites or mold spores) can be a very time-consuming or even impossible task.

In this regard, conducting an allergen test is only advisable if a person has previously become familiar with what measures may be required to eliminate allergens and considers them acceptable in their situation.

(2) If hypersensitivity to a particular allergen is detected, a person can also try treatment by immunotherapy. Immunotherapy helps normalize the body's response to the allergen and can significantly reduce the need for medications for the symptomatic treatment of allergic rhinitis. The disadvantages of immunotherapy are that it takes a long time (at least several years), involves costs (as does symptomatic treatment), and carries a certain (albeit extremely small) risk of a dangerous anaphylactic reaction.

In this regard, conducting an allergen test may be advisable if a person has familiarized himself with the features of immunotherapy from the very beginning, and finds this method a valid choice in his situation.

In all other cases, for the patient himself, testing for allergens is useless. If the test shows increased sensitivity to certain allergens, but the person does not consider allergen removal measures or immunotherapy applicable to his situation, his only treatment option will be symptomatic remedies that he could have used without this test.

Another problem with allergen testing is the fact that some people who initially show no hypersensitivity to allergens eventually develop sensitivity to a particular allergen over time. This means that allergen test results cannot completely rule out allergic rhinitis in people who have had a runny or stuffy nose for a long time.

Endoscopic examination of the nose

During an endoscopic examination of the ENT, the doctor inserts a special optical instrument into the nasal cavity (it looks like a thin tube or cord), which allows, with great accuracy, to examine the inner surface of the nose and the outlet openings of the paranasal sinuses.

The value of endoscopic examination is as follows:

(1) It allows you to identify signs of inflammation characteristic of chronic sinusitis: purulent sputum or swelling of the mucous membrane in the middle nasal passage, the presence of polyps in the nasal cavity, etc. With this examination, the doctor can also exclude other, more rare, causes of prolonged runny nose and/or nasal congestion (for example, the presence of a tumor in the nasal cavity).

(2) Endoscopy makes it possible to collect sputum from the outlets of the paranasal sinuses for bacteriological culture. Using this analysis, the sensitivity of microbes to antibiotics can be determined. This information may be useful if symptomatic treatment fails and the doctor plans antibiotic treatment.

The question regarding the advisability of endoscopy is related to the fact that for chronic sinusitis, in the initial stages, only symptomatic treatment is recommended (rinsing the nose with saline solution + nasal sprays with corticosteroid drugs). Therefore, identifying the exact signs of chronic sinusitis using endoscopy does not change the initial treatment plan, and therefore has no practical benefit to the patient.

On the other hand, endoscopic examination becomes advisable if symptomatic treatment of nasal congestion is not effective enough and the person would like to try another treatment.

In such a situation, an endoscopic examination of the nose can help determine whether there are other causes that may be contributing to the persistent runny nose and/or nasal congestion. In particular, endoscopy can exclude (or confirm) the presence of a deviated nasal septum or much rarer problems: tumors or fungal infections. If the examination shows...

Included in the preparations

Included in the list (Order of the Government of the Russian Federation No. 2782-r dated December 30, 2014):

VED

ONLS

ATX:

R.03.B.B.01 Ipratropium bromide

Pharmacodynamics:

M-cholinergic receptor blocker. It is believed that the dilation of the bronchi caused by ipratropium bromide is due to competitive binding to m-cholinergic receptors of bronchial smooth muscles. Reduces the secretion of glands (including bronchial and digestive).

Prevents the narrowing of the bronchi that occurs as a result of inhalation of cigarette smoke, cold air, and the action of various bronchoconstrictor substances.

When used inhalation, it has virtually no resorptive effect. When used systemically, it causes an increase in heart rate, improves AV conduction; unlike atropine, it does not affect the central nervous system.

Pharmacokinetics:

When administered via inhalation, ipratropium bromide is characterized by extremely low absorption from the respiratory mucosa.

The concentration of the active substance in plasma is at the lower limit of definition and can only be measured when using high doses of the active substance, as well as through the use of specific enrichment methods. When administered in therapeutic doses by inhalation, plasma concentrations of ipratropium bromide were 1000 times lower than after oral and intravenous administration. Does not accumulate.

Ipratropium bromide is excreted primarily through the intestines. About 25% is excreted unchanged, the rest in the form of numerous metabolites.

Indications:

For inhalation use: treatment and prevention of chronic obstructive respiratory diseases: chronic bronchitis with broncho-obstructive syndrome (with or without emphysema), mild to moderate bronchial asthma, especially with concomitant diseases of the cardiovascular system; bronchospasm during surgical operations, chronic onic obstructive pulmonary disease . Preparation of the respiratory tract before the administration of aerosols of antibiotics, mucolytics, glucocorticosteroids, sodium cromoglycate.

For intranasal use: chronic rhinitis with hypersecretion.

X.J30-J39.J31 Chronic rhinitis, nasopharyngitis and pharyngitis

X.J40-J47.J43 Emphysema

X.J40-J47.J44 Other chronic obstructive pulmonary disease

X.J40-J47.J45 Asthma

XVIII.R00-R09.R09.3 Sputum

XXI.Z40-Z54.Z51.4 Preparatory procedures for subsequent treatment, not classified elsewhere

Contraindications:Hypersensitivesensitivity (including to atropine and its derivatives), pregnancy (first trimester). With caution:Angle-closure glaucoma, urinary tract obstruction (including prostatic hyperplasia), pregnancy (II and III trimester), lactation, children under 6 years of age. Pregnancy and lactation:Contraindicated in the first trimester of pregnancy. Use in the second and third trimesters of pregnancy is possible if there are strict indications. Contraindications for use during lactation have not been established.Application is possible if the expected effect of therapy in the mother exceeds the potential risk for the child. Directions for use and dosage:

Inhalation - 2 doses of aerosol (40 mcg) 4 times a day (if necessary, up to 12 inhalations).

Solution for inhalation: adults and children over 14 years old - 0.1-0.5 mg 3-4 times a day through a nebulizer; children 6-14 years old - 0.1-0.25 mg 3-4 times a day via nebulizer; children under 6 years old - 0.1-0.25 mg 3-4 times a day (under medical supervision).

Side effects:

For inhalation use: Possible dry mouth, increased sputum viscosity, sometimes cough, paradoxical bronchospasm.

Effects associated with anticholinergic action: tachycardia, palpitations, impaired accommodation, decreased secretion of sweat glands, impaired gastrointestinal motility, urinary retention (in patients with obstructive lesions of the urinary tract, the risk of developing urinary retention increases).

Allergic reactions: possible skin rash, itching, urticaria, angioedema, oropharyngeal edema, anaphylaxis.

In case of contact with eyes - disturbances in accommodation; In patients with angle-closure glaucoma, intraocular pressure may increase.

For intranasal use: in some cases, local reactions are possible - dryness and irritation of the nasal mucosa, allergic reactions.

Overdose:

Symptoms: increased anticholinergic reactions (including dry mouth, impaired accommodation, increased heart rate).

Treatment: symptomatic therapy.

Interaction:

When used simultaneously with anticholinergic drugs, an additive effect occurs.

With simultaneous use, the bronchodilator effect of beta-agonists and xanthine derivatives is potentiated.

With the simultaneous use of antiparkinsonian drugs, quinidine, tricyclic antidepressants, the anticholinergic effect of ipratropium bromide may be enhanced.

When used simultaneously with salbutamol, there is a risk of increased intraocular pressure and the development of acute angle-closure glaucoma, especially in predisposed patients.

Special instructions:

If emergency relief of an attack of suffocation is necessary, monotherapy with ipratropium bromide is not recommended, since its bronchodilator effect develops later than that of beta-agonists.

The safety and effectiveness of intranasal use in children under 12 years of age has not been determined.

Impact on the ability to drive vehicles and operate machinery

Given the possibility of ipratropium bromide affecting visual acuity, caution should be exercised when driving during treatment. vehicles and performing other potentially dangerous work that requires concentration.

Instructions

Clinical and pharmacological groups

12.005 (Bronchodilator - m-cholinergic receptor blocker)
24.029 (Vasoconstrictor drug for local use in ENT practice)
12.001 (Bronchodilator)

Pharmacological action

M-cholinergic receptor blocker. It is believed that the dilation of the bronchi caused by ipratropium bromide is due to competitive binding to m-cholinergic receptors of bronchial smooth muscles. Reduces the secretion of glands (including bronchial and digestive).

Prevents the narrowing of the bronchi that occurs as a result of inhalation of cigarette smoke, cold air, and the action of various bronchoconstrictor substances.

When used inhalation, it has virtually no resorptive effect. When used systemically, it causes an increase in heart rate, improves AV conduction; unlike atropine, it does not affect the central nervous system.

Pharmacokinetics

When administered via inhalation, ipratropium bromide is characterized by extremely low absorption from the respiratory mucosa.

The concentration of the active substance in plasma is at the lower limit of definition and can only be measured when using high doses of the active substance, as well as through the use of specific enrichment methods. When used in inhalation in therapeutic doses, plasma concentrations of ipratropium bromide were 1000 times lower than after oral and intravenous administration. Does not accumulate.

Ipratropium bromide is excreted primarily through the intestines. About 25% is excreted unchanged, the rest in the form of numerous metabolites.

Dosage

Individual, depending on the indications, age, dosage form used.

Drug interactions

When used simultaneously with anticholinergic drugs, an additive effect occurs.

With simultaneous use, the bronchodilator effect of beta-agonists and xanthine derivatives is potentiated.

With the simultaneous use of antiparkinsonian drugs, quinidine, tricyclic antidepressants, the anticholinergic effect of ipratropium bromide may be enhanced.

When used simultaneously with salbutamol, there is a risk of increased intraocular pressure and the development of acute angle-closure glaucoma, especially in predisposed patients.

Pregnancy and lactation

Use in the second and third trimesters of pregnancy is possible if there are strict indications. Contraindications for use during lactation have not been established.

Side effects

For inhalation use: dry mouth and increased viscosity of sputum are possible.

In case of contact with eyes - disturbances in accommodation; In patients with angle-closure glaucoma, intraocular pressure may increase.

For intranasal use: in some cases, local reactions are possible - dryness and irritation of the nasal mucosa, allergic reactions.

For systemic use: possible dry mouth, anorexia, constipation, impaired accommodation, increased intraocular pressure, urination disorders, decreased secretion of sweat glands; rarely - extrasystole.

Indications

For inhalation use: treatment and prevention of chronic obstructive respiratory diseases: chronic bronchitis with broncho-obstructive syndrome (with or without emphysema), mild to moderate bronchial asthma, especially with concomitant diseases of the cardiovascular system; bronchospasm during surgical operations. Preparation of the respiratory tract before the administration of aerosols of antibiotics, mucolytics, corticosteroids, sodium cromoglycate.

For intranasal use: chronic rhinitis with hypersecretion.

For oral and intravenous administration: sinus bradycardia, caused primarily by the influence of the vagus nerve, bradyarrhythmias with sinoatrial block, AV block of the second degree, bradysystolic form of atrial fibrillation.

Contraindications

Hypersensitivity to ipratropium bromide.

Mainly for systemic use: increased intraocular pressure, prostatic hyperplasia, mechanical stenosis of the gastrointestinal tract, tachycardia, megacolon, first trimester of pregnancy.

Special instructions

Use with caution in the form of inhalations in patients with angle-closure glaucoma, urinary tract obstruction due to prostatic hyperplasia.

If emergency relief of an attack of suffocation is necessary, monotherapy with ipratropium bromide is not recommended, because its bronchodilator effect develops later than that of beta-agonists.

The safety and effectiveness of intranasal use in children under 12 years of age has not been determined.

Impact on the ability to drive vehicles and operate machinery

Given the possible effect of ipratropium bromide on visual acuity, during treatment, care should be taken when driving vehicles and other potentially hazardous activities.

Preparations containing IPRATROPIUM BROMIDE

ATROVENT ® N (ATROVENT ® N) aerosol dosage. d/inhal. 20 mcg/1 dose: 10 ml balloon (200 doses)
. IPRATROPIUM STERI-NEB solution for inhalation. 250 mcg/1 ml: 1 ml or 2 ml amp. 20, 30 or 60 pcs.
. ATROVENT ® (ATROVENT ®) solution for inhalation. 250 mcg/1 ml: dropper bottle. 20 ml
. BERODUAL ® (BERODUAL ®) solution for inhalation. 500 mcg+250 mcg/1 ml: dropper bottle. 20 ml
. IPRAVENT aerosol for inhalation. dosage 40 mcg/1 dose: 15 g balloon (200 doses)
. BERODUAL ® N (BERODUAL ® N) aerosol for inhalation. dosage 50 mcg+20 mcg/1 dose: 10 ml balloon (200 doses)
. IPRAVENT powder for inhalation. in capsules 40 mcg: 10 or 30 pcs. included with or without an inhaler
. XYMELIN EXTRA ◊ nasal spray 500 mcg+600 mcg/1 ml: vial. 10 ml with dosage. device
. IPRAMOL SREI-NEB solution for inhalation. 200 mcg+1 mg/1 ml: amp. 2.5 ml 20, 30 or 60 pcs.

IPRATROPIUM BROMIDE - description and instructions provided by the Vidal drug reference book.