Antitussive Research Articles

The comprehensive strategy in the human health risk assessment of total chromium impurities in cough syrups with Marshmallow Root (Althaea officinalis) available in Polish pharmacies: regulatory aspects and special emphasis on Cr(VI) mode of action

Chromium, which can currently only be considered pharmacologically active and not an essential element, is a very intriguing elemental impurity in final pharmaceutical products, especially traditional herbal medicinal products. This kind of traditional herbal medicinal product with Marshmallow root (Althaea officinalis L., radix) registered in the EU is widely used among the European population. The aim of this article is to propose a double regulatory strategy in assessing the human health risk of total chromium impurities in cough syrups with Marshmallow Root (Althaea officinalis) available in Polish pharmacies. We applied the strategy based on the requirements of the ICH Q3D (R1) guideline for the assessment of Cr impurities in final traditional herbal medicinal products with Marshmallow Root registered in the EU. Furthermore, we applied the strategy based on the concept of margin of exposure (MoE) considering Cr(VI) genotoxicity mode of action (MOA) and based on BMD10 for Cr(VI) as a point of departure (PoD). The total Cr content was in the range: 1.12–9.61 µg/L (in comparison with the ICH Q3D R1 guidelines: 1100 µg/g). Total Cr levels in a single dose were relatively high compared to raw results, but were not a threat to patients. Comparison of estimated results with oral PDE value for Cr in final drugs suggested by the ICH Q3D R1 guideline (10,700 µg/day) show that all the products analyzed were below this value (the highest result was 278.40 ng/day). Despite conservative assumptions, the MoE values obtained for Cr in daily dose for each Marshmallow Root cough syrup were above 10,000; therefore, exposure to Cr would not cause a health risk for specific population groups (children and adults). It can be summarized that each of the phytopharmaceuticals analysed with Marshmallow root available in Polish pharmacies does not represent a health hazard to patients. We confirm the safety of Cr impurities by applying a double regulatory strategy without the application of an expansive and demanding HPLC-ICP-MS technique for Cr speciation.

Novel HPTLC method for simultaneous estimation from ternary mixture of chlorpheniramine maleate, dextromethorphan hydrobromide and phenylephrine hydrochloride in syrup formulations

A synergic antihistamine, cough suppressant, and decongestant combination of chlorpheniramine, dextromethorphan, and phenylephrine is used to treat acute respiratory infections caused by seasonal viruses. The effective qualitative and quantitative methods require the simultaneous measurement of a ternary combination in the pharmaceutical syrup dosage form. Therefore, a new, simple, fast and robust high performance thin layer chromatographic (HPTLC) method has been developed and validated for chlorpheniramine maleate (CPM), dextromethorphan hydrobromide (DEXO) and phenylephrine hydrochloride (PE). The chromatographic separation was carried out on precoated aluminium plates with silica gel 60 F254 as the stationary phase. Mobile phase used was chloroform: methanol: ammonia (2.5:7.5:0.3, v/v/v) for proper separation. The detection was carried out at 270nm wavelength in absorbance mode. Developed method was validated as per International Council for Harmonization (ICH) Q2 (R1) guideline. The linearity range is 400 to 1400ng/band for CPM, 3000 to 11500ng/band for DEXO and 1000 to 3500ng/band for PE with correlation coefficient ≥0.995. The consistent lower values of relative standard deviation (RSD, %) for precision and robustness study indicate the method reliability. The percent recovery ranged from 97.82 to 102.03% indicates the good accuracy of the method. The proposed method was complying for the analytical method validation parameters suggested by the ICH Q2 (R1) guideline. The method was found to be simple, rapid and reliable for the simultaneous estimation of CPM, DEXO and PE from its pharmaceutical syrup dosage form. The method was successfully applied to quantify these analytes from the several pharmaceutical syrup dosage form.

Modern Treatment of Dry Post-viral Cough. Focus on Efficiency and Safety

Cough is the most common symptom of bronchopulmonary diseases, about which patients consult the doctors of both primary and secondary care. Cough can be caused by diseases of the respiratory tract, digestive tract, and cardiovascular diseases. However, cough most often develops during acute respiratory viral infections (ARVI), which disrupts the patient’s normal activities and limits his work capacity. Since most respiratory infections are viral in nature, the use of antibacterial drugs will not only be of no benefit, but will also significantly worsen the patient’s condition. The objective: to analyze the effectiveness and tolerability of a combined antitussive agent, which includes codeine, thermopsis extract, licorice root and sodium bicarbonate, in the treatment of dry post-viral cough. Materials and methods. The study included 60 patients with a dry cough that caused by ARVI, namely: 49 (82%) men and 11 (18%) women. The average age of the patients was 46±4.7 years. Most of the subjects (90%) had smoking experience of more than 20 years. The research participants were divided into two groups of 30 people each. The groups were comparable by age, duration and severity of symptoms, as well as clinical manifestations of respiratory disease. The patients of the first group took a combined antitussive drug containing codeine, thermopsis extract, licorice root, and sodium bicarbonate for 5 days. Patients of the second group received alternative antitussive drugs. At the beginning and at the end of treatment, the severity of cough was determined on a visual analog scale and the physical, psychological and social conditions of patients in both groups were assessed using the Leicester Acute Cough Questionnaire. Results. As a result of the research, it was found that the patients of the first group, who received the combined antitussive drug, have achieved the desired treatment result much earlier and more effectively than the patients of the second group. The intensity of their cough decreased by 2.5 times during the treatment period. The patients of the first group also had better results of treatment, comparing indicators of physical, psychological and social conditions. In the control group, positive results of treatment were determined, although a less significant effect was found. Conclusions. The conducted study confirmed the high efficiency of the combined antitussive agent, which includes codeine, thermopsis extract, licorice root and sodium bicarbonate, in the treatment of dry debilitating cough caused by ARVI. Thanks to the use of this drug, the severity of cough significantly decreased, which led to a significant improvement in the general condition and quality of life of patients.

The many faces of a cough in a child: Issues of differential diagnosis and treatment

Studying the causes of cough, which is one of the most common respiratory symptoms when seeking medical help, remains a pressing problem for doctors of various specialties. Due to the growing interest in herbal remedies, in the current study we aimed to analyze the effectiveness of marshmallow root in the treatment of cough. We conducted a systematic search in modern scientific literature in electronic databases PubMed, EMBASE, Cochrane Library, Wiley, PubFacts, Springer Link platform, scientific publishing house Elsevier, CyberLeninka. An analysis of 80 full-text reviews on the use of herbal medicine in the treatment of cough showed higher quality of life scores, lower rates of adverse events and less severe cough. The authors also provide evidence that herbal therapy successfully complements traditional treatment methods, providing longer periods of remission for chronic cough. Although coughing is a protective reflex responsible for clearing secretions and foreign bodies from the airways, it can be an unpleasant symptom that causes discomfort in patients. The use of preparations based on root extract of Althaea officinalis L leads to the formation of a protective film, which promotes faster regeneration of the damaged mucous membrane of the respiratory tract caused by a dry cough. The mucous membrane of the respiratory tract is a highly vascularized tissue. In this regard, anti-inflammatory phytochemicals that improve lesion repair, such as local neovascularization, are critical to promote healing. The herbal medicinal product containing the active component marshmallow root extract fully meets safety requirements and can be successfully used in patients with acute and chronic respiratory diseases.

Un esordio psicotico misterioso

The authors describe the case of a 13-year-old boy presenting with a confusional state possibly due to the abuse of dextromethorphan contained in a cough syrup.

Over-investigation and overtreatment in pediatrics: a survey from the European Academy of Paediatrics and Japan Pediatric Society.

Avoiding over-investigation and overtreatment in health care is a challenge for clinicians across the world, prompting the international Choosing Wisely campaign. Lists of recommendations regarding medical overactivity are helpful tools to guide clinicians and quality improvement initiatives. We aimed to identify the most frequent and important clinical challenges related to pediatric medical overactivity in Europe and Japan. Based on the results, we aim to establish a (European) list of Choosing Wisely recommendations. In an online survey, clinicians responsible for child health care in Europe and Japan were invited to rate 18 predefined examples of medical overactivity. This list was compiled by a specific strategic advisory group belonging to the European Academy of Paediatrics (EAP). Participants were asked to rate on a Likert scale (5 as the most frequent/important) according to how frequent these examples were in their working environment, and how important they were considered for change in practice. Of 2,716 physicians who completed the survey, 93% (n = 2,524) came from 17 countries, Japan (n = 549) being the largest contributor. Pediatricians or pediatric residents comprised 89%, and 51% had 10-30 years of clinical experience. Cough and cold medicines, and inhaled drugs in bronchiolitis were ranked as the most frequent (3.18 and 3.07 on the Likert scale, respectively), followed by intravenous antibiotics for a predefined duration (3.01), antibiotics in uncomplicated acute otitis media (2.96) and in well-appearing newborns. Regarding importance, the above-mentioned five topics in addition to two other examples of antibiotic overtreatment were among the top 10. Also, IgE tests for food allergies without relevant medical history and acid blockers for infant GER were ranked high. Overtreatment with antibiotics together with cough/cold medicines and inhaled drugs in bronchiolitis were rated as the most frequent and important examples of overtreatment across countries in Europe and Japan.

The Impact of Medical Comorbidities on Cough Improvement Following Superior Laryngeal Block.

Chronic refractory cough is defined as cough lasting greater than 8 weeks and with an unclear etiology. Blockade of the internal branch superior laryngeal nerve (iSLN) has been shown to be safe and effective in the treatment of chronic cough. It remains unknown, however, if underlying comorbidities impact patient response to iSLN blockade. A total of 44 patients aged 18 years and older were seen at our institution's Laryngology clinics between 2019 and 2022 and treated with iSLN blockade. Patient demographics, comorbidities, and pre- and post-treatment cough severity index (CSI) scores were collected from electronic medical records. Two-tailed independent T tests were used to compare CSI scores between groups with and without 4 underlying comorbidities: GERD, pulmonary history, smoking history, and evidence of vocal fold paresis or asymmetry on stroboscopy. Patients with a history of GERD or smoking and those with evidence of glottic insufficiency had similar improvements in CSI compared to those who did not (22.5 ± 26.4 vs 45.0 ± 47.1, P = .36; 32.7 ± 27.8 vs 29.0 ± 38, P = .85; 41.3 ± 18.8 vs 27.2 ± 37.7, P = .195). Patients with underlying pulmonary conditions had a significantly reduced response to iSLN blockade than did patients without underlying disease (9.85 ± 15.0 vs 47.4 ± 38.1, P = .028). Underlying lung pathology may contribute to decreased iSLN blockade efficacy in the treatment of chronic refractory cough from laryngeal hypersensitivity and its treatment is likely necessary for optimal symptom reduction. Characterizing patient comorbidity profiles can help guide patient counseling on expected treatment efficacy.

Ambroxol-induced leukocytoclastic vasculitis: A case report and literature review

Cutaneous leukocytoclastic vasculitis (LCV) that primarily affects the skin, can be idiopathic or linked to infections, autoimmune diseases, neoplasms, and medications. An immune complex-mediated vasculitis of the dermal capillaries and venules is the histological hallmark of LCV, a small vessel vasculitis. This case report describes a 36-year previously healthy man who was presented to the outpatient department (OPD) with complaints of edema and development of numerous reddish-purple patches (caused by petechiae) after intake of cough syrup containing ambroxol. Ambroxol affects human monocytic cells THP-1, and prevents the generation of platelet-derived growth factor (PDGF)-AB that is produced by lipopolysaccharide (LPS) by inhibiting the expression of PDGF-A messenger Ribonucleic acid (RNA). An extracellular signal-regulated kinase (ERK) on p44/42 is activated by LPS, and ambroxol reduces this activation. In addition, 2-(2-amino-3-methoxyphenyl)-4H-1-benzopyran-4-one (PD 98059), a Mitogen-Activated Protein Kinase Inhibitors (MEK), MEK-1-specific inhibitor, prevents p44/42 ERK activation and PDGF synthesis brought on by LPS. Megakaryocytes, erythrocytes, leukocytes, and their progenitors are stimulated to multiply by PDGF to the numerous endogenous growth factors that mesenchymal stem and stromal cells secrete. Ambroxol reduces the number of megakaryocytic progenitors and boosts apoptosis by inhibiting the production of PDGF and related signaling pathways. It is strongly advised that patients must be made more aware of the risks associated with using such over-the-counter medications.

Dominant lignan profiles and antidiabetic activity of thermally treated and non-treated burdock seeds

Burdock seeds (Fructus arctii) are used as a traditional medicine for cough, inflammation, detoxification, cancer and diabetes, usually as decoction obtained with seeds subjected to thermal pre-treatment. The present work aimed to perform the phytochemical characterization of the stir-baked and non-baked seeds of various Arctium lappa populations from nine localities. Arctiin was dominant compound in non-baked seeds ranging from 40.6–92.6 mg/g. Thermal treatment resulted in a significant transformation of phenolic compounds and arctigenin was prevalent in the baked samples with the content from 25.2–57.4 mg/g. The antidiabetic potential of baked and non-baked burdock seed extracts was further evaluated in vitro by inhibition of α-amylase and α-glucosidase activity, while molecular docking analysis was used to reveal the main molecular interactions underlying the inhibitory effects on these enzymes. In vitro study showed that stir-baked burdock seed extracts were stronger inhibitors of both enzymes compared to non-baked. The several extracts showed strong inhibition of both enzymes by almost or more than 60%, which was lower compared to acarbose (82.99% at a concentration of 1 mg/mL). Arctin and arctigenin were individually significantly stronger inhibitors of α-amylase and particularly α-glucosidase compared to burdock extracts and acarbose, and their activity was concentration dependent. Moreover, antidiabetic activity for the most active sample was determined in vivo using animals on high-fat and sucrose diet, where promising results were obtained. Briefly, after three months of administration of the stir-baked seed extract (100 mg/kg body weight), complete recovery from a hyperglycemic state was achieved. According to the obtained results A. lappa stir-baked seed extract is a potential drug with hypoglycemic action as indicated by in vitro, in vivo and in silico studies.

COVID-19 home remedy consumption and perceived effectiveness among adult population in Brunei Darussalam: a PLS-SEM approach

BackgroundThe Coronavirus Disease 2019 (COVID-19) caused by SARS-CoV-2 affects the respiratory system and causes severe acute respiratory infections. Several cultures have influenced the use of home remedies to ease mild symptoms of COVID-19 sometimes alongside conventional medicine. The aim of this study was to investigate the usage of COVID-19 home remedies among the adult population in Brunei.MethodsThe study design was a cross-sectional study using an online survey and distributed nationwide. The statistical analysis of the data included descriptive statistics describing the sociodemographic characteristics of the respondents, their experience with COVID-19 infection, consumption of general home remedies and COVID-19 home remedy, their practice of COVID-19 home remedy use, and their attitude towards the general use of home remedy. Sub-group analysis including Pearson's chi-square test and Fisher's exact test was computed for the variables in relation to the COVID-19 home remedy use and the perceived effectiveness of the types of home remedy. Multivariate analysis including Partial Least Squares Structural Equation Modelling (PLS-SEM) was applied to determine the correlations between the factors and outcomes measured. P-value less than 0.05 is considered statistically significant.ResultsThere was a total of 864 eligible responses included in the study. The primary findings showed COVID-19 home remedy was used by 72.2% of the study participants. Most frequently used types of COVID-19 home remedy were cloves (37%), lemon (37%), and honey (23%). There was an infrequent usage of coconut (4.6%), eucalyptus oil (3.7%), habbatussauda (3.5%), traditional/ herbal cough syrup (2.4%), and turmeric (2.2%). The PLS-SEM demonstrated that ‘Experience’ appears to be a central endogenous variable that affects the decision on the use of COVID-19 home remedy. This relationship is mediated by ‘Safety’, ‘Source’, and ‘Opinion’ which have significant contributions to the outcome, accounting for 98.2% of the variance explained (R-square = 0.982).ConclusionsThe outcome of this study establishes the baseline prevalence of COVID-19 home remedy consumption among Bruneian residents and compared the previous study on Brunei’s general use of traditional medicine. The present findings could help nurses and other healthcare professionals in Brunei understand the practice of Bruneian adults on the consumption of home remedies for COVID-19.

Impurities in over-the-counter pseudoephedrine leading to methcathinone detection in urine

Methcathinone, a psychoactive substance with stimulant properties, has raised concerns in recent years due to its presence in urine screenings, even among individuals with no history of drug abuse. To prevent misjudgment, this work aims to explore the source of methcathinone in urine. A total of 58 urine samples tested positive for methcathinone in the National Taiwan University Hospital cohort, with 27 linked to illicit drug use and 31 from individuals with no drug use history. Co-occurrence analysis revealed a strong association between methcathinone and over-the-counter cold medications containing pseudoephedrine or ephedrine. In an in vivo experiment, participants who consumed pseudoephedrine-containing drugs showed the presence of methcathinone in their urine, suggesting a connection between these substances. Additionally, tests on pharmaceutical products containing pseudoephedrine detected small amounts of methcathinone as impurities. The findings suggest that the presence of methcathinone in nonillicit drug users may be attributed to impurities in over-the-counter pseudoephedrine-containing medications. This raises concerns about potential misinterpretations of drug screening results and underscores the need for more comprehensive criteria for assessing drug use. This study contributes to our understanding of the origin of methcathinone in urine, which has implications for legal justice and drug screening practices.

Antihistaminic, Antiarthritic, and Antiobesity Activities of Yellow Horn Poppy Natural Products

Background: Yellow horn poppy ( Glaucium flavum, syn. Chelidonium flavum) in the family Papaveraceae, is growing in many geographical areas; it is mostly native to Northern Africa, Western Asia, and Europe. The plant is well known for its different types of alkaloids, including aporphines, protopines, and phenolic compounds. In Eastern Europe, the HCl and HBr salts of glaucine (the common active constituent in G. flavum) have been approved as cough suppressants, in addition to several therapeutic applications in traditional medicine. The natural products of G. flavum varied according to the geographical habitat, the stage of maturity, and the selected plant organ. Materials and Methods: For the first time, the extraction and isolation of natural products (alkaloids and flavonoids) from dried aerial parts of the Libyan population of yellow horn poppy and testing their biological effects, which include antihistaminic, antiarthritic, and antiobesity effects. Results: Alkaloids (glaucine and isoboldine) and flavonoid constituents (quercetin-7- O-rutinoside and rutin) have been isolated, while the biological activity results showed that quercetin-7- O-rutinoside and rutin showed half-maximal inhibitory concentration (IC50) (µg) = 29.7 and 46.6, 26.2 and 61.3, and 58.8 and 50.1 for antihistaminic, antiarthritic, and antiobesity, respectively, compared with those of glaucine and isoboldine effects, IC50 = 77.4 and 159.3, 61.7 and 118.7, and 237.8 and 157.6, respectively. Conclusion: According to the obtained results, the antihistaminic, antiarthritic, and antiobesity effects of the flavonoid compounds were stronger than those of the alkaloidal constituents of yellow horn poppy.

A Mini-Review on the Chemical Constituents and Biological Activities of Lysimachia capillipes Hemsl.

Abstract: Lysimachia capillipes Hemsl. is an annual flowering plant, mainly distributed in some parts of Asia. In the early 1970s, it was discovered by the folk of Le'an county, Jiangxi province. Lysimachia capillipes Hemsl., contains many bioactive components (flavonoids, saponins, volatile oils, organic acids, etc.) and has a wide spectrum of pharmacological activities. This plant medicine was used in the treatment of cold cough, asthma, rheumatism, pain, irregular menstruation, neurasthenia, restoring deficiency, expelling roundworm, anti-tumor, etc. in Chinese folk. In this minireview, the progress on the chemical constituents and biological activities of Lysimachia capillipes Hemsl., was comprehensively summarized by searching the CNKI, PubMed, Web of Science, Scopus, and Google Scholar databases using “Lysimachia capillipes Hemsl.” or “Manshanxiang” as the keywords. This article may provide a reference for researchers for further study of Lysimachia capillipes Hemsl.

Phyto Pharmaceutical Advances on Black Turmeric as a Functional Herb

Abstract: Herbal medicine is one of humanity's oldest professions, and herbal medicine's therapeutic efficacy has been recognised since the dawn of time. In many parts of India, herbal treatments have been found to be effective in the treatment of malaria, diarrhoea, jaundice, diabetes, cough, fever, snakebite, miscarriages, and gonorrhoea. Curcuma caesia is a perennial herb with bluish-black rhizomes that is native to Northeast and Central India. In antioxidant, antiinflammatory, and human tumour cell proliferation, inhibitory effects of the rhizomes of indigenous Curcuma caesia were investigated in this work. According to Research, Inc., the global curcumin market was worth USD 46.6 million, with North America being the largest regional market and India being one of the largest curcumin producers. With a revenue-based compound yearly growth rate (CAGR) of 14.8% throughout the projection period, Europe is predicted to be the fastest-growing region, with the global market. Because of expanding scientific talent and a large network of biotechnology and food chemistry applications, curcumin quality and quantity are projected to improve in the future. The study emphasizes the importance of using the bioactive components of curcuma caesia in nanotechnology, liposomes, niosomes, micelles, and cyclodextrin.

EFFECT OF DIFFERENT SOLVENT EXTRACTS ON THE YIELD AND IN VITRO ANTIBACTERIAL ACTIVITY, WITH GC-MS ANALYSIS OF ACTIVE EXTRACTS FROM VERNONIA AMYGDALINA LEAVES

Vernonia amygdalina, commonly known as ‘Bitter leaf’, is a small perennial shrub with various medicinal properties including the treatment of stomach disorders, fever symptoms, diabetes, hypertension, and coughs. V. amygdalina is a potent source of antibacterial properties that may be beneficial in preventing bacterial infections and associated diseases such as fever and diarrhea. V. amygdalina also has been extensively studied for its antioxidant, anti-inflammatory, antifungal, anticancer and antidiabetic properties. The present study aims to determine the most efficient solvent for extracting antibacterial-rich V. amygdalina extracts. Dried leaves of V. amygdalina were extracted using several solvents (methanol, ethanol, and dichloromethane) to assess the extraction yield. The antibacterial potential of all extracts against Staphylococcus aureus, Escherichia coli and Pseudomonas aeruginosa was evaluated using the agar disc diffusion assay. The profiling of the active extract was accomplished using gas chromatography coupled with mass spectrometry (GC-MS). Among the solvents tested, ethanol exhibited the highest extraction productivity, with a percentage yield of 49.20%. The dichloromethane extract displayed the highest inhibition zones against all bacteria strains ranging from 16.67 ± 1.20 mm to 21.33 ± 0.5 mm at 200 mg/mL. The GC-MS analysis of dichloromethane extract identified compounds such as phytol, flavonoids, vitamin E, and squalene. The findings of this study revealed that the choice of the extraction solvent is greatly affecting the antibacterial efficacy of V. amygdalina. In conclusion, the efficacy of V. amygdalina against pathogenic bacteria strains could be explored for further pharmaceutical application and should be encouraged in the development and production of new antibiotics.

Medicinal plants and functional foods sold by market vendors and used by their clients for COVID-19 in Gondar City, Ethiopia

Background: Many Ethiopians use traditional medicines. However, little is known about the role of open markets as sources of alternative medicines in preventing and treating COVID-19. Objectives. The objectives of this study are to identify medicinal plants and plant products sold by vendors in the markets of Gondar City and used by their clients to treat the COVID-19-related symptoms of fever, cough, and headache. Methods and Materials: Questionnaires were used to interview vendors and clients. Results: The research identified 38 vendors who sold traditional medicines and 37 clients who reported using medicines for fever, cough, and headache. Of the 14 medicinal, food, and spice plants and plant products sold, the most common were garlic (Allium sativum) followed by black cumin (Nigella sativa) seeds, haregresa (Zehneria scabra) leaves, and basil (Ocimum trifolium) leaves. The plant materials most commonly used were haregresa leaves, garlic, and flax seeds. Four of the plants have active anti-coronavirus, immune-modulatory, and anti-inflammatory compounds. The sale and use of medicinal plants and functional foods reflects traditional cultural practices in Ethiopia. Conclusion: Open-air markets are a major source of indigenous foods and medicines that may be valuable in the management of COVID-19. Medicinal plant products sold for fever, headache, and cough in Gondar City may have mostly palliative and immuno-modulatory benefits. Several areas needing further study are identified.

Endoscopic Biofeedback Training for Cough and Swallowing: The What, Why, and How

Purpose: Endoscopic biofeedback training is a type of augmented extrinsic feedback that provides information about physiological processes and bolus flow information through the use of flexible endoscopy. The goal of this tutorial is to describe why and how to incorporate endoscopic biofeedback training into cough and swallowing treatment when working with people with dystussia and dysphagia. Method: In this tutorial, we will review the diagnostic advantages and limitations of flexible endoscopic evaluation of swallowing as it relates to biofeedback training. We will then (a) review what is known about endoscopic biofeedback training in the field of speech-language pathology; (b) identify which airway protective behaviors clinicians might be best suited for endoscopic biofeedback training; and (c) provide a guide, including sample scripts and video demonstrations, that clinicians can use to aide in the implementation of endoscopic biofeedback training. Conclusions: Endoscopic biofeedback training for cough and swallowing habilitation and rehabilitation may be a useful addition to a speech-language pathologist's therapeutic armamentarium. However, more research is needed to comprehensively characterize the long-term effects on endoscopic biofeedback training on cough and swallowing treatment-related outcomes. Supplemental Material: https://doi.org/10.23641/asha.25043579

Ethnobotanical survey of medicinal plants used by traditional healers in Karayar tribal village, Tirunelveli district, Tamil Nadu, India

This research aims to document and evaluate the traditional medical practices and the use of ethnomedicinal plants by the Kani tribal healers living in Karayar, Tirunelveli district, Tamil Nadu, India. The study documented 67 plant species from 59 genera and 35 families. Sixty-seven medicinal plants are used to treat thirty-one ailments, with the most common use of plants being for the treatment of cough (7 plants). Fabaceae has the highest number of species (10 species). The leaves of 23 species are used for medicinal purposes. This documentation can be valuable for pharmacologists, foresters, conservationists, researchers, and those interested in herbal medicine.

Combination therapy for productive cough in acute respiratory viral infection (ARVI) and acute bronchitis in real clinical practice

Aim. To evaluate effectiveness and safety of combination drug containing ambroxol, guaifenesin and levosalbutamol (Ascoril LS), oral solution, in comparison with monocomponent drugs in the treatment of productive cough in adult patients with acute respiratory viral infection (ARVI) and acute bronchitis.
 Materials and methods. Open randomized study included patients with clinical symptoms of ARVI and acute bronchitis, having productive cough with difficulty in sputum discharge. 160 patients were randomized into 4 groups that received the study drug or comparison drugs (ambroxol, acetylcysteine, Rengalin) 3 times a day for 20 days. After 5, 10, 15 and 20 days of treatment, the doctor assessed subjective complaints and effectiveness of therapy. The primary endpoint was the proportion of patients with high and very high efficacy, recovery from work, and clinically significant cardiovascular events.
 Results. Satisfaction with clinical effect of therapy with Ascoril LS was noted by 96% of patients, tolerability and ease of administration by 99%. 97% of patients are satisfied with price/quality ratio. The overall percentage of satisfaction with treatment Ascoril LS was 99%. Tolerability of therapy was assessed by all patients as good, without the development of significant adverse events. During therapy for productive cough, a significant decrease in cough was noted in Ascoril LS group already on the 5th day of therapy (57%) and subsequently at all follow-up visits. Restoration of working capacity of patients in Ascoril LS group due to complete regression of productive cough was established in 50% of patients on the 5th day of treatment. On days 10 and 15, 75% and 90% of patients, respectively, were able to begin work due to complete relief of cough, which is significantly more compared to other treatment groups. It is important that in all cases Ascoril LS was prescribed at the very beginning of the disease, which made it possible to achieve the described results
 Conclusion. The effectiveness of a new combination drug containing ambroxol, guaifenesin and levosalbutamol for the treatment of productive cough in adult patients with ARVI and acute bronchitis exceeds the effectiveness of monocomponent therapy with comparator drugs. The safety profiles of the study drug and comparison drugs were comparable, including in patients with cardiovascular risk.

Сontemporary approaches to the treatment of acute bronchitis: benefits of herbal medicine

Acute bronchitis (AB) is an inflammation of the lower respiratory tract of predominantly viral etiology, the leading clinical symptom of which is a cough (usually productive), lasting no more than 2 weeks, in combination with characteristic signs of infection of the lower respiratory tract. OB is one of the most pressing problems of modern pulmonology, which is associated with a high incidence, reaching 30–40% annually. According to the results of epidemiological studies, OB is one of the most common reasons for patients seeking medical care in outpatient practice. In children, the incidence of OB in the Russian Federation averages 75–250 per 1000 per year, which is approximately 100 times higher than the incidence of pneumonia. According to the clinical recommendations of the Ministry of Health of the Russian Federation, in the treatment of OB, in the vast majority of cases, the prescription of antibiotics is unjustified. For patients with OB who have a productive cough, it is recommended to prescribe mucoactive drugs to thin and improve sputum expectoration. Herbal medicine traditionally occupies an important place in the treatment of cough. To date, the most convincing evidence base has been obtained for combination preparations, including extracts of thyme herbs, ivy leaves and primrose roots. One of the most studied and effective herbal medicines for the treatment of acute bronchitis is the drug Bronchipret. The active ingredients of Bronchipret (syrup) are standardized extracts: liquid thyme herb extract and liquid ivy leaf extract; those of Bronchipret TP (film-coated tablets) are dry thyme herb extract and dry primrose root extract. Using this combination allows achieving maximum effectiveness due to a synergistic effect of the active ingredients used.