IPRATROPIUM Bromide (Ipratropium Bromide)

pharmachologic effect

Blocator M-cholinoreceptors. It has a bronchyolic (expanding bronchial lumen) action, reduces the secretion of glands, including bronchial, digestive. Effectively eliminates spasm (sharp narrowing of the lumen) bronchi associated with the influence of wandering nerves. It warns the narrowing of the bronchi, resulting from inhalation of cigarette smoke, cold air, the actions of various bronchokonstrictor (causing the narrowing of the lumen of the bronchi) substances. When inhalation use practically does not have a resortive effect (the action of a substance manifested after suction in blood).

Indications for use

Treatment and prevention of chronic obstructive diseases respiratory tract (diseases of the lungs with a sharp decrease in the lumen of the bronchi): chronic obstructive bronchitis (inflammation of bronchi, combined with a violation of air through them) with emphysens (increased airiness and reduced tone pulmonary fabric) or without it; bronchial asthma light and middle degree gravity, especially with concomitant diseases of cardio-vascular system; bronchospasm as surgical operations.

Mode of application

Install individually, taking into account age and sensitivity to the drug, type of disease and the dosage form used. Dosage aerosol adults and children over 3 years for the prevention of respiratory failure in chronic obstructive bronchitis and bronchial asthma are prescribed 1-2 doses on average 3 times a day; When applied to therapeutic purposes, additional inhalations of 2-3 doses of aerosol can be carried out. A solution for inhalations to adults and children over 6 years old are prescribed 3-5 times a day. When using an electric sprayer or respirators, a single dose rolls 4-8 drops into the spraying device; When using a manual sprayer - 20-30 inhales of undiluted solutions. Powder for inhalations - adults and children over 6 years old Inhalation of the contents of one capsule (0.2 mg) 3 times a day (through a spinchâllaler or turbochhatler - special inhalers for receiving the drug). The bromide is used both for monotherapy (by one drug) and in combination with beta-adrenoreceptor stimulants and xanthine derivatives.

Side effects

Dry mouth, increased sputum viscosity. In case of contact with the eye - violation of accommodation (violation of visual perception); In patients with a closedian glaucoma, an increase in intraocular pressure is possible. When applying an aerosol intranasally (in the nose) in some cases, local responses are possible: dryness in the nose, irritation of the nasal mucosa, allergic reactions.

Contraindications

Increased sensitivity to the drug. The dosage aerosol for intranasal use is not recommended for children under 6 years old. Care should be taken when the drug is prescribed to patients with closed gloomy, obstruction (violation of passability) urinary tract Due to hypertrophy (increasing volume) of the prostate gland. In the 1st trimester of pregnancy, the drug apply only by strict indications.

Form release

Dosage aerosol for inhalations (1 dose - 0.02 mg); Powder for inhalations of 0.2 mg in capsules; Inhalation solution (1 ml - 0.25 mmg).

Storage conditions

List of Aerosol Block Store away from fire and sources high temperatures.

Active substance:

bromide Jiprathopia

Authors

Links

• Official instructions for the drug of the Jipratropium Bromide.
• Modern Medicines: Full practical guide. Moscow, 2000. S. A. Kryzhanovsky, M. B. Vittynova.

Attention!
Description of the drug " Ipratropium bromide"This page is a simplified and supplemented version. official instruction for use. Before purchasing or using the drug, you should consult a doctor and familiarize yourself with the annotation approved by the manufacturer.
Information about the preparation is provided solely with an informational purpose and should not be used as a guide to self-medication. Only a doctor may decide on the appointment of the drug, as well as determine the doses and methods for its use. LSR-005420.10-100610

Trade (patented) title: Sherry Sky IPratropium

International UnPatented Name:

Bromide Jiprathopia.

Dosage form:

Solution for inhalation

Structure:

1 ml of 0.025% inhalation solution contains:
Active substance: The monohydrate bromide iprathopia (in terms of bromide and bromide) 250 μg.
Excipients: Sodium chloride, hydrochloric acid 1H, water purified.

Description: Transparent, colorless or almost colorless liquid

Pharmacological group: m-cholinoblocator

ATH code: R03BB01.

Pharmacological properties
The browing agent, blocks the M-cholinoreceptors of the smooth muscles of the tracheobronchial tree (mainly at the level of large and medium bronchi) and suppresses reflex bronchokonstriction. Having structural similarity with the acetylcholine molecule is its competitive antagonist. Effectively prevents the narrowing of bronchi, resulting from inhalation of various bronchosphampory agents, and also oppresses bronchial spasms associated with the influence of wandering nerves. With inhalation, there is practically no resortive action. The bright effect develops in 5-15 minutes, reaching a maximum after 1-2 hours, and it lasts up to 6 hours (sometimes up to 8 hours).

Pharmacokinetics
Absorption is extremely low. Up to 90% of the inhalant dose is swallowed, in the gastrointestinal tract is practically not absorbed and removed mainly with the feet (25% - in unchanged form, the rest is in the form of metabolites). The onborn part (small) is metabolized in 8 inactive or weaklyactive anticholinergic metabolites (excreted by the kidneys). Not cumulating. The half-life of the drug that fell into the bronchial tree is 3.6 hours; 70% of this dose is displayed with urine. Changes in pharmacokinetic parameters in patients with impaired renal function, liver and in elderly patients do not have clinical significance and do not require dose correction.

Indications for use
Reversible obstruction of the respiratory tract, including in chronic obstructive pulmonary disease, bronchial asthma, chronic obstructive bronchitis, lung emphysema.

Contraindications

• Increased sensitivity to atropine and its derivative;
• Increased sensitivity to the yipratropy of bromide or to other components of the drug;

Carefully - closed-dense glaucoma, obstruction of urinary tract, prostate hyperplasia; breast-feeding, childhood (up to 6 years).

Application during pregnancy and in breastfeeding period
The drug is contraindicated in the first trimester of pregnancy. Purpose of the drug in the II and III trimesters of pregnancy and during lactation is possible only if the intended benefit for the mother exceeds possible risk For the fetus or infant.

Method of application and dose
The preparation of the IPratropium Strolie Sky is used inhalation with the help of inhalers - nebulizers (see the section "Technique of using the drug" of this instruction).

Adults (including older) and children over 12 years old: 2.0 ml (40 drops \u003d 500 μg) 3-4 times a day. Maximum daily dose - 8.0

Children from 6 to 12 years old: 1.0 ml (20 drops \u003d 250 μg) 3-4 times a day. Maximum daily dose - 4 ml

Children under 6 years old: 0.4-1.0 ml (8-20 drops \u003d 100-250 μg) 3-4 times a day. Maximum daily dose - 4 ml. Treatment of children should be carried out under medical supervision.

If necessary, the drug can be breeding with 0.9% sodium chloride solution.

Side effects
Dry mouth headache, nausea, increased sputum viscosity. Rarely: constipation, weakening of motorcycle gastrointestinal tract, urine delay, paradoxical bronchospasm, cough, tachycardia (including sufficient), flickering arrhythmia, feeling heartbeat, accommodation paresis.

Allergic reactions - skin rash (including urticule and multiform erythema), tongue swelling, lips, face, laryngospasm and other anaphylaxis. When applied in the therapeutic doses of side effect on the bronchial secretion was not noted.

Overdose
Due to inhalation of a dose of 5 mg, tachycardia is observed, but single doses of 2 mg in adults and 1 mg in children did not cause side effects. A single oral dose of a bromide ipratopia, equal to 30 mg, causes minor manifestations of systemic anticholinegic effects, such as dry mouth, accommodation paresis, an increase in heart rate. Treatment is symptomatic.

Interaction with others drugs
Enhances the bronchhalytic effect of β2-adrenomimetics and xanthine derivatives. The anticholinergic effect is enhanced by anti-parkinsonic drugs, quinidine, tricyclic antidepressants. With simultaneous use, it enhances the effect of other anticholinergic agents - additive action.

special instructions
Care should be taken at the first applications of the drug through the nebulizer. There are data on rare cases of the development of paradoxical bronchospasm. With a decrease in the efficiency of the drug, you should contact a doctor. It is not recommended for emergency relief attack of choking (the bronchhalytic effect is developing later than that of beta-adrenostimulants).

Patients should be able to properly apply the preparation of the Stratropium Stri-Sky. It should be avoided by entering the solution in the eyes. Patients predisposed to the development of glaucoma should be particularly preventing the need to protect the eye from the drug entering.

Technique of use of drug

• Before use medicinal preparation You need to read the manual of the manufacturer of nebulizers.
• Prepare a nebulizer according to the instructions of its manufacturer.
• Separate the stary-sky (ampoule with sterile solution) from the block, to do it and pull it (Fig. 1).
• Holding the ampoule vertically up the cap, break the cap (Fig. 2).
• Squeeze the solution into the nebulizer tank (Fig.3)
• Use the nebulizer according to the instructions of its manufacturer.
• The mouth should be rolled after the end of inhalation.
• If the mask was used, it is necessary to rinse the skin of the face.
• The solution remaining unused in the nebulizer chamber should be pulled out.
• Wash nebulizer thoroughly.

When using the drug, the solution to the eye should be avoided.

Form release
1 ml or 2 ml of the drug in a low-density polyethylene ampoule. 5 ampoules are soldered with each other in the form of a block. Each block is placed in laminated foil. 4 blocks along with the instructions for use are placed in a cardboard pack. For 6 blocks, along with the instructions for use, placed in a cardboard pack and 2nd cardboard packs are placed in a cardboard box.

Storage conditions
Store at a temperature not higher than 25ºС in a protected location. Do not allow freezing. Keep out of the reach of children.

Shelf life
3 years. Do not use after the expiration of the expiration date specified on the package.

Conditions of vacation from pharmacies
According to the doctor's prescription

Owner RU: Norton Helska Limited protruding under the brand name Iveks Pharmalian school Yuki, United Kingdom

Manufacturer: Ivex Pharmaceuticals Yuki Limited, Preston Brooke, Rancorn, Cheshire WA7 3FA, United Kingdom.

Address for receiving claims: 119049, Moscow, Schabovka Street, House 10, Building 2, Business Center "Concord".

(Ipratropium bromide)

Trade names

Arurthopid, Atrovant, Wagos, Efficient, Itropic.
Group Affiliation

M-cholinoblocator

Description active substance (MNN)

Bromide Jiprathopia.
Dosage form

inhalation aerosol dosage, capsules with inhalation powder, inhalation mortar
pharmachologic effect

Blocking remedy, blocks M-cholinoreceptors smooth musculature of tracheobrichial tree (mainly at the level of large and medium bronchi) and suppresses reflex bronchokonstriction, reduces the secretion of the glance of the mucous membrane of the nasal cavity and bronchial glands. Having structural similarity with the acetylcholine molecule is its competitive antagonist. Effectively prevents the narrowing of bronchi, resulting from inhalation of cigarette smoke, cold air, the actions of various bronchosphampory agents, and eliminates the spasm of bronchi associated with the effect of N.Vagus. In the inhalation use, there is practically no resortive effect - for the development of tachycardia, it is necessary to inhalation of about 500 doses, while only 10% reaches small bronchi and alveoli, and the rest settles in the throat or oral cavity and swallows. The bright effect develops in 5-15 minutes, it reaches a maximum after 1-2 hours and continues up to 6 hours (sometimes up to 8 hours).
Indications

COPD (with emphysema or without it) bronchial asthma (easy and moderate severity), especially with accompanying diseases of the SCC. Bronchospasm with surgical operations, on the background of "cold" diseases. Samples for the invertibility of bronchorate; To prepare the respiratory tract before administration of antibiotics, musolitic drugs, GKS, Cromoglycian acid in aerosols.
Contraindications

Hypersensitivity, pregnancy (I trimester) .c caution. Clotted glaucoma, urinary tract obstruction (prostate hyperplasia), children's age (up to 6 years - aerosol for inhalations, up to 5 years - solution for inhalations).
Side effects

Dry mouth, headache, nausea, increased sputum viscosity. Rarely - tachycardia, heartbeat, accommodation paresis, weakening Motoric gastrointestinal tract, constipation, urine delay, cough, paradoxical development of bronchospasm. If you get into the eyes - mydriasis, accommodation paresis, an increase in intraocular pressure (in patients with closed-nailed glaucoma), pain in the eye. Allergic reactions - skin rash (including urticaria and multiform erythym), swelling of the language, lips and face, laryngospasm, etc. manifestations of anaphylaxis. When using an intranasal aerosol - dryness and irritation of the mucous membrane of the nasal cavity, allergic reactions. Exposure. Symptoms: amplification of anticholinergic reactions. Treatment: symptomatic.
Method of application and dose

Dosage aerosol: adults and children over 6 years old - for the prevention of respiratory failure at COPD and bronchial asthma - 0.4-0.6 mg (2-3 doses) several times a day (on average 3 times), for treatment - additional inhalations can be carried out 2-3 doses of aerosol. Children under 12 years old in the treatment of asthma (as auxiliary therapy) - 18-36 μg (1-2 inhalations), if necessary, every 6-8 hours. Solution for inhalations: adults with bronchitis, emphysema, COPD - 250-500 μg 3-4 times a day (every 6-8 h) ; With asthma - 500 μg 3-4 times a day (every 6-8 h). Children from 5 to 12 years old - 125-250 μg as needed 3-4 times a day.
special instructions

Enhances the bronchological effect of beta-adrenostimulants and xanthine derivatives (theophylline). The anticholinergic effect is enhanced by anti-parkinsonic drugs, quinidine, tricyclic antidepressants. With simultaneous use with others. Anticholinergic LS is an additive effect.

Funds with low or unproved efficiency in symptomatic treatment of colds, nose, and / or frequent sneezing

The results of scientific studies show that Drops and sprays for nose with corticosteroidshaving high efficiency in many cases long running / nasal congestion associated with allergic rhinitis, chronic hymoritis or vasomotor rhinitis, they only have modest efficacy in acute infectious rheuble. On average, 14 people should use these medicines within 15 days, in order for one person to help to help significantly alleviate nose breathing.

Antihistamine drugs in the form of tablets can only be effective in people who have symptoms of a cold infection on the background of allergic rhinitis.

Acute bacterial sinusitis (sinusitis, frontititis, etmoiditis, sphenoiditis)

What is a sinusitis?

The term "sinusitis" is used in medicine to describe the state 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 with air, which are located with the right and on the left side of the nose, in the thick of the bone upper jaw. They communicate with the cavity of the nose through small holes located on the walls of the right and left nasal stroke.

From the inside the maxillary sinuses are covered with a mucous membrane, similar to the nose mucous membrane.

Besides topper sinusIn the thickness of the bones of the skull there are some more sizes of smaller sizes, which are also communicated with the nasal cavity, through small holes:

• two frontal sinuses (they are located in the thicker of the forehead in the right and left eyebrows);
• a network of sinuses of the lattice bone (they are located in the central part of the nose);
• one wedge-shaped sinus (it is located thicker wedge-shaped bone Based on the skull).

As we have already explained above, in most people, sharp viral infections of the respiratory tract (ie, cold), cause inflammation of only nasal moves. In relatively rare cases (5-10%), viral infection extends to a mucous membrane of one or more of the incomplete sinuses and causes its inflammation. In medicine, this condition is called acute viral sinusitisor Rino-sinusitis.

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

Much less often, in 0.5-2% of ill people, after termination viral infectionInside the sinuses develop bacterial infection. In medicine, this condition is called acute bacterial sinusitis. Unlike a viral infection that proceeds not dangerous and does not require any special treatmentBacterial infection of the incomplete sinuses can cause serious complications. For this reason, when her symptoms appear, a sick child or an adult needs an additional observation, and, in some cases, in a special treatment.

Of all the forms of sinusitis, the inflammation of the maxillary sinuses (sinusitis) is observed most often. Inflammation frontal sinuses (Frontitis), sinuses of the lattice bone (etmoid) or sinuses of a wedge-shaped bone (sphenoid) is observed much less frequently.

What symptoms and signs can the acute bacterial sinusitis (sinusitis) can manifest?

For acute bacterial sinusitis (and other forms of bacterial sinusitis), the following symptoms are characterized, provided that they are already present, at least 10 days *, without signs of improvement, or intensified after a short-term improvement in the state of the diseased person: purulent runny nose, i.e. release of opaque (yellowish, brown, greenish) mucus from the nose or the sensation of the mucus flowing into the throat; more or less pronounced nasal congestion; feeling of pain and / or pressure represented by sides of the nose, in the area around the eyes, in the forehead or in the whole head **; symptoms can be more pronounced with the right or on the left side or may be bilateral. * Purulent runny nose (selection of turbid, painted mucus from the nose) or increased temperaturewhich lasts less than 10 days and gradually weaken, are not signs of bacterial infection. The color of the mucus, which is highlighted during the cold, is determined by the presence of cells in it immune system (neutrophils), not bacteria, and therefore, short-term release of painted mucus is possible in viral infection. The temperature may be a sign of bacterial infection only if the disease immediately began with a high temperature (39 s and above) and is accompanied by purulent discharge from the nose for 3-4 days. ** The sinusitis can cause pain or sense of pressure in the face, with the right or left of the nose. Frontitis can cause severe headache localized in the forehead area above the eyeballs. The sphenoid, usually causes blunt pain in the back of the head, which can be given to the forehead area and behind the orbits. However, observations of big groups People who diagnosed bacterial sinusitis have been confirmed by objective surveys, showed that the localization of pain does not always indicate which separation sinuses was inflamed. Additional symptoms of acute bacterial sinusitis (and other forms of acute sinusitis) may be: the cough associated with the irritation of the throat with flowing mucus (this symptom is characteristic mainly for children); feeling of weakness, breakdown; scattering smell or complete loss of the ability to distinguish odors; pain in the upper jaw or in teeth; feeling of mortgage or pressure in the ears.

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

In this regard, all people who have the symptoms of acute sinusitis (or other shape of the sinusita) have been present for more than 10 days or has become worse after a short-term improvement, it is recommended to refer to Lor to the doctor for inspection, and, if necessary, the beginning of treatment with antibiotics.

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

In the overwhelming majority, acute bacterial sinusitis (and other forms of sinusitis) end with complete recovery and do not cause any dangerous complications or consequences.

Only in rare cases, the infection spreads out of the incomplete sinuses in the eye area or in the skull cavity and causes inflammation of the tissues of the eye, brain, or cranial brain nerves. This represents the immediate danger to the life of a fallen person and, without adequate treatment, can lead to death or difficult consequences.

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

As we have already told above, all people who have symptoms of acute sinusitis are present for more than 10 days or in which the symptoms of the disease not only do not weaken, but also gradually increase, it is recommended to refer to Laurus.

The doctor will have to inspect the ill person in order to make sure there is no signs of dangerous development of infection.

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

Conducting any additional surveys is recommended only in cases where the doctor discovers the signs of dangerous development of infection. In such situations, the doctor may suggest CT CT ( computer tomography) or MRI (magnetic resonant tomography) head.

Both of these surveys make it possible to accurately assess the condition of the incomplete sinuses and the structures adjacent to them and identify signs of dissemination of infection. Nevertheless, the results of these surveys do not allow to distinguish a viral sinusitis from bacterial. The pictures of CT and MRI viral and bacterial inflammation are manifested by the same changes.

Conducting X-ray of the incomplete sinuses is not recommended, due to the fact that, in this case, this method of examination does not allow to assess the degree of prevalence of infection.

How quickly should antibiotic treatment for acute bacterial sinusitis (sinusitis) should help? What if the treatment does not help?

In the first 2-3 days after the start of treatment with antibiotics, the state of a sick person should begin to improve gradually. If initially the sick man had a temperature, it should start to subscribe. Significant relief of symptoms may occur after 7-10 days. Full recovery (disappearance of symptoms) can take 14 days or more.

If within 48-72 hours after the start of treatment with antibiotics, a fallen child or an adult will not be better, you need to turn to Lor to the doctor to revise the treatment plan.

If, from the very beginning, the person received only symptomatic treatment, the doctor will have to recommend to begin treatment by amoxicillin.

If, from the very beginning, a person took amoxicillin, the doctor may prescribe amoxicillin in combination with clavulanic acid, for 10 days.

If a child or an adult has already accepted amoxicillin with clavulanic acid, the doctor may recommend treatment with doxycycline, antibiotics from the fluoroquinolone group (levofloxacin or moxifloxyphloxacin), a combination of clindamycin with a zephixime (or cefpodoxime) or a combination of a leinzolid with a cuefisim.

In what cases is it necessary to conduct a puncture (puncture) of the incomplete sinuses with a hyimorite?

Given the high efficiency of the available medicinal treatment And the fact that in most cases the bacterial sinusitis proceeds without serious complications, at present, the puncture of puncture (puncture) of the incomplete sinuses is considered justified in the following situations:

1. If, despite long-term treatment with antibiotics, symptoms of sinusitis (sinusitis) are not stopped or increasing. In this case, the puncture (puncture) allows the doctor to collect material to determine the sensitivity of microbes to antibiotics. Currently, for this purpose, the puncture of the incomplete sinuses is increasingly replaced by less invasive, but quite effective in this respect, endoscopic nose examination.
2. If a sick person has signs of dangerous development of infection. In this case, with the help of a puncture, the doctor can remove the liquid from the inflamed sinus and introduce antibiotics into it.

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

This section will show an explanation of the possibilities of treatment and diagnostics for people who are concerned with one or more of the symptoms indicated below:

• Frequent or permanent runny nose in the form of transparent or purulent mucous membranes from the nose or sputtering in 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 shown below, these symptoms, in different combinations, may be related to the following diseases and states:

1. Allergic rhinitis;
2. Chronic sinusitis (chronic hymorite);
3. Vasomotor rhinitis associated with such phenomena as:
   • Nose mucous membrane irritation chemicals at home or in the workplace;
   • Increased sensitivity of the mucous membrane of the nose to the cold air, the change of weather conditions, strong smells or contaminated air;
4. Changes in the reactivity of the nasal mucosa, which occurs in some people with age
5. Side effects of some drugs:
   • Sprays (drops) for nose containing vasoconstrictors;
   • Medicines from elevated arterial pressure;
   • Birth control pills;
6. Not- allergic rhinitis with eosinophilic syndrome;
7. The curvature of the nasal partition;
8. An increase in the size of adenoids (in children).

We will start with recommendations regarding drugs for symptomatic treatment A long runny nose, nasal congestion and / or frequent sneezing in children and adults, the feasibility of the use of which is supported by scientific data.

As will be shown in sections dedicated to specific diseases and states provoking chronic runny nose, nasal congestion and frequent sneezing, in most cases, it is recommended to solve these problems. symptomatic treatment.

Diagnostic surveys and analyzes at least in the initial stages may be useless to patients, since their results often do not change the treatment plan. In many cases, even after the exact diagnosis, the most effective, safe and cheap, and, consequently, the most acceptable, for most patients, the possibility of treating problems provoking a long runny nose and nasal congestion, precisely symptomatic drugs may remain.

Conducting surveys for a long running / nose / sneezing / sneezing may be appropriate, (1) If symptomatic treatment does not help solve the problem, or (2) if the doctor and patient have serious grounds to believe that the results of the surveys may affect the subsequent treatment algorithm. More detailed recommendations on this subject will be presented below, in the section on diagnostics, as well as in sections regarding the solution of each specific problem.

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

Available to date, scientific data supports the feasibility of applying the following tools for symptomatic treatment of prolonged non-nose / nasal congestion and / or frequent sneezing:

1. Regular Nose Washing Water saline;
2. Drops or sprays for nose with corticosteroids;
3. Drops or sprays for nasal with antihistamine preparations;
4. Antihistamine preparations in the form of tablets;
5. Drops or sprays for nasal with bromide ypratropy;

• Efficiency in terms of elimination of a cold, nasal, sneezing and other symptoms;
• Possible side effects and safety of treatment;
• The possibility of combining with other methods of treatment;
• Recommendations on proper use;

We believe that based on this data, readers will be able to make an informed decision on what treatment will be more appropriate in their case.

Washing the nose with salt solution during chronically rope and nasal congestion

Regularly washing the nasal salt solution is the treatment of the first line (that is, one of the most effective, safe and economically favorable treatment options), in many cases, long running and / or nasal congestion associated with chronic sinusitis (sinusitis), allergic rhinitis or vasomotor rhinitis.

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

Compared to others symptomatic drugs, Nose washing less effectively eliminates nasal congestion and does not eliminate abundant runny nose. However, if necessary, it can be combined with all other means.

What solutions can be used to wash the nose?

To wash the nose, you can use a conventional saline (it is sold in a pharmacy in large vials), or a solution prepared at home according to the following recipe: in 1 l warm water you need to dissolve 2 teaspoons of a cook salt and 2 teaspoons of food soda.

It is not recommended to use more concentrated solutions, as they are not more efficient, and can be more irritating the mucous membrane of the nose.

How to make a nasal wash with a salt solution?

To wash the nose you need to use a saline temperature of room temperature.

First you need to gain 250 ml of solution in a large syringe or at some other vessel suitable for this purpose: rubber pear, plastic bottle With a thin tip or a teapot with a long nose (there are special teapots for washing the nose).

Next steps need to be carried out above the sink:

• Bending over the sink, you need to turn your head to the side, so that the nostril you are going to rinse the first was on top.
• After that, you need to carefully enter the tip of the syringe (pears or other vessel, which you will use) in the nostril, which you will use) and start slowly enter the saline solution into the bow.
• The solution should flow throughout the nasal move and flow through another nostril or through the mouth.
• Having finished washing (i.e. using all 250 ml of solution), you can slightly unimpose.
• After that, you need to dial a new portion of the solution, turn your head in the opposite direction and repeat the procedure for the second nostril.
• Washer needed 2 times a day.

At first, the washing causes a strong burning in the nose, however, with subsequent repetitions, this feeling passes and the procedure becomes quite tolerable.

Drops and sprays for nose with corticosteroids during chronic rheore and nose

The research results indicate that, with systematic use, drops or sprays for nose with corticosteroids (glucocorticoids) are one of the most effective tools For the symptomatic elimination of the nasal congestion, as well as the runny nose, frequent sneezing and itching in the nose associated with:

• allergic rhinitis,
• chronic sinusitis (with polypami and without polyps),
• vasomotor rhinitis,
• non-allergic rhinitis with eosinophilic syndrome,
• medication rhinitis associated with long use of droplets or sprays from a cold with vasoconducting means.

Currently, preparations containing the following active substances are available:

• Triamcinolone acetonide;
• Budesonide;
• Flunisolide;
• Flitazone propionate;
• Flitazone Furoate;
• Mometazone Furoate;
• Cyclesonide;
• Becklametazone dipropionate.

Clinical studies, during which a comparison of drugs with different active substances from this group have been compared, showed that they all have comparable efficiency. In this regard, if you don't satisfy you with one active substance (price, smell, the taste in your mouth after application, form: spray or drops, etc.), you can try another medicine, with another active substance.

The effect of droplets and sprays for the nose with corticosteroid drugs is developing slowly, on average, for the first 5-36 hours after the first application. In this regard, these drugs are not suitable for cases when it is necessary to quickly eliminate the runny nose, nasal congestion, sneezing or itching in the nose. Much more suitable means for this purpose are the antihistamine drugs in the form of nasal sprays and tablets, as well as drops and sprays with vasoconducting agents and the bromide and yipratropy.

On the other hand, with systematic use, drops and sprays for the nose with corticosteroids provide reliable monitoring of nose and runny nose.

With an allergic rhine, the maximum effect is developing within 1 week of regular use of these drugs.

In chronic sinusitis and vasomotor ritin, finally evaluate the effectiveness of treatment in 3 months of systematic use of these drugs.

If necessary, droplets and sprays for nose with corticosteroid drugs can be combined with other means. In particular, the combination of these drugs with regular washing of the nose salt solution increases the effectiveness of treatment in terms of eliminating a cold and nasal congestion associated with chronic sinusitis.

If in a few months of proper use, these funds will not be able to effectively eliminate the nasal congestion, itching into the nose, sneezing or water rhosts, they can be combined with drops and sprays for nose with antihistamine drugs.

What side effects can cause these medicines?

Under the condition of proper use, drops and sprays for nasal with corticosteroid drugs rarely cause any serious side effects.

The most frequent side effects of these drugs are associated with the irritation of the mucous membrane of the nose and include: a feeling of dryness in the nose, a feeling of burning or tingling in the nose after using the drug, it is possible to appear blood streams in the mucus that is distinguished from the nose.

On average, 4-8% of people who regularly use these medicines, there are minor bleeding from the nose, but during the studies, this by-effect With the same frequency appeared in the group of patients who took placebo Placebo

.

The probability of the appearance of bleeding from the nose and other side effects can be reduced due to the proper application of the drug in the nose:

1. Shoot the vessel with the medicine well;
2. Tilt head forward, looking into the floor;
3. After the introduction, you do not need to deeply inhale the medicine or throw the head. If the remnants of the drugs will flow from the nose, they can be blocked with a nose handkerchief. After making medicine, you can wash it to finally wash off its remnants from the skin.

In rare cases, with long-term use of droplets and sprays for nasal with corticosteroids, perforation is possible, i.e. The appearance of the hole in the nasal partition. It can manifest frequent bleeding from the nose.

It is reliably known that careless use outcomes and creams for skin With corticosteroids can cause skin atrophy (see Recommendations for the safe use of ointments and creams with corticosteroid hormones). However, observations of people who used drops and sprays for a nose with corticosteroids for a long time (from 1 year 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 work endocrine system And on metabolism. In particular, these drugs do not change the production of natural corticosteroid hormones in adrenal glands, do not contribute to the emergence of overweight, diabetes or increased blood pressure (as opposed to long-term treatment with corticosteroids in the form of tablets or injections).

Observations of people who use drops (sprays) for nose with corticosteroids show that these drugs do not affect the state of the eyes (unlike eye dropswhich can contribute to an increase in intraocular pressure and the development of cataracts). Nevertheless, if you would like to use nasal drugs for a long time, be sure to ask the doctor if you need to periodically measure intraocular pressure.

The effect of droplets and sprays for nose with corticosteroids on growth in children was studied during several studies. It was found that the use of propionate budesonide preparations and backetsone drugs can cause a slight slowdown in the child's growth (growth slowdown was estimated compared to the projected growth rates, which the child was to be achieved at the end of the year of observation).

At the same time, it was found that the preparations of fluticasone propionate, momethazone of the furoate and trimcenolon of acetonide do not have any influence growth. In this regard, at the moment, for the treatment of allergic rhinitis, vasomotor rhinitis or chronic sinusita In children, these medicines are recommended first.

Antihistamine preparations in the form of pills in chronic cold and sneezing

If the most pronounced and unpleasant symptoms are runny nose (release of water mucus), sneezing and itching in the nose, highly effective symptomatic agents can be antihistamines of second generation in the form of tablets.

Currently, drugs containing such active substances as:

• Cetirizin,
• Levocetyriazine
• Fexophenadine
• Loratadine,
• Desloratadin.

Compared to older drugs (diphenhydramine, chloropheniramine, hydroxyzine), these drugs are not caused (or cause, but to a much lesser extent) drowsiness and reducing vigilance.

The most frequent side effects of antihistamine drugs in the form of tablets is:

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

The effectiveness of these funds was proved during a number of studies in which patients with allergic rhinitis took part. The results of these studies have shown that, in terms of eliminating the nasal congestion, antihistamine drugs in the form of tablets are somewhat less effective than drops and sprays for nose with corticosteroids, however, they can be a very suitable solution for many people with a slight or medium criticized rhushed, sneezing or Itching in the nose.

The effect of treatment becomes noticeable during the first hours after taking medication. Maximum positive effect Developed with systematic and long-term reception of these drugs (within a few weeks).

With an allergic rhine, different antihistamines have different biological properties and can demonstrate different efficacy from different people. For this reason, if one medicine does not help or cause unpleasant side effects, it may be the right solution to try another drug.

If a person already takes constant treatment with drops or sprays with corticosteroids, adding antihistamine drugs in the form of tablets, usually does not increase the effectiveness of treatment.

On the other hand, if a person started treatment with antihistamine drugs in the form of tablets and this treatment does not well control the symptoms of allergic rhinitis (for example, it does not have enough nasal congestion), treatment efficiency can be increased by adding drops or sprays for nasal with corticosteroids.

Antihistamines in the form of droplets or sprays for the nose during chronically rope, sneezing and nasal congestion

According to the results of studies, drops and sprays for nasal with antihistamine preparations are very effective symptomatic means against rhinar, sneezing, itching in the nose and nasal congestion associated with allergic rhinitis, chronic sinusitis and vasomotor rhinitis.

Sprays with antihistamine drugs can be combined with washing the nasal with brine and with nasal preparations with corticosteroids. The superiority of combination treatment, compared with the treatment of any of the funds separately, was proven during observations of people with severe symptoms of allergic rhinitis, vasomotor rhinitis and chronic sinusitis.

Currently, drops and sprays for nose, containing antihistamine drugs such as azelastine and solatadine. Different agents containing these active substances have comparable effectiveness.

Possible side effects from the use of droplets and sprays for nose with antihistamine drugs can be: a feeling of burning in the nose, an unpleasant bitter taste in the mouth (after applying the medication) and headache. Sleepiness is observed with a frequency of 0.4-3% (and almost with the same frequency in the group of people receiving Placebo Placebo- Any substance does not have the properties of medication, but externally similar to the medicine.
Placebo uses in studies of dedicated to study the effectiveness of drugs in the treatment of certain diseases: one group of patients give a real medicine, and the other group is placebo, while patients in the second group are confident that they receive a real medicine.
Comparison of the results of treatment in both groups allows you to determine which of the treatment effects are associated directly with the action of the drug.). Also possible bleeding from the nose. The probability of the appearance of this and other side effects can be reduced by the proper administration of the drug:

1. Shake the vessel with the medicine well.
2. Tilt head forward, looking into the floor.
3. Place the tip of the bottle with the medicine in the nostril. The bottle needs to be left hand for the right nostril and right hand for the left nostril.
4. It is necessary to send the tip towards the outer side of the nasal cavity, since the drug entering the nasal partition often causes irritation and bleeding.
5. After the introduction, you do not need to deeply inhale the medicine or throw the head. If the remnants of the drugs will flow out of the nose, they can be launched with a nose handkerchief.

The advantages of sprays with antihistamine drugs (compared to antihistamine preparations in the form of tablets) are as follows:

• They rarely cause side effects (in particular there is no risk of reducing vigilance, which may be important for people working with complex equipment or when driving a car).
• They are more effective in terms of eliminating the nasal.
• They help people with allergic rhinitis, which antihistamine medicines did not help in the form of tablets.
• Their action begins very quickly - after 15-20 minutes (compared to 150 minutes in the case of preparations in the form of tablets).

IPRATRUE Bromide with frequent or chronic cold

Drops and sprays for a nose with a bromide iprathopia block the work of glands that produce sputum into the nose. Preparations containing this active substance can be very effective in terms of symptomatic treatment of rhiny, but they almost do not eliminate the nasal congestion.

The use of nasal sprays with bromide yipratropy (0.03%) can be the best solution in situations under which a runny nose appears in the form of heavy liquid seals from the nose:

• rubber, which appears in some people in cold weather;
• rubber in contact with strong smelling substances or smoke;
• rubber characteristic of the elderly;
• strong runny nose with allergic ritin, etc.

With a very strong rheore, more concentrated means containing 0.06% of the bromide iphtropy can be used.

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

If necessary, the bromide and bromide can be combined with other symptomatic means if they are not well eliminated well.

Means that should not be used to treat a long runny nose or can only be used for a short period of time

For long-term symptomatic treatment, the runny nose and nasal congestion is not recommended to use vasoconstrictor drugs in the form of droplets or sprays for the nose. As mentioned above (see Symptomatic treatment of a cold rheumat and nasal congestion, at home, in children and adults) The safety and effectiveness of these funds, at the moment, are not studied enough, especially in children.

In addition, there is reason to believe that during long-term use, these drugs not only do not eliminate the nasal congestion, but also can increase it.

Diagnostic capabilities with prolonged rope and nasal congestion

As mentioned above, unlike many other problems, in which the decision begins with a survey for the formulation of an accurate diagnosis, with a prolonged (chronic) rheore / nasal congestion, in many cases, a more appropriate solution is the beginning of symptomatic treatment, without surveys.

Surveys and analyzes are becoming appropriate in the following situations:

• If symptomatic treatment with the above preparations did not help to eliminate the runny nose or nasal congestion (for several months of proper use);
• If the doctor and patient have reason to believe that the results of the surveys may affect the subsequent treatment algorithm.

Below we describe the main surveys and analyzes, the feasibility of which in chronic rheore and / or nasal congestion is maintained by scientific data:

1. Analyzes for allergens;
2. Endoscopic nasal examination;
3. Computer tomography of the nose and the incomplete sinuses.

For each survey, we will show how its results can affect the tactics of treatment.

Analyzes on allergens

Analysis on the most common air allergens allows you to determine whether there is a long runny nose, nasal congestion and / or frequent sneezing to be associated with such substances like pollen plants, particles of ticks present in home dust, disputes of mold, dandruff pet, etc.

In cases where the analysis shows that a person really has increased sensitivity to one or another allergens, a doctor and patient may assume that the cause of the problem is allergic rhinitis and, except for symptomatic tools, they can choose two new treatments:

(1) A person can try to eliminate allergen from his environment to which he has increased sensitivity. As will be shown below, in the section on an allergic rhinitis, some people, adequately organized measures to eliminate allergens help significantly alleviate the runny nose and nasal congestion.

The problem, in this case, is that the elimination of some allergens (for example, ticks in home dust or mold argument) can be a very time-consuming or even impracticable task.

In this regard, the analysis of allergens is appropriate, only if a person got acquainted in advance with what measures may be required to eliminate allergens and considers them acceptable in their situation.

(2) in case of detection increased sensitivity To a specific allergen, a person can also try treatment by immunotherapy. Immunotherapy allows you to normalize the body's reaction to the allergen and can significantly reduce the need for medicines for the symptomatic treatment of allergic rhinitis. Disadvantage of immunotherapy is the fact that it takes for a long time (at least several years), implies certain expenses (as well as symptomatic treatment), and is associated with a certain (albeit exclusive) risk of a hazardous anaphylactic reaction.

In this regard, the analysis of allergens may be appropriate if a person has familiarized himself with the peculiarities of immunotherapy from the very beginning, and this method finds this method for a permissible choice in his situation.

In all other cases, for the patient himself, analyzes for allergens are useless. If the analysis shows the increased sensitivity to one or another allergens, but the person does not consider the removal of allergens or immunotherapy applicable in its situation, the only treatment option for it will remain symptomatic means that it could use and without this analysis.

Another problem associated with the analysis of allergens is the fact that in some people who first show the absence of increased sensitivity to allergens over time, the sensitivity to one or another allergen is still developing. This means that the results of allergens analyzing are not allowed to completely exclude allergic rhinitis in people who have a runny nose and nasal congestion for a long time.

Endoscopic nose examination

During the endoscopic survey, the ENT doctor introduces a special optical tool into the nose cavity (it looks like a thin tube or cord), which allows, with great accuracy, to inspect the inner surface of the nose and the outlet holes of the incomplete sinuses.

The value of the 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 an average nose passage, presence of polyps in the nasal cavity, etc. With the help of this survey, the doctor may also exclude other, more rare, reasons for long running and / or nasal congestion (for example, the presence of a tumor in the nasal cavity).

(2) Endoscopy makes it possible to assemble a wet from the outlet holes of the incomplete sinuses for bacteriological sowing. With this analysis, you can determine the sensitivity of the microbes to antibiotics. This information may be useful if symptomatic treatment turned out to be unsuccessful and the doctor plans treatment with antibiotics.

The question regarding the feasibility of carrying out endoscopy is related to the fact that in chronic sinusitis, in the initial stages, only symptomatic treatment is recommended (washing the nose with brine + sprays for nasal with corticosteroid drugs). In this regard, the identification of accurate signs of chronic sinusitis with endoscopy does not change the initial treatment plan, and, therefore, does not have practical benefit for the patient.

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

In such a situation, the endoscopic nose inspection helps to determine if there are any other reasons that support prolonged runny nose and / or nasal congestion. In particular, endoscopy makes it possible to exclude (or confirm) the presence of the curvature of the nasal partition or much more rare problems: tumors or fungal infections. If the survey shows ...

R03AK03 (Fenoterol in combination with other drugs)
R03BB01 (Ipratropium Bromide)
R01AB06 (xylometazoline in combination with other drugs)

Analogs of the drug in ATX codes:

Before using the drug, Bromide, you should consult with your doctor. This application instruction is intended exclusively for familiarization. For more information, please contact the manufacturer's annotation.

Clinical and pharmacological groups

12.005 (Broncholic drug - Blocator M-cholinoreceptors)
24.029 (vasoconductive drug for local application in LOR-Practice)
12.001 (bronchhalytic drug)

pharmachologic effect

Blocator M-cholinoreceptors. It is believed that the expansion of the bronchi, caused by the bromide, caused by the bromide, is due to competitive binding to M-cholinoreceptors smooth muscles Bronchi. Reduces the secretion of the glands (including bronchial and digestive).

Prevents the narrowing of the bronchi, resulting from inhalation of cigarette smoke, cold air, the actions of various bronchokonstrictor substances.

With inhalation, there is practically no resortive action. With systemic use causes an increase in heart rate, improves AV conductivity; Unlike atropine does not affect the CNS.

Pharmacokinetics

With the inhalation route of administration for the bromide, the bromide is characterized by extremely low absorption from the mucousa of the respiratory tract.

Concentration active substance The plasma is located on the lower boundary of the definition, and it can be measured only when using high doses of the active substance, as well as through the use of specific enrichment methods. In the inhalation use in the therapeutic doses, the concentration of the plasma bromide in the plasma bromide was 1000 times lower than after receiving inside and in / in administration. Does not cumulative.

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

IPRATRUE Bromide: Dosage

Individual, depending on the testimony, the age used for the dosage form.

Medicinal interaction

With simultaneous use with anticholinergic agents, an additive action occurs.

With simultaneous use, the bronchological effect of beta adrethrenimetics and xanthine derivatives is potentiated.

See also:

With the simultaneous use of anti-parkinsonic drugs, quinidine, tricyclic antidepressants is possible to enhance the anticholinergic effect of the bromide ipratopia.

With simultaneous use with salbutol, the risk of increasing intraocular pressure and the development of acutely closed gloomy, especially in predisposed patients.

Pregnancy and lactation

Application in II and III trimesters of pregnancy is possible with strict indications. Contraindications for use during lactation are not established.

Hipratropy Bromide: Side effects

With inhalation use: dry mouth, increased sputum viscosity.

When entering eyes - disorders of accommodation; In patients with a closedian glaucoma, an increase in intraocular pressure is possible.

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

Under systemic use: dry mouth, anorexia, constipation, accommodation violation, an increase in intraocular pressure, urination disorders, reducing the secretion of sweat glands; Rarely - extrasystolia.

Indications

For inhalation applications: Treatment and prevention of chronic obstructive diseases of the respiratory tract: chronical bronchitis from broncho-prestructive syndrome (with or without emphysema), bronchial asthma light and moderate severity, especially with accompanying diseases of the cardiovascular system; Bronchospasm with surgical operations. Preparation of the respiratory tract before introducing antibiotics in aerosols, Mulitatic tools, GKS, sodium chromiumlicate.

For intranasal applications: chronic rhinitis With hypersecretion.

For introducing inside and in / in the introduction: sinus bradycardia, due to mainly influence wandering nerve, bradyarithmias with synoyatrial blockade, AV blockade of the II degree, bradyism form of atrial flicker.

Contraindications

Increased sensitivity to the IPratropy Bromide.

Mostly for systemic use: an increase in intraocular pressure, prostate hyperplasia, mechanical stenosis of the gastrointestinal tract, tachycardia, megalolon, I trimester of pregnancy.

special instructions

With caution to apply in the form of inhalation in patients with closed-dealer glaucoma, urinary tract obstruction due to prostate hyperplasia.

If you need to emergency relief, the attack of suffocation monotherapy and bromide is not recommended, because His bronchological effect is developing later than that of beta adrenomimetics.

The safety and efficacy of intranasal use in children under 12 years is not defined.

Impact on the ability to driving vehicles and control mechanisms

Given the possibility of the influence of the IPratropy of bromide on visual acuity, caution should be taken when driving vehicle And other potential hazardous species Activities.