If your baby is coughing. Choosing medications for children under 3 years of age

Updated: 04/23/2021 15:29:31

Expert: Pogrebnoy Stanislav Leonidovich

*Review of the best according to the editors of expertology.ru. About the selection criteria. This material is subjective in nature, does not constitute advertising and does not serve as a purchase guide. Before purchasing, consultation with a specialist is required.

All medications that are classified as expectorants, or expectorants, serve one purpose: to effectively remove mucus from small and medium-sized bronchi.

Accumulated mucus must be removed, since it constantly irritates the sensitive endings, or receptors of the cough reflex arc. As a result, the patient begins to cough and bronchospasm occurs. Sputum is a very good breeding ground for the proliferation of not only viruses, but also pathogenic bacteria and fungi. Finally, trophic disorders of the mucous membrane of the bronchial tree, caused by excessive accumulation of sputum, lead to chronic inflammation, which can accompany a person for many years.

In some cases, sputum is poorly expectorated, stagnation and secondary infection with bacterial flora occur, and this contributes to the chronicity of the pulmonary infection. Medicines that help remove phlegm by stimulating physiological mechanisms are classified as expectorant drugs.

In other cases, the physiological mechanisms of expectoration of sputum work well, but it is so thick that it does not clear on its own. Therefore, in this situation, other means are needed that act not on the mechanisms of sputum removal, but on its physical and chemical properties. They contribute to the liquefaction and melting of sputum, and therefore are called mucolytics, in some cases you can find another name - secretolytics.

Finally, there is a third group of drugs that help fight cough. But their effect is completely opposite: they do not contribute at all to stimulating the discharge of sputum, nor to its liquefaction, nor to expectoration. They simply struggle with coughing as a painful symptom that significantly reduces their quality of life. After all, not every cough needs good drainage and sputum removal.

There are such conditions, for example, associated with excessive irritation of cough receptors (after being in a smoky atmosphere). And in this case, we need drugs that suppress either the cough center located in the brain, or act on receptors that are located in the bronchi and reduce their sensitivity. As a result, cough, as a symptom, either begins to bother you much less or disappears completely. This rating of cough medications includes representatives of all these three groups.

Rating of the best expectorants

Medicines that stimulate expectoration

These medications mainly affect the ciliated or ciliated epithelium, which covers the inner mucous membrane of the bronchi. They stimulate special movements of the bronchioles, that is, small bronchi, which resemble intestinal peristalsis. The task of the peristaltic waves of the bronchi is to move sputum from the depths to the periphery. Also, these expectorant medications stimulate an increase in the secretion of secretions by the bronchial glands, and slightly reduce the thickness of sputum, although this is not their main function. Among these medicines there are quite a few of herbal origin, and they work effectively, despite the existence of other, synthetic drugs.

Pertussin

Rating: 4.9

The rating of effective and affordable expectorant drugs Pertussin opens. This is a complex medicine that consists of thyme extract, supplemented with potassium bromide. In fact, Pertussin belongs to two groups at once: both stimulants and mucolytics. After all, potassium bromide is a compound that is very good at thinning sputum.

The product is produced in the form of syrup, and is used in adults at 15 ml in a single dose, or one tablespoon, and for children it is prescribed in a much smaller dose - from half a teaspoon three times a day. The dosage is prescribed individually by a pediatrician. Pertussin, like other drugs from this group, is used for the treatment of acute inflammatory diseases of the bronchopulmonary system - tracheitis, bronchitis, laryngitis, and in the treatment of pneumonia. A significant number of domestic pharmaceutical enterprises produce the drug Pertussin. Pertussin is a very inexpensive and popular expectorant medicine. One 100 ml bottle of syrup can be purchased for 12 rubles.

Advantages and disadvantages

The disadvantages of Pertussin include its slow expectorant effect: it is indicated for a course of treatment, with a minimum duration of 10 days. Also, if the patient is intolerant to bromide, heartburn or allergic reactions may occur, and in case of overdose, nausea may occur. Pertussin is not indicated for everyone. Considering that Pertussin contains a small amount of ethyl alcohol, it should not be prescribed to persons with severe liver damage, alcoholism, epilepsy, and children under three years of age. It should not be prescribed to diabetics, since the bulk of the excipients is sugar syrup. The obvious advantage of Pertussin is the lowest price of all possible expectorant drugs in the ranking, which is why it occupies the first “popular” place.

Mukaltin

Rating: 4.8

Mucaltin is a tableted dry extract of medicinal marshmallow, and is classified as a herbal medicine; each tablet contains 50 mg of dry extract. Mucaltin is indicated for pneumonia, acute and chronic bronchitis, obstructive pulmonary diseases, and bronchiectasis. The principle of action of Mucaltin is classic for this group, and is explained by an increase in the activity of the ciliated or ciliated epithelium of the bronchi, increased peristalsis and increased bronchial secretion, which leads to effective expectoration. Mucaltin is used according to a simple regimen: 1 or 2 tablets three times a day, taken before meals. When prescribing Mucaltin to children, you can first dissolve the tablet in a small amount of water; the drug can be prescribed to children aged 12 years and older. Mucaltin is produced by several domestic enterprises, for example, Medisorb, Pharmstandard. A package of 30 tablets will cost the patient only 41 rubles.

Advantages and disadvantages

The advantages of the expectorant Mucaltin include good tolerability and the absence of overdose symptoms, availability and low price, the ability to combine Mucaltin with other drugs for the treatment of bronchial diseases, it is allowed during pregnancy and breastfeeding. In rare cases, allergic reactions and symptoms of dyspepsia may occur: abdominal discomfort, mild nausea. The disadvantages of Mucaltin include its insufficiently rapid onset of effect: it takes several days to activate physiological mechanisms. But almost all drugs that act only on “physiology” suffer from this drawback, unlike mucolytics, in which the sputum, when used, liquefies literally after a few hours.

Licorice syrup

Rating: 4.7

Licorice root is an effective and popular herbal expectorant. Glycyrrhizin contained in licorice enhances the secretion of the glands of the upper respiratory tract, which facilitates the production of sputum. Licorice is produced in different dosage forms, both in the form of syrup and in the form of lozenges.

If we are talking about syrup, then you need to take into account contraindications, which are caused by the presence of 10 g of ethyl alcohol and sugar syrup. Thus, it is not advisable to give licorice syrup to children, pregnant women, people suffering from chronic alcoholism, those with consequences of traumatic brain injury and epilepsy, as well as diabetics. Chewable tablets do not have such restrictions.

Expectorant syrup should be used in adults one teaspoon three times a day, diluting it in a glass of water, and in the case of tablets - one or two tablets three times a day - until completely absorbed. In both cases, if the sputum does not come out well, you need plenty of warm drinks. By the way, this advice is good for all medications without exception that stimulate sputum production, and alkaline mineral water is especially good.

The indications for the use of various forms of licorice are exactly the same - inflammatory diseases of the bronchi, cough, in which there are difficulties with the removal of sputum. Licorice syrup is produced by the Tula Pharmaceutical Factory, and lozenges are produced by Vneshtorgfarma. In the case of tablets, one package of 50 pieces can be purchased for 130 rubles.

Advantages and disadvantages

Licorice is good for the removal of sputum, it can be used in complex therapy with other medications, and has no interactions. But still, sometimes patients may experience side effects, signs of individual intolerance - diarrhea and allergic reactions, and if licorice preparations are used for too long, it helps to reduce the concentration of potassium in the blood. This can lead to increased blood pressure, changes in electrolyte metabolism in the body, and contribute to the development of peripheral edema, so licorice should be used in short courses or under medical supervision.

Cough syrup from Universal Pharma

Rating: 4.6

This drug, or medicinal product, can claim to be unique in the rating due to its simple and effective name, which has a clear commercial benefit. It is enough for the patient, upon coming to the pharmacy, to say that he needs “cough syrup”, and the finished bottle will appear on the counter. In fact, cough syrup is a combination of the components that were described above. This syrup contains marshmallow, licorice, echinacea and vitamin C.

In addition to its effect on the physiological mechanisms of sputum removal, this syrup can be prescribed for chronic infections of the bronchopulmonary system, and has a general strengthening property. This syrup is used three times a day, 2-3 teaspoons dissolved in warm water during meals. This syrup is produced by the domestic company Universal Pharma, and 100 ml of syrup costs only 75 rubles.

Advantages and disadvantages

Unlike the previous forms in the form of expectorant syrup described above, this syrup does not contain ethyl alcohol, but only sugar and potassium sorbate. Therefore, the only limitation for the use of this syrup is diabetes mellitus, but it is indicated for children and can be used in people suffering from alcohol dependence, in the presence of epilepsy and in the consequences of brain injuries. The effectiveness of this syrup is higher than the individual use of Mucaltin and licorice, since it is a complex preparation.

How to help with a cough in a baby without fever

If a child coughs frequently and this prevents him from breathing and eating, the help of a pediatrician is needed. In case of rare attacks, it is necessary to try to find the cause of the cough reflex from the above and provide assistance to the baby:

• take the baby in your arms and calm him down;
• free his chest from tight clothing;
• give the child warm water;
• provide access to fresh air in the room, take a walk with your child outside;
• If there is a large amount of mucus and crusts in the child’s nose, they must be carefully removed with a soft cloth and an aspirator.

A nursing mother should reconsider her diet, try to do wet cleaning in the baby’s room more often, not turn on the batteries at full power during the cold season, and use a humidifier.

If your baby gets sick with ARVI, it is necessary to start antiviral therapy.

The best mucolytic drugs for expectoration

Mucolytic drugs do not act on the physiological mechanisms of the bronchopulmonary system, and not on secretion, but only on the sputum itself. The main mechanism of their action is the activation of enzymes that produce sputum hydrolysis, or the breakdown of mucus molecules (mucins) into more mobile fragments. But, despite the composition of mucolytics, it is imperative to remember that along with these medications for expectoration, it is imperative to prescribe plenty of warm fluids, at least one and a half liters per day, if we are talking about treating an adult. If there is a deficiency of fluid, no matter how well the drug affects the structure of sputum, it will be very difficult to remove it.

Ambroxol (Ambrobene, Ambrohexal, Ambrosal, Bronchovern, Lazolvan, Medox)

Rating: 4.9

Such a number of different synonyms and trade names indicates the great popularity of all products that contain Ambroxol. We will look at one of the most popular and high-quality drugs, Ambrobene, which is produced by the German company Merkle. Ambroxol is a classic mucolytic - benzylamine. Unlike drugs of the first group, it begins to act not after a few days, but after 30 minutes. In addition to its effect on sputum, Ambroxol has a slight effect on the glands and epithelium. This substance helps form a surfactant, or a special fat-like lubricant that coats the smallest respiratory units, the acini, from the inside and prevents them from sticking together.

The expectorant Ambrobene is indicated for all diseases of the bronchopulmonary system, both acute and chronic, in which sputum is poorly formed and discharged. In this article we will not dwell in detail on dosage regimens, since Ambrobene is produced not only in tablets and syrup, not only in capsules that have a prolonged effect, but also in a solution for intravenous administration, and even in the form of a solution for ultrasonic inhalation. In each of these cases there may be a special dosage regimen prescribed by the doctor. Ambrobene in tablets can be bought for 100 rubles, one bottle of syrup with a volume of 100 ml - for 100 rubles, and extended-release capsules and a solution for intravenous administration will cost approximately in the same price range.

Advantages and disadvantages

Since this drug is artificially synthesized, it can and quite often develops some side effects. These include nausea, various taste disorders, and occasionally dry mouth and throat. All Ambroxol preparations, including Ambrobene, are contraindicated in the first trimester of pregnancy, in later stages - only as prescribed by a doctor, and after assessing the degree of risk. It is better not to prescribe Ambroxol in patients with severe impairment of liver and kidney function. Ambroxol is indicated for children, but under the age of two years it is necessary to be treated only under the supervision of a specialist. A huge advantage of Ambrobene is its very rapid effect and availability in various forms of administration.

Fluimucil (Acylcysteine, ACC)

Rating: 4.8

This expectorant, which is available both as a solution for oral administration and inhalation, and in granules and effervescent tablets, contains acetylcysteine. Its action is based on the ability of sulfhydryl groups, or sulfur-hydrogen compounds, to break apart the mucopolysaccharide molecules that make up sputum. As a result, the molecules become shorter, which reduces the viscosity of sputum, increasing its fluidity and ability to leave the bronchial tree.

This drug in any form is well absorbed from the gastrointestinal tract, and works equally well both when used internally and in inhalation. Fluimucil has a wide range of indications, and, in addition to traditional inflammatory bronchopulmonary diseases, it is successfully used for emphysema and cystic fibrosis, and for lung atelectasis, when the communication of a segment with its bronchus is disrupted by blockage of the bronchus with a plug of dense sputum.

If we talk about effervescent tablets, the dosage regimen for adults is very convenient. One 600 mg tablet is dissolved in half a glass of water and drunk, with a frequency of only once a day. To use other forms, consultation with your doctor is necessary, especially when prescribing inhalations for the first time. Fluimucil is produced by the Italian pharmaceutical company Zambon, and the price of this drug is low. The most expensive form is effervescent tablets, and one package of 20 pieces will cost 370 rubles. But you need to remember that one tablet is enough for one day of use, which means that this package will last for 3 weeks.

Advantages and disadvantages

An undeniable advantage of Fluimucil, which more than compensates for its shortcomings, is its powerful liquefying effect. Not every expectorant drug will be able to expel a dense mucus plug that has clogged the main segmental bronchus and caused atelectasis of the lung, that is, its exclusion from breathing. But this remedy has side effects: sometimes heartburn, sometimes skin rash. Contraindications include exacerbations of gastric ulcers, for granules – children under 2 years of age, and for effervescent tablets even up to 18 years of age, lactation and pregnancy, as well as liver and kidney diseases.

Bromhexine (Bronchotil, Paxirazole, Solvin, Phlegamine)

Rating: 4.7

The expectorant Bromhexine is a mucolytic and at the same time a stimulator of bronchial smooth muscles. Just like Ambroxol, it stimulates the synthesis of surfactant, which facilitates alveolar ventilation, and is indicated for all chronic diseases of the bronchopulmonary system with an inflammatory component. It can also be used for chest injuries, in the preoperative period and after thoracic operations in complex therapy. The most commonly produced tablets contain bromhexine hydrochloride in dosages of 4 and 8 mg. It is used in uncomplicated cases, one to two tablets three times a day, depending on age, the dosage may vary, so it is prescribed by a doctor. In addition to tablets, there is a solution, syrup for inhalation and other forms for convenient use.

Bromhexine, like the popular Ambroxol, is produced by many different companies. This is Berlin-Chemie, this is Grindeks, this is Nycomed and Akrikhin, and other companies. The cheapest tablets can be purchased for 9 rubles. for a package of 50 tablets, and of course, it will be the domestic pharmaceutical company Ozon. For comparison, the same dosage of 8 mg, but only in a package of not 50, but 25 tablets, produced by the German company Berlin-Chemie, will cost from 95 rubles.

Advantages and disadvantages

Bromhexine is a convenient and powerful drug, available in various dosages and forms, is inexpensive, and acts as quickly as acylcysteine ​​or Fluimucil. But this drug has contraindications, and, in addition to individual intolerance, it is also necessary to take into account exacerbation of gastric and duodenal ulcers, breastfeeding and the first trimester of pregnancy. This expectorant is not recommended for use in children under three years of age.

Libexin Muco (Carbocysteine)

Rating: 4.6

The active ingredient of the drug Libexin Muco is carbocisteine. Carbocysteine ​​is similar to acylcysteine, but slightly modified. It affects the glycoproteins of bronchial secretions and mucus, but at the same time it is capable of activating a special enzyme called sialic transferase. As a result, special cells of the bronchial mucosa begin to secrete it, and this leads to a stable balance of the acid-base state of the mucus, namely, to the normalization of the ratio of acidic and neutral components. As a result, the mucus becomes more liquid, and even helps to protect and improve the regenerative properties of the bronchial membrane.

Carbocysteine ​​is able to improve the secretion into the bronchial lumen of special antibodies, or secretory immunoglobulins of class A. The medicine is indicated for all diseases in which sputum becomes very viscous and difficult to separate. The drug is also prescribed as a prophylactic agent before bronchoscopy, to facilitate the procedure.

This expectorant is available in syrup form and adult patients need to take 15 ml three times a day, while children need a lower dosage as prescribed by the doctor. This drug is produced by the French company Sanofi, and you can purchase a 125 ml bottle starting at a price of 400 rubles.

Advantages and disadvantages

One of the undeniable advantages of Libexin Muco is not only the ability to treat diseases of the bronchopulmonary system, but also to use it to liquefy mucous secretions in diseases of the ENT organs, for example, chronic rhinitis and sinusitis. Libexin Muco has some contraindications, which include not only peptic ulcers, like other mucolytics, but glomerulonephritis and cystitis. It is also contraindicated in pregnant women and children under two years of age, and special monitoring is required when taking this drug in diabetics, since the syrup contains sugar.

Antitussives

The purpose of antitussive drugs is to suppress cough as a process, and these drugs should be used only when the doctor is sure that the removal of sputum will not cause any benefit to the patient, and the inhibition of cough centers in the brain, or a decrease in the activity of peripheral receptors will not cause harm to the patient. In the event of a diagnostic error, a significant deterioration in the patient's condition may occur.

So, with a painful and dry cough, which is one of the symptoms of an acute respiratory viral infection, an inexperienced doctor can immediately prescribe antitussive drugs, that is, begin to fight the cough, instead of stimulating sputum production. The patient will no longer experience the painful sensation, but the pathological process of transforming viral bronchitis into bacterial bronchitis will continue in the bronchi, and purulent sputum will form and accumulate. As a result, a high temperature may rise, signs of intoxication, shortness of breath, pain in the side, and pneumonia will develop. Therefore, there are certain and specific indications for prescribing antitussives. It is much safer to err on the other side and prescribe mucus secretions by mistake than to suppress a cough unnecessarily.

Of course, the cough reflex is most strongly suppressed by drugs with the so-called narcotic potential, based on codeine phosphate - 3-methylmorphine, one of the opium alkaloids. These are drugs such as Dianin and Estocin. But we will not dwell on medications for the prescription of which strict prescription forms are required; we will dwell on those cough medicines that can be bought without a prescription.

But, before starting to list them, it is necessary to make it clear to the reader, who will use the acquired knowledge in practice, that on your own, without a doctor’s prescription, and especially for the first time and without permission, in no case should you prescribe these drugs to yourself. There is a very good chance that more harm will be done than good.

Sinecode (butamirate)

Rating: 4.9

First of all, the name of the drug itself is interesting. Almost all drug names that indicate their composition provide information about what the drug contains. The drug Sinekod immediately states what is not in it. Translated from Latin, sine codeinum means “devoid of codeine”, containing no codeine. Thus, the very name of the medicine states that it does not contain narcotic substances. But there are other analogues with the names Codelac, Omnitus.

Butamirate is a centrally acting antitussive, and is available in the form of a syrup with vanilla flavor for adults, and in drops for children. Butamirate does not contain drugs, but directly affects the cough center. Along the way, it promotes the expansion of the bronchi, facilitates breathing, and increases blood saturation with oxygen. The drug is indicated to reduce cough in cases where it can cause harm. This is the postoperative period in thoracic (thoracic) surgery, to prevent dehiscence of sutures on the lungs and bronchial cults, during minimally invasive interventions, for example, during bronchoscopy. Also, one of the indications for taking Sinecod and its analogues, like other antitussive drugs, is whooping cough. With this disease, coughing attacks are so painful and prolonged that children can turn blue and lose consciousness.

The drug is used in adults, 15 ml three or four times a day; there is a measuring cap for dosage. Drops are prescribed to children depending on age. The minimum dose of 10 drops four times a day is indicated for children from 2 months to a year, and for children over five years of age, the drug is prescribed in the form of a syrup of 5 ml 3 times a day. The exact dosage can be obtained from a pediatric pulmonologist. The drug Sinecode is produced by the Swiss company Novartis, and you can buy a bottle of 100 ml of syrup for 175 rubles, and drops in a small bottle of 20 ml will cost 300 rubles.

Advantages and disadvantages

The advantage of Sinecode is the absence of drug interactions, the possibility of taking it almost from the second month of life, and a lasting effect. A huge advantage is the absence of addiction and the formation of dependence, since the medicine does not contain a narcotic substance. The negative aspects include the rare, but still development of side effects in the form of drowsiness, nausea and rash. Sinekod is not recommended for use in the first trimester of pregnancy, or during breastfeeding. But this drug was included in the rating as effective and reliable, which fully meets the objectives.

Libexin (prenoxdiazine)

Rating: 4.8

Here, in the rating of antitussives, we again come across a unique name for the drug, and this is a very special case. As we remember, in the previous section of mucolytic drugs for expectoration, we had a remedy called Libexin Muco, or carbocisteine, one of the best phlegm thinners. The same drug is simply called Libexin, and no longer contains carbocysteine, but a special substance, prenoxdiazine, and its function is completely opposite: to act on peripheral bronchial receptors and suppress cough. Patients should be especially careful not to purchase a drug with a very similar name, which will reduce cough, instead of stimulating expectoration. Why such a similar name was chosen for a drug that can easily be confused with a drug with the opposite effect is completely unclear, especially since the drugs contain completely different active ingredients.

Prenoxdiazine hydrochloride is available in tablets, in the amount of 100 mg per tablet, and the task of this substance is to block the cough reflex in the periphery. It slightly anesthetizes the bronchial mucosa, which leads to a decrease in the irritability of cough receptors. This remedy is quite strong, and the antitussive effect is equal to that of codeine. But, unlike codeine, Libexin does not cause dependence or addiction.

Indications for use are any conditions that are accompanied by the appearance of an empty and unproductive cough. This may be a cough of non-pulmonary origin, for example, in patients with heart failure at night, when the lack of myocardial contractility overwhelms the pulmonary circulation with blood. Indications for taking Libexin are postoperative conditions in thoracic surgery and minimally invasive interventions.

Libexin is used one tablet three times a day, and in severe cases the dose is doubled. The drug can also be prescribed to children, but only depending on body weight. The drug Libexin is produced by the Hungarian company Hinoin, and one package of 20 tablets costs from 350 rubles.

Advantages and disadvantages

Libexin, like Sinekod, was included in the rating, firstly, for its safety relative to cough narcotics, and secondly, for its good and persistent effect. As for the negative aspects, you should not exceed the dosage, otherwise side effects such as dry mouth, skin rash and mild sedation may occur. The product should be used with caution in children, and it is contraindicated in persons intolerant to lactose, which is included in the tablet as an auxiliary filler.

Falimint (acetylaminonitropropoxybenzene)

Rating: 4.7

Falimint tablet contains 25 mg of active substance with a name that is difficult to pronounce. By the way, if we digress a little from the serious topic, then in terms of difficulty of pronunciation this active substance takes first place in the ranking.

Falimint has a local anesthetic effect, in which the bronchial mucosa begins to go numb and becomes insensitive to irritating effects. In addition, Falimint is an antiseptic, and since it is available in absorbable tablets, it causes a sensation of minty coolness in the mouth, refreshes, and, what is very important, does not dry out the mucous membranes, and numbness is not felt in the mouth.

Falimint is indicated, in addition to diseases of the bronchopulmonary system, accompanied by an unproductive cough, also for various inflammatory lesions of the oral cavity. These are stomatitis and gingivitis, a condition after dental intervention, sore throat, pharyngitis and laryngitis. Falimint is indicated before preparing for various instrumental studies in ENT practice, to reduce the possibility of secondary infection and complications. The tablets are dissolved in the mouth, 3 to 5 times a day, but not more than 10 tablets. The manufacturer does not recommend long-term use of Falimint, and, naturally, in order for the maximum antiseptic effect to manifest itself for a long time, you should not drink water or eat food after resorption. The drug Falimint is produced by Berlin-Pharma CJSC.

Advantages and disadvantages

The advantage of Falimint is that, in addition to its mild antitussive effect, it is widely used in ENT practice and dentistry to treat a large number of diseases that are extremely common. The main disadvantage of Falimint is the fact that, unfortunately, it has disappeared from sale since 2022. Manufacturers explain this vaguely, sometimes they talk about re-registration of the drug, sometimes they complain about problems in production, and it is not yet clear whether Falimint will be sold again. There are no official statements that Falimint may pose a health risk, so we can hope that this product will reappear in retail stores, perhaps under a different name.

HOW AND WHEN TO USE DOCTOR MOM® SYRUP FOR TREATING COUGH?

Doctor MOM® syrup, recommended for adults and children over 3 years of age, is an expectorant based on natural herbal ingredients.

>Precisely and carefully selected components of Doctor MOM® syrup allow you to alleviate and eliminate the following conditions:

• dry paroxysmal cough, accompanied by bronchospasms and lack of sputum;

cough with thick, hard-to-clear sputum. Doctor MOM® syrup allows you to make sputum more liquid and facilitate its separation, as well as have an anti-inflammatory effect on the bronchial mucosa.