Commonly used medicines for respiratory diseases

Currently, the core medications commonly used in clinical practice for respiratory diseases are divided into five categories, namely antipyretic analgesics, antitussive and expectorant drugs, antihistamines/decongestants for symptomatic relief, antiviral/antibacterial drugs for treatment, and long-term control + emergency drugs for chronic airway diseases such as asthma and COPD. All drugs need to be used according to the symptoms and causes. Mixed use without indication is not only ineffective but may also lead to risks such as liver and kidney damage and drug resistance.

I have been in the respiratory department for almost 8 years, and I have encountered more patients who had problems with taking medications randomly than those who were admitted to the hospital because of their critical condition. When mycoplasma and influenza were prevalent a while ago, a 22-year-old young man came to the doctor with fever, headache, and runny nose. He was worried that he would not recover. He also took ibuprofen, compound paracetamol capsules, and Ganmao Ling granules. That night, he felt nauseous and had yellow urine. His transaminase test soared to three times the normal upper limit. This is a typical drug-induced liver injury.

Speaking of which, many people don’t know that the compound cold medicines we often buy are actually a “family bucket of symptoms”. Most of them also contain acetaminophen (reducing fever and relieving pain), loratadine-like antihistamine ingredients (stopping nose and relieving sneezing), and pseudoephedrine ( (to clear the nose), some also add dextromethorphan (antitussive). If you only have a symptom of fever, there is no need to take this compound preparation. Just take acetaminophen or ibuprofen alone. Taking more useless ingredients will put more burden on the liver and kidneys.

There has been a lot of controversy about these two antipyretic drugs. Some people say that ibuprofen has serious side effects, while others say that acetaminophen is safer. In fact, there is no absolute good or bad at all: adults with normal liver and kidney functions can use either one at regular doses. Those with severe gastric ulcers or aspirin-based asthma People who prefer acetaminophen should choose acetaminophen as much as possible. Infants under three months old and people with severe liver dysfunction also give priority to acetaminophen. People with fever during pregnancy and people with severe underlying liver diseases are more suitable to use ibuprofen. You can choose according to your needs. There is no need to compete with each other.

Many people's first reaction when they have a cough is to take cephalosporin or amoxicillin. This misunderstanding really fools too many people. Last month, there was an old chronic bronchitis patient who had been smoking for 30 years. He had a cough for half a month and took two boxes of cephalosporins at home, but it didn't help at all. It was found that he had an acute exacerbation of COPD. There was no bacterial infection at all. He took the medicine for half a month in vain and increased the risk of drug resistance. Generally speaking, if you have a dry cough that makes you unable to sleep at night or speak normally at work, you can use dextromethorphan to relieve the cough. However, if you have phlegm, avoid antitussives. Otherwise, the phlegm will block the airway and easily aggravate the infection. At this time, expectorants such as ambroxol and acetylcysteine ​​are more suitable. By the way, there is still controversy in the academic circles about the statement that "the combination of ambroxol and antibiotics can increase the concentration of drugs in the lungs." Some studies believe that there is indeed a synergistic effect, and some believe that the difference is not statistically significant. Clinical practice generally does not deliberately require the two drugs to be taken at intervals, so don't be too entangled.

As for the "anti-inflammatory drugs" that everyone is most concerned about, that is, antibacterial drugs and antiviral drugs, don't take them as a panacea. Oseltamivir is only effective against influenza A and B, and is useless against COVID-19, mycoplasma, and common colds. It is best to take it within 48 hours of the onset of illness for the best effect. It is of little significance to use it after more than 72 hours. Antibacterial drugs such as amoxicillin, cephalosporin, and azithromycin are only effective against pathogens such as bacteria, mycoplasma, and chlamydia, and are completely useless against viral infections. There are now different views on whether to use antibacterial drugs early for respiratory tract infections: some grassroots doctors are afraid of missing the diagnosis of combined bacterial infections and will recommend early use. However, authoritative guidelines generally require blood pictures and imaging evidence of infection before prescribing. If you are not sure, it is best to check the fingertip blood before making a decision. Don't take it by yourself.

There are also inhalers that patients with asthma and COPD always keep at home, but many people use them incorrectly. I used to have a patient who was over 60 years old. He usually didn’t take any control medicine. He kept an albuterol aerosol in his pocket and sprayed it twice when he was wheezing. He sprayed it up to a dozen times a day. When he was sent to the emergency room for an acute attack last time, the albuterol spray had no effect at all, and he almost couldn’t be saved. You must know that albuterol is an emergency medicine and should only be used during acute attacks. Frequent use over a long period of time can easily lead to drug resistance, and it will no longer be used when it comes to saving lives. ； On the contrary, people are afraid that inhaled hormones such as budesonide and fluticasone, which are "hormone dependent", are the core drugs for long-term control of airway inflammation and reducing acute attacks. If used regularly, the side effects are almost negligible and there is no addiction at all.

By the way, there is another point that is easily overlooked. Western medicine ingredients are also added to many Chinese patent medicines. For example, acetaminophen is included in Ganmao Ling and Vitamin C Yinqiao Tablets. When taking it, be sure to read the ingredient list clearly and don’t take too much combined with Western medicine. As for whether you should take medicine for a common cold, there is no standard answer: some people think it is a self-limiting disease and will be fine after three or four days, and there is no need to take medicine. Others feel that the symptoms are severe enough to interfere with taking care of children at work. There is nothing wrong with taking some medicine to relieve the discomfort. It all depends on personal tolerance. No one is right or wrong.

In the final analysis, medicines are used to solve problems, not to hoard them, nor do they make you better quickly if you take them more. Prescribing the right medicine is easy to say. When it comes to you, it is always right to be more careful. If you are really unsure, ask a doctor or pharmacist. It is much more reliable than just relying on online posts.