Bronchitis and its Most Common Drug List

Have you been coughing up lots of thick mucus lately? Or is a nagging dry cough bothering you too much? If yes, you are probably suffering from a respiratory condition, known as bronchitis.

Bronchitis is characterized by inflammation of the bronchial tubes, which are the primary airway passage of the lungs. Respiratory tract is extensively branched to facilitate flow of air to and away from the lungs. The trachea (i.e. windpipe) gives off two main branches on either side, known as right main bronchus and left main bronchus. These bronchi, then enter the lungs and give off several smaller branches, known as bronchioles.

Normally, the bronchial walls produce mucous which has a protective action. However, in bronchitis, the swollen and irritated bronchi produce excess mucous, which narrows the airway and causes breathing discomfort.

Based on the duration of the symptoms, bronchitis can be acute or chronic bronchitis. Acute bronchitis is the more common form and lasts for a few days and resolves on its own. Chronic bronchitis on the other hand, lasts for months to years and requires ongoing treatment. Chronic bronchitis is usually seen in smokers. It along with emphysema refers to a respiratory condition, known as Chronic Obstructive Pulmonary Disease (COPD).

Symptoms

Bronchitis usually manifests as exaggerated features of common cold, which are listed below.

• Chest congestion: In bronchitis, the chest feels congested or full due to excess production of mucus.
• Cough: Excess mucus produces the urge of coughing. The color of sputum may be white, yellow or green, depending on the severity of the condition. Very rarely, blood-stained sputum may be seen.
• Shortness of breath: Overproduction of mucus blocks the passage of air through the bronchi, thus causing shortness of breath.
• Wheezing: Respiratory discomfort may produce a typical wheezing or whistling sound while breathing.
• Fever: Bronchitis patients may develop a low-grade fever.
• Other symptoms: Various other symptoms, such as body aches and chills may also be seen. It is not uncommon to experience runny nose and sore throat in bronchitis.

A significant fact here is that, cough may persist for several weeks even after the resolution of all other symptoms.

Treatment

Treatment of bronchitis depends on the type of bronchitis and severity of the condition. Acute bronchitis is a mild reversible condition, which usually resolves on its own within few days to weeks, without any medication. Rest and plenty of fluids can effectively treat acute bronchitis.

However, chronic bronchitis is a serious condition requiring long-term drug therapy. A major challenge in the treatment of chronic bronchitis, is posed by something called as an “acute exacerbation of chronic bronchitis” (AECB). It refers to a sudden worsening of symptoms of chronic bronchitis occurring due to a potential allergen, toxin or an infection (bacteria or virus).

The goal of treatment in bronchitis is to provide symptomatic relief and eliminate infection (if any). Respiratory discomfort is usually relived by administration of expectorants, antitussives, methylxanthines, adrenergic agonists, anticholinergic drugs, phosphodiesterase-4 inhibitors and inhaled steroids. Oral steroids and antibiotics are more effective in counteracting an acute exacerbation of chronic bronchitis. NSAIDs are used to combat fever, which may be seen in bronchitis.

Other than medications, an educational physical therapy known as Pulmonary rehabilitation, can also aid in management of the condition.

Most of the drugs used in the treatment of bronchitis also serve as chief medications in the treatment of other respiratory diseases, such as asthma and COPD.

The drugs used in bronchitis are as follows.

1. Expectorants

Expectorants act by reducing the viscosity of the sputum, thus facilitating its easy removal. These drugs increase the bronchial secretions and make the mucous thin which can be easily cleared by coughing, hence relieving the symptoms of bronchitis.
However, regular use of expectorant is not much supported as most doctors recommend natural ways of clearing mucous. At present, US-FDA has terminated the marketing of all expectorants, except Guaifenesin.

I. Guaifenesin

Available as: Oral preparations (tablets and syrups)

US-FDA Status: Approved for bronchitis
Availability: Over-the-counter
Generic name: guaifenesin
Brand name: Mucinex tablet
Side-effects: Dizziness, headache, diarrhea, hives
Indicated in pregnancy: Only if benefit outweighs fetal risk
Alcohol content: Absent

It is also used to relieve the chest congestion caused by common cold and allergies.

II. Mucolytics

Although US-FDA has disapproved all other expectorants, certain mucolytics such as ambroxol and bromhexine are available as over-the-counter medications in other countries.

Available as: Oral preparations (Tablets and syrups)

A. Ambroxol
US-FDA Status: Unapproved for bronchitis
Generic name: ambroxol hydrochloride
Brand name: Ambrodil syrup
Side-effects: Nausea, gastric irritation, lacrimation
Indicated in Pregnancy: Not indicated in first trimester
Alcohol Content: Absent

B. Bromhexine
US-FDA Status: Unapproved for bronchitis
Generic name: bromhexine hydrochloride
Brand name: A-cold syrup
Side-effects: Gastric irritation, nausea, lacrimation, rhinorrhea
Indicated in Pregnancy: Not indicated in first trimester
Alcohol Content: Absent

2. Antitussives

Coughing is caused by a complex mechanism involving the nerves of the respiratory tract and the cough center in the brain. The nerves of respiratory tract such as lower pharynx, trachea, larynx and smaller airways, are stimulated. These nerves on stimulation send a signal to the cough center of the brain (medically, known as medulla oblongata). The cough center further evokes a response that causes coughing.

Antitussives relieve coughing by two mechanisms: central and peripheral. Through central mechanism, antitussives inhibit the cough center of the brain, thus raising the threshold of coughing. Peripheral mechanism of action of antitussives involve rendering the local nerve endings numb, i.e. blocking the passage of signal from nerves of throat to the brain.
Various antitussives used in the treatment of bronchitis are listed below.

I. Opioid Antitussive

This group of drug acts on opioid receptors present in the brain, thus inhibiting the cough reflex. Codeine, hydrocodone and ethyl morphine are widely used opioid antitussive which acts on µ receptors of brain and suppresses coughing. They produce morphine-like action and pain-relieving action.
However, there are various fatal side-effects associated with opioids, such as respiratory depression, which may lead to death. Also, the misuse of this drug is common due to its addiction liability. Hence, a medical consultation is necessary before taking this drug.

Available as: Oral preparations (tablets and solutions), usually in combination with other medications

A. Combination of Hydrocodone and Guaifenesin
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: hydrocodone bitartrate and guaifenesin
Brand name: Flowtuss solution
Side-effects: Breathing difficulty, irregular fast heart rate, blue or pale nails or lips
Indicated in pregnancy: Only if absolutely indicated
Alcohol content: Absent

B. Combination of Hydrocodone and Homatropine Methylbromide
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: hydrocodone bitartrate/ homatropine methylbromide
Brand name: Tussigon tablet
Side-effects: Painful urination, reduced urine volume and frequency of urination
Indicated in pregnancy: Only if absolutely indicated
Alcohol content: Absent

II. Non-Opioid Antitussive

These antitussives inhibit the cough center, thus relieving the symptoms of bronchitis. However, unlike opioids, these do not produce central side-effects such as euphoria and respiratory depression. Dextromethorphan is a widely used non-opioid antitussive in bronchitis.

A. Dextromethorphan

Available as: Oral preparations (tablets, gels, syrups, solutions, suspensions and lozenges)

US-FDA Status: Approved for bronchitis
Availability: Over-the-counter
Generic name: dextromethorphan polistrex
Brand name: Delsym suspension
Side-effects: Confusion, blurred vision, dizziness, difficulty in urination
Indicated in pregnancy: Safe in pregnancy
Alcohol content: Absent

3. β-2 Adrenergic Agonist

The bronchial walls have a receptor, known as β-2 Adrenergic receptors. This group of drugs stimulates these receptors, which on stimulation cause dilation of bronchi, thus relieving respiratory discomfort associated with bronchitis. These are usually inhaled to produce desirable results.

However, these should not be used in patients without wheezing.

Available as: Aerosol preparation in Metered dose inhalers (MDIs) and Dry powder inhalers (DPIs)

I. Long-acting β-2 adrenergic agonists

A. Salmeterol
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: salmeterol xinafoate in MDIs
Brand name: Serevent
Side-effects: Chest tightness, wheezing, headache, cough with mucous, breathing difficulty, runny or stuffy nose, throat irritation
Indicated in Pregnancy: Yes
Alcohol Content: Absent

A. Formoterol
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: formoterol inhalation powder in DPIs
Brand name: Foradil Aerolizer
Side-effects: Sneezing, cold or flu-like symptoms, chills, ear congestion, hoarseness, body ache
Indicated in Pregnancy: Yes
Alcohol Content: Absent

II. Short-acting β-2 adrenergic agonists

A. Albuterol
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: albuterol
Brand name: Proventil-HFA
Side-effects: Pounding pulse and heartbeat, trembling feet, arms and legs
Indicated in Pregnancy: Yes
Alcohol Content: Present (As ethanol in propellant)

B. Terbutaline
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: terbutaline nebulizer
Brand name: Bricanyl
Side-effects: Headache, light-headedness, sweating, trembling in hands, arms, legs and feet
Indicated in Pregnancy: Yes
Alcohol Content: Absent

4. Methylxanthines

This group of drugs acts on all the smooth muscles of the body and causes relaxation of the muscles. Theophylline is a widely used methyl xanthine used in bronchitis and other respiratory conditions, such as asthma and COPD. The most prominent effect of theophylline is seen on bronchial smooth muscles. Hence, it is a potent bronchodilator and is of therapeutic advantage in bronchitis.

Available as: Oral preparations

I. Theophylline
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: theophylline oral
Brand name: Theo-24
Side-effects: Trembling, persistent vomiting, chest pain, slow or pacing irregular heartbeat, fainting, rapid pulse, increase in urine volume, seizures
Indicated in Pregnancy: Safe during second and third trimester. However, risk during first trimester has not been completely ruled out
Alcohol Content: Absent

5. Anti-cholinergic drugs

This group of drugs inhibits a particular receptor, known as muscarinic receptors, which are present on the bronchial smooth muscles. These receptors cause constriction of the bronchi. Anti-cholinergic drugs inhibit these receptors and cause bronchodilation.

Inhlaed anti-cholinergics can benefit patients of bronchitis, but a combination of anti-cholinergics and β-2 adrenergic agonists has shown to produce remarkable results in bronchitis.
This combination is also used as a rescue medication in an acute attack of asthma.

Available as: Aerosol preparation in metered device (inhaler or nebulizer)

I. Ipratropium bromide
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: ipratropium bromide
Brand name: Atrovent HFA
Side-effects: Shortness of breath, bladder pain, bloody or cloudy urine, painful urination, chest tightness, cough with mucous
Indicated in Pregnancy: Yes
Alcohol Content: Present (In propellant)

II. Tiotropium bromide
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: tiotropium inhalation spray
Brand name: spiriva respimat
Side-effects: Pain in jaw, arm or back, sweating, fast or irregular heartbeat, nausea, chest heaviness
Indicated in Pregnancy: Yes
Alcohol Content: Absent

6. Corticosteroids

Corticosteroids are steroid hormones, which are produced by the adrenal gland and play an important role in various physiologic processes in the human body. Corticosteroids are broadly classified as mineralocorticoids and glucocorticoids. Although both are potent anti-inflammatory drugs, glucocorticoids are specifically beneficial in bronchitis. Glucocorticoids (commonly referred to as steroids) relieve the airway inflammation and hence, are used in bronchitis. Based on the condition of the patient, the route of administration of glucocorticoid is decided.

Available as: Aerosol preparation in metered dose inhalers (MDIs) and dry powder inhalers (DPIs) as well as oral preparations

I. Inhaled steroids
This is an effective treatment method in patients of bronchitis.

Aerosol preparation in MDIs

A. Beclomethasone propionate
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: beclomethasone dipropionate
Brand name: Qvar inhaler
Common side-effects: Deepened voice, unpleasant taste in mouth, headache, vomiting, nausea, sore throat, upset stomach
Indicated in Pregnancy: Yes
Alcohol Content: Present (As Ethanol in propellant)

B. Mometasone
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: mometasone inhalation
Brand name: Asmanex HFA
Common side-effects: Cold or flu-like symptoms, cough, congestion, dry or sore throat, body aches
Indicated in Pregnancy: Yes
Alcohol Content: Present (As Ethanol in propellant)

Dry Powder Inhalation in DPIs

A. Budesonide
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: budesonide inhalation powder
Brand name: Pulmicort Turbuhaler
Common side-effects: Vaginal itching and discharge, ear ache, pain on urinating, fever, abdominal pain, diarrhea, shortness of breath, trouble swallowing, red or watery eye
Indicated in Pregnancy: Yes
Alcohol Content: Absent

II. Oral steroids
Inhaled steroids may not produce much relief in an acute exacerbation of chronic bronchitis. Hence, a short course of oral steroids is administered.

A. Prednisolone
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: prednisolone
Brand name: Prelone syrup
Side-effects: Nausea, dizziness, heartburn, insomnia, infections
Indicated in Pregnancy: Yes
Alcohol Content: Absent

B. Hydrocortisone
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: hydrocortisone
Brand name: Cortef tablet
Side-effects: Trouble sleeping, dry mouth, anxiety, blurred vision, reduce urine volume, aggression, mental depression, weight gain, restlessness
Indicated in Pregnancy: Yes
Alcohol Content: Absent

C. Dexamethasone
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: dexamethasone
Brand name: Dexamethasone elixir
Side-effects: Trouble walking, sleeping or thinking, blurred vision, agitation, mood changes, aggression, anxiety
Indicated in Pregnancy: Indicated only for short-term use
Alcohol Content: Absent

Oral Corticosteroids are also used in treatment of other diseases, such as allergic diseases, arthritis, etc.

7. Phosphodiesterase-4 Inhibitors

Commonly referred to as PDE4 inhibitor, this group of drugs increases the amount of a chemical called cyclic adenosine monophosphate (cAMP) in smooth muscles of lung, which causes bronchodilation. Hence, PDE4 inhibitors are usually used in chronic bronchitis.

Available as: Oral preparations

I. Roflumilast
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: roflumilast
Brand name: Daliresp tablet
Side-effects: Unexplained weight loss, diarrhea, cough, chills
Indicated in Pregnancy: Only if absolutely indicated
Alcohol Content: Absent

These are also used in COPD with frequent exacerbations.

8. Non-Steroidal Anti-inflammatory Drugs (NSAIDs)

This group of drugs inhibits an enzyme, known as cyclo-oxygenase enzyme. This enzyme is needed for the production of a compound, called Prostaglandin. These prostaglandins are pain-inducing compounds. NSAIDs produce analgesic (pain-relieving), anti-pyretic (relieving high temperature i.e. fever) and anti-inflammatory (relieves swelling) effect.

Patients of bronchitis may experience symptoms of general illness, such as body ache, fever and fatigue. There are several classes of drugs included in NSAIDs. However, some analgesic-antipyretic NSAIDs can be used for symptomatic relief in bronchitis patients.

Available as: Oral preparations and Injections (intravenous, intramuscular and subcutaneous)

Oral preparation

I. Ibuprofen
US-FDA Status: Approved for bronchitis
Availability: Over-the-counter
Generic name: ibuprofen
Brand name: Ibuprofen tablet
Side-effects: Belching, abdominal pain, cloudy urine, bloating
Indicated in Pregnancy: Only if absolutely indicated
Alcohol Content: Absent

II. Acetaminophen Oral
US-FDA Status: Approved for bronchitis
Availability: Over-the-counter
Generic name: acetaminophen
Brand name: Tylenol tablet
Side-effects: Black tarry stools, cloudy urine, rashes, hives
Indicated in Pregnancy: Only if absolutely indicated
Alcohol Content: Absent

Injectable preparation

I. Acetaminpohen Injection
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: acetaminophen
Brand name: Ofirmev injection
Side-effects: Pain at the injection site, allergic reaction, hives, itching
Indicated in Pregnancy: Only if absolutely indicated
Alcohol Content: Absent

NSAIDs are also used in certain other conditions, such as arthritis, toothache, menstrual cramps, etc.

9. Antibiotics

These are anti-microbial agents, which act against bacteria. Centers for Disease Control and Prevention strictly condemns the use of antibiotics in bronchitis as it is mostly caused by virus. Hence, administration of antibiotic in bronchitis has no therapeutic benefit.[1]

However, if a bacterial infection has superimposed an existing condition of chronic bronchitis, it may worsen the symptoms. In such cases of acute exacerbations of chronic bronchitis, broad-spectrum antibiotics are prescribed.

Various class of antibiotics used in the treatment of bronchitis are described below.

I. Beta- Lactam antibiotics
These antibiotics have a beta-lactam ring in their chemical structure. Penicillin, cephalosporins and carbapenems are the beta lactam antibiotics advovated in the use of bronchitis.

A. Penicillin
It inhibits the bacterial cell wall synthesis, thus killing the bacteria. Hence, penicillin is a bactericidal antibiotic.

Available as: Oral preparations and Injections (intravenous and intramuscular)

Oral preparation

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: amoxicillin
Brand name: Amoxil oral suspension
Side-effects: Abdominal pain, bleeding gums, black tarry stools, bloating, blistering of skin
Indicated in Pregnancy: Only if benefit outweighs feta risk
Alcohol Content: Absent

Injectable preparation

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: penicllin G sodium vial
Brand name: Pfizerpen
Side-effects: Muscle or joint pain, swelling of ankles or feet, sore throat
Indicated in Pregnancy: Only if absolutely indicated
Alcohol Content: Absent

B. Cephalosporins
They act in a similar fashion as penicillins, i.e. they inhibit bacterial cell wall synthesis and thus are bactericidal. However, they differ from penicillin as they produce this bactericidal action by binding to different proteins on bacterial cell wall.

Available as: Oral preparation and injections (intravenous and intramuscular)

Oral preparation

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: cefixime
Brand name: Cefixime oral suspension
Side-effects: Frequent loose stools, diarrhea, bleeding gums, agitation
Indicated in Pregnancy: Only if benefit outweighs risk
Alcohol Content: Absent

Injectable preparation

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: ceftriaxone
Brand name: Ceftriaxone injection
Side-effects: Cough, chest pain, chills, black tarry stools
Indicated in Pregnancy: Only if benefit outweighs risk
Alcohol Content: Absent

Ceftriaxone is also used in other severe bacterial infection, such as meningitis.

C. Carbapenems

Being a member of beta lactam antibiotic class of drug, carbapenems inhibit the bacterial cell wall synthesis, thus producing a bactericidal effect. However, unlike penicillin and cephalopsorin, it has a much wider range of therapeutic action, i.e. it acts against a variety of bacterial pathogens.

i) Imipenem
In order to enhance its action, it is usually combined with a drug, known as Cilastin. Cilastin is a potent inhibitor of an enzyme which metabolises the imipenem. Thus, a combination of cilastina and imipenem, prolongs the duration of action of the drug, hence acting as an effective drug in bronchitis.

Available as: Injectable preparations

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: imipenem/ cilastin sodium
Brand name: Primaxin injectable powder
Side-effects: Dizziness, confusion, convulsions, tremors, pain at site of injection
Indicated in Pregnancy: Only if benefit outweighs risk
Alcohol Content: Absent

II. Tetracycline Group of Antibiotic
This group of antibiotics is bacteriostatic i.e. it inhibits the growth of bacteria. Tetracyclines bind to a particular ribosome of the bacteria and thus, inhibit the protein synthesis.

A. Doxycycline

Available as: Mostly oral preparations

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: doxycycline hyclate
Brand name: Doryx tablet
Side-effects: Clay colored stools, bloating, chills, cough, peeling or blistering of skin
Indicated in Pregnancy: Usually contraindicated
Alcohol Content: Absent

It is also used to treat acne and prevent malaria.

III. Macrolides
These antibiotics have a macrocyclic lactone ring. They inhibit protein synthesis, hence act against bacteria. However, the point of significance here is that it is bacteriostatic at low dose and is bactericidal at high doses. Erythromycin and Azithromycin are the macrolide antibiotics used in the treatment of bronchitis.

Available as: Oral preparations

A. Erythromycin

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: eryhtromycin
Brand name: Ery-tab tablet
Side-effects: Rapid heartrate, cough, dizziness, chills, diarrhea
Indicated in pregnancy: Usually indicated
Alcohol content: Absent

B. Azithromycin
Azithromycin is a newer analogue of erythromycin and has an extended spectrum of activity than erythromycin.

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: azithromycin
Brand name: Zithromax oral suspension
Side-effects: Cracked skin, diarrhea, loose stools, fever
Indicated in pregnancy: Only if absolutely indicated
Alcohol content: Absent

Azithromycin is also used to treat skin infections, ear infections and Sexually transmitted diseases (STDs).

IV. Fluoroquinolones
This group of drugs is bactericidal as it inhibits the DNA synthesis by inhibiting certain bacterial enzymes, namely DNA gyrase and topoisomerase IV.

Available as: Oral preparation and injections (mainly intravenous)

A. Levofloxacin
US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: levofloxacin
Brand name: Levofloxacin tablet
Side-effects: Cracked skin, diarrhea, loose stools, fever
Indicated in pregnancy: Only if absolutely indicated
Alcohol content: Absent

It is also used in the treatment of other respiratory infections, such as pneumonia.

V. Combination of Sulfamethoxazole and Trimethoprim
Sulfamethoxazole belongs to a class of drug, called sulfonamide and Trimethoprim belongs to pyrimidine inhibitor class of drugs. Both these antibiotics inhibit the formation of folic acid, which is necessary for bacterial growth. Hence, both these antibiotics are bacteriostatic antibiotics.

Available as: Oral preparation

US-FDA Status: Approved for bronchitis
Availability: Prescription only
Generic name: sulfamethoxazole/ trimethoprim
Brand name: Septra tablet
Side-effects: Abdominal pain, chills, black tarry stools, change in skin color, dizziness, dark urine, diarrhea
Indicated in pregnancy: Usually contraindicated
Alcohol content: Absent

This combination is also used to treat Urinary Tract Infection (UTI), ear infection, shigellosis, traveler’s diarrhea and a variant of pneumonia.

OTC

Inhalers, expectorants, NSAIDs and certain antibiotics constitute the OTC drugs in bronchitis. However, the availability varies among the countries based on the norms of drug regulatory bodies.

Various over-the-counter medications for bronchitis, available in different countries, have been listed in the table below.

Name of the Country	OTC Drug(s) Available
Argentina	Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Ibuprofen (oral) Acetaminophen (oral)
Australia	Beclomethasone dipropionate (nasal) Mometasone (nasal) Theophylline (oral) Ipratropium bromide (nasal) Salbutamol Bromhexine (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Austria	Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Canada	Mometasone (nasal) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
China	Beclomethasone dipropionate (nasal) Prednisolone (oral) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Croatia	Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Czech Republic	Beclomethasone dipropionate (nasal) Ipratropium bromide (nasal) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Denmark	Beclomethasone dipropionate (nasal) Bromhexine (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
France	Beclomethasone dipropionate (nasal) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Ibuprofen (oral) Acetaminophen (oral)
Germany	Beclomethasone dipropionate (nasal) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Greece	Prednisolone (oral) Bromhexine (oral) Ambroxol (oral) Ibuprofen (oral) Acetaminophen (oral)
Hungary	Ipratropium bromide (nasal) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
India	Beclomethasone dipropionate (nasal) Mometasone (nasal) Prednisolone (oral) Ipratropium bromide (nasal) Salbutamol Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral) Codeine (oral)
Ireland	Beclomethasone dipropionate (nasal) Ipratropium bromide (nasal) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Italy	Beclomethasone dipropionate (nasal) Ipratropium bromide (nasal) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Japan	Beclomethasone dipropionate (nasal) Prednisolone (oral) Theophylline (oral) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Mexico	Salbutamol romhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Philippines	Bromhexine (oral) Ambroxol (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Russia	Beclomethasone dipropionate (nasal) Mometasone (nasal) Ibuprofen (oral) Acetaminophen (oral)
Singapore	Beclomethasone dipropionate (nasal) Salbutamol Bromhexine (oral) Ambroxol (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
South Africa	Beclomethasone dipropionate (nasal) Mometasone (nasal) Prednisolone (oral) Theophylline (oral) Ibuprofen (oral) Acetaminophen (oral)
South Korea	Beclomethasone dipropionate (nasal) Prednisolone (oral) Salbutamol Bromhexine (oral) Ambroxol (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Spain	Beclomethasone dipropionate (nasal) Prednisolone (oral) Ipratropium bromide (nasal) Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
Switzerland	Bromhexine (oral) Ambroxol (oral) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
The Netherlands	Ipratropium bromide (nasal) Bromhexine (oral) Ambroxol (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)
UK	Beclomethasone dipropionate (nasal) Mometasone (nasal) Theophylline (oral) Ipratropium bromide (nasal) Guaifenesin (oral) Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral) Azithromycin (oral)
USA	Dextromethorphan (oral) Ibuprofen (oral) Acetaminophen (oral)

The importance of a doctor’s consultation cannot be ignored. Self-medication is not recommended due to the side-effects associated with the medications.

Therefore, seek medical consultation prior to starting any therapy.