What medications can be used to reduce upper airway secretions?

From the Guidelines

To reduce upper airway secretions, anticholinergic medications such as glycopyrrolate, atropine, and scopolamine are the primary options, as they effectively block acetylcholine receptors and inhibit secretion production from salivary and mucous glands 1. These medications can be administered through various routes, including intravenous, oral, and transdermal, depending on the patient's condition and needs. For example, glycopyrrolate can be given at a dose of 0.1-0.2 mg IV or 1-2 mg orally every 4-8 hours, while atropine can be administered at a dose of 0.4-0.6 mg IV/IM/SC every 4-6 hours. Scopolamine, on the other hand, can be applied as a transdermal patch of 1.5 mg behind the ear every 72 hours. In addition to anticholinergic medications, other options such as antihistamines, decongestants, and mucolytics may also be considered, depending on the underlying cause of the secretions and the patient's overall condition. For instance, patients with allergic rhinitis contributing to secretions may benefit from antihistamines like diphenhydramine or loratadine, while those with thick, tenacious secretions may require mucolytics like N-acetylcysteine or guaifenesin. It is essential to weigh the potential benefits and risks of these medications, particularly in elderly patients, who may be more susceptible to side effects such as dry mouth, urinary retention, constipation, blurred vision, and confusion. Adequate hydration and humidified air may help prevent excessive drying of the airways, and patients should be closely monitored for any adverse effects. According to a study published in the Journal of the National Comprehensive Cancer Network, scopolamine, atropine, hyoscyamine, and glycopyrrolate are options to reduce excessive secretions associated with dyspnea 1. Another study published in the journal Chest found that oral N-acetylcysteine can reduce the rate of exacerbations in COPD patients, making it a potential option for patients with chronic obstructive pulmonary disease 1. Overall, the choice of medication and treatment approach should be individualized based on the patient's specific needs and medical history.

From the FDA Drug Label

In Anesthesia Glycopyrrolate Injection is indicated for use as a preoperative antimuscarinic to reduce salivary, tracheobronchial, and pharyngeal secretions; Medications to reduce upper airway secretions include glycopyrrolate, which can be used to reduce salivary, tracheobronchial, and pharyngeal secretions 2.

• The antisialagogue effects of glycopyrrolate persist up to 7 hours.
• Glycopyrrolate injection is indicated for use as a preoperative antimuscarinic to reduce upper airway secretions. Key points:
• Glycopyrrolate can be administered intravenously or intramuscularly.
• The recommended dose of glycopyrrolate injection in pediatric patients is 0.004 mg/kg intramuscularly, given 30 to 60 minutes prior to the anticipated time of induction of anesthesia 2.

From the Research

Medications to Reduce Upper Airway Secretions

Medications that can be used to reduce upper airway secretions include:

• Anticholinergics, such as ipratropium bromide and tiotropium bromide, which inhibit mucus hypersecretion by blocking muscarinic receptors 3, 4
• Beta 2-adrenoceptor agonists, such as salbutamol, which can increase mucociliary clearance and reduce mucus secretion 5, 6
• Corticosteroids, which can reduce inflammation and mucus secretion in the airways 3, 7
• Mucolytics, such as those that degrade polymers in secretions, which can help break down mucus and make it easier to expectorate 7
• Mucoregulatory agents, such as anti-inflammatory agents and anticholinergic agents, which can reduce the volume of airway mucus secretion 7
• Macrolide antibiotics, which have been shown to have mucoregulatory effects and reduce mucus secretion in certain conditions 3, 7

Classes of Mucoactive Agents

Mucoactive agents can be classified into several categories, including:

• Expectorants, which increase the volume or hydration of airway secretions
• Modifiers of airway water transport, which can increase the hydration of airway secretions
• Mucolytics, which degrade polymers in secretions
• Mucokinetics, which increase mucociliary efficiency or cough efficiency
• Mucoregulatory agents, which reduce the volume of airway mucus secretion 7

Combination Therapy

Combination therapy with multiple medications, such as anticholinergics and beta 2-adrenoceptor agonists, may provide greater bronchodilation and reduction in mucus secretion than monotherapy 6