From the Guidelines
Excessive respiratory secretions can be managed with anticholinergic medications such as glycopyrrolate or scopolamine, which are considered first-line treatments. These medications work by blocking acetylcholine receptors, reducing secretion production. According to the study by 1, glycopyrrolate does not effectively cross the blood-brain barrier and is less likely to cause delirium, but it can produce anticholinergic side effects.
Some key points to consider when managing excessive respiratory secretions include:
- Using anticholinergic medications like glycopyrrolate (0.2-0.4 mg every 4-6 hours orally or 0.1-0.2 mg IV/IM every 4 hours) or scopolamine (1.5 mg transdermal patch changed every 72 hours) as first-line treatments
- Considering hyoscyamine (0.125-0.25 mg orally every 4 hours) as an alternative option
- Using mucolytics such as N-acetylcysteine (600 mg orally twice daily) to break down mucus proteins and make secretions thinner and easier to clear
- Increasing respiratory tract fluid with guaifenesin (200-400 mg orally every 4 hours) to thin mucus
- Using atropine (0.4-0.6 mg subcutaneously every 4-6 hours) in hospital settings
It is essential to accompany these medications with adequate hydration to maintain appropriate mucus consistency. Additionally, positioning patients properly, using suction when necessary, and ensuring proper humidity levels can enhance medication effectiveness. Treatment should be tailored to the underlying cause of excessive secretions, whether from infection, COPD, or other respiratory conditions, and side effects like dry mouth, urinary retention, and confusion (especially in elderly patients) should be monitored, as noted in the study by 1.
In terms of specific medication dosages and administration, the study by 1 provides guidance on the use of scopolamine, atropine, hyoscyamine, and glycopyrrolate to reduce excessive secretions associated with dyspnea. The study also highlights the importance of considering the underlying cause of excessive secretions and tailoring treatment accordingly.
Overall, the management of excessive respiratory secretions requires a comprehensive approach that takes into account the underlying cause of the condition, the patient's overall health status, and the potential side effects of medications, as discussed in the study by 1.
From the FDA Drug Label
Glycopyrrolate, like other anticholinergic (antimuscarinic) agents, inhibits the action of acetylcholine on structures innervated by postganglionic cholinergic nerves and on smooth muscles that respond to acetylcholine but lack cholinergic innervation These peripheral cholinergic receptors are present in the autonomic effector cells of smooth muscle, cardiac muscle, the sinoatrial node, the atrioventricular node, exocrine glands and, to a limited degree, in the autonomic ganglia. Thus, it diminishes the volume and free acidity of gastric secretions and controls excessive pharyngeal, tracheal, and bronchial secretions.
Glycopyrrolate is used to manage excessive respiratory secretions.
- The medication works by inhibiting the action of acetylcholine on smooth muscles and exocrine glands, thereby reducing the volume of secretions.
- It is specifically used to control excessive pharyngeal, tracheal, and bronchial secretions 2.
From the Research
Medications for Excessive Respiratory Secretions
- Mucoactive medications can be used to reduce hypersecretion, make secretions easier to transport, or increase the efficiency of cough or mucus clearance 3
- Mucoactive agents are medications used to improve the clearance of airway secretions, and include classes of medications such as anticholinergics, ss2-adrenoceptor agonists, corticosteroids, mucolytics, and macrolide antibiotics 4, 5
- Specific medications that have been used to manage excessive respiratory secretions include:
- Acetylcysteine (although its use is not recommended due to potential adverse effects on cough transport) 4
- Inhibitors of nerve activity, such as large conductance calcium-activated potassium (BKCa) channel activators 5
- Tachykinin receptor antagonists 5
- Epoxygenase inducers, such as benzafibrate 5
- Inhibitors of mucin exocytosis, such as anti-myristoylated alanine-rich C kinase substrate (MARCKS) peptide and Munc-18B blockers 5
- Inhibitors of mucin synthesis and goblet cell hyperplasia, such as epiderial growth factor (EGF) receptor tyrosine kinase inhibitors, p38 mitogen-activated protein (MAP) kinase inhibitors, and retinoic acid receptor-a antagonists 5
- Non-pharmacological interventions, such as mechanical insufflation-exsufflation, expiratory muscle training, manually-assisted cough, and percussive ventilation, may also be used to manage excessive respiratory secretions 6, 7