What is Ascoril LS?
Ascoril LS is a combination medication containing levosalbutamol (a bronchodilator), guaifenesin (an expectorant), and sometimes ambroxol, used primarily for managing respiratory conditions with both bronchospasm and mucus hypersecretion, though its individual components have varying levels of evidence supporting their use. 1
Components and Mechanisms
Levosalbutamol (R-Salbutamol)
- Levosalbutamol is the R-isomer of racemic salbutamol, functioning as a short-acting β2-agonist that provides bronchodilation by relaxing airway smooth muscle. 2
- The R-isomer alone theoretically avoids potential adverse effects of the S-isomer, which may oppose beneficial β2-agonist effects in experimental models. 2
- In clinical practice, levosalbutamol has shown mixed results compared to racemic salbutamol in COPD patients, with some pediatric studies suggesting superiority in acute asthma exacerbations (improved respiratory rate, heart rate, SpO₂, and PEFR with less tachycardia). 2, 3
- As a short-acting β2-agonist, it is appropriate for relief of acute symptoms and bronchospasm, consistent with guideline recommendations for SABA use. 4
Guaifenesin
- Guaifenesin is an expectorant that works by increasing mucus volume and altering mucus consistency to facilitate expectoration, potentially enhancing ciliary function. 5
- The American College of Chest Physicians recognizes guaifenesin as effective in decreasing subjective measures of cough in upper respiratory infections. 5
- However, for acute bronchitis specifically, mucokinetic agents including guaifenesin are NOT recommended due to lack of consistent favorable effect on cough. 5
- Clinical evidence for guaifenesin shows inconsistent results, with some benefit demonstrated in chronic bronchitis and bronchiectasis but questionable efficacy in acute conditions. 5, 6
- Unlike anticholinergic medications, guaifenesin does not cause dry mouth, urinary retention, or cognitive impairment, making it suitable when anticholinergic effects would be undesirable. 5
Clinical Applications
Studied Indications
- A Russian study of 60 COPD patients concurrent with coronary heart disease showed Ascoril provided significant cough reduction by day 2, with complete relief in 87% by day 7, without pronounced negative effects on heart rate. 1
- The combination showed bronchodilatory and expectorant effects in patients with grade I-II COPD. 1
- Similar combination formulations (ambroxol-theophylline-guaifenesin) have demonstrated efficacy in acute exacerbations of chronic bronchitis, with 96% of patients reporting "much" or "very much" improvement. 7
Guideline Context
- Short-acting β2-agonists like levosalbutamol are the treatment of choice for relief of acute symptoms in asthma and COPD, but regular scheduled daily chronic use is not recommended. 4
- Increasing use of SABA treatment or use >2 days/week for symptom relief generally indicates inadequate disease control requiring anti-inflammatory therapy. 4
- For chronic respiratory conditions, inhaled corticosteroids remain the mainstay of management, with bronchodilators as adjunctive therapy. 4
Important Caveats
Cardiovascular Considerations
- β2-agonists can cause tachycardia and increase cardiovascular events, with meta-analysis showing single doses increasing heart rate by 9.1 beats/min and relative risk for adverse cardiovascular events of 2.54. 4
- This is particularly relevant in patients with concurrent coronary heart disease, though the Ascoril study showed transient HR increases that normalized by day 7. 1
- β2-agonists may also reduce serum potassium by 0.36 mmol/L. 4
Anticholinergic Avoidance
- In conditions like Sjögren's syndrome with xerotrachea, anticholinergics should be avoided to prevent drying of secretions, making guaifenesin-containing combinations potentially preferable. 4
- Guaifenesin and nebulized saline are recommended for patients with concern for xerotrachea. 4