Symptomatic treatment of viral infections. Episode 71

Monika Rachtan
Hi Monika Rachtan, I would like to welcome you very warmly to the next episode of Po Pierwsze Pacjent. Although it is hard to believe, autumn has finally arrived, and this is the season of increased incidence of viral and bacterial infections. But it turns out that the viral ones are more numerous - as many as 90% infections are actually viral infections, which only require mostly symptomatic treatment. Today, I will be discussing how to effectively treat infections with my guest, Professor Adam Jerzy Sybilski. Welcome, Professor.

Adam Jerzy Sybilski
Good morning, madam, good morning to you.

Monika Rachtan
The professor is a specialist in paediatrics.

Adam Jerzy Sybilski
That's right. It all adds up.

Monika Rachtan
Professor, is it really such a big faux pas to treat a viral infection with an antibiotic?

Adam Jerzy Sybilski
I don't know, a faux pas? I think it is simply a mistake. However, yes, indeed, what you said, 90% is a viral infection. I would also like to remind us a little of the terminology here, or perhaps tell you, because we very often say I have a cold, and what is a cold? Well, a cold is an illness and it is an illness which is, well, sometimes quite serious, because now, by definition, a cold is an acute viral infection of the nasal mucous membrane and the nasal sinuses, or generally the upper respiratory tract. Very often this is accompanied by symptoms from the throat, i.e. pharyngitis. But indeed, as you said, it is mainly viral infections. Most often it is a very common virus, and it is fortunate that it is the most common, as it is the mildest. In addition to this, there are two other viruses that often cause these infections. This is the coronavirus, although not the SARS-CoV-2 one, but a certain variant of it. Although recent years have shown that we may also have more in common and more to do with the SARS-CoV-2 virus.

Adam Jerzy Sybilski
Because I think it is also becoming a bit of a seasonal virus. Just like the flu virus, it will probably also haunt us mainly every year in autumn and winter, which we are already seeing. There are just a bit more infections.

Monika Rachtan
What are the professor's observations? Are they actually? Because there is already more and more talk on TV that covid is back. Again you have to isolate yourself, again you have to vaccinate yourself, vaccinate yourself, it's difficult now, but again we're sort of being threatened with a pandemic or an epidemic. Is there actually a real threat that something like that could happen?

Adam Jerzy Sybilski
I mean, yes, maybe scaring is never good. Although we know from history that if you frighten people a little, they are always more motivated to behave in a hygienic way. This isolation, this certain disinfection like washing hands, keeping a distance, and so on and so forth. All this makes sense not only during a pandemic and not only during a period of increased incidence of disease, but in general. However, we should always be careful and bear in mind that these infections, viral infections, are transmitted droplet-borne, and there is no other way of stopping this exposure or this transmission of the virus, as we say, than by keeping a distance and possibly wearing a mask. I think that at the moment, I would say that we should wear masks everywhere, but I think that this is not yet the time. On the other hand, in places where we meet more sick people, i.e. in hospitals, in clinics, maybe in pharmacies, this is absolutely to be considered, because indeed we also meet in our clinic. We have more patients at the moment. I run a children's clinic, so it's automatically my observations in the paediatric population.

Adam Jerzy Sybilski
And indeed there are in the last few weeks more patients with COVID 19. It may not be as it was 2 3 years ago, nevertheless there is indeed a noticeable increase in covid and coronavirus infection.

Monika Rachtan
And how is COVID affected now? Because we know that these different variants of COVID 19 were characterised by different symptoms. Once it was more often very high fevers, on the other hand we had sinusitis. And how do you get sick with COVID now?

Adam Jerzy Sybilski
This is a very difficult question, because it is indeed changing, and I can only tell you what I see in my own neighbourhood, either on the basis of patients at my clinic, or on the basis of how I myself have experienced COVID, or how my friends and neighbours have experienced it. It seems to be a little bit milder at the moment, but the respiratory symptoms are definitely the leading symptom. It is a runny nose, of course, a sore throat, if it is an older child a cough. Sometimes there is diarrhoea, but it is quite typical, and the fevers are not very high, so a typical viral illness of the upper respiratory tract, one could say a typical cold. Yes, it's mostly mild. What we hospitalise. It's a bit more severe. These symptoms are there, but also compared to what it was two or three seasons ago, I think they are at least mild for now. On the other hand, what it will be in November, December, March, I don't know and it could be different.

Monika Rachtan
It is also worth remembering that there is another virus, which the professor also mentioned, the influenza virus, and here we can be vaccinated effectively. It is worth remembering this for both adults and children.

Adam Jerzy Sybilski
Well, yes, it is very important. Well unfortunately the statistics show that we vaccinate poorly for this flu. It is only ever a few per cent of the population, where in comparison in other countries it is 60 to 70 per cent of vaccinated patients. Sorry, they are not yet patients thankfully. On the other hand. However, in our country, this vaccination rate is very, very low. I will not go into why, so to speak. Because there are many, many, many threads here for another conversation. Definitely. However, I would just like to say that there are certain groups of patients, so-called risk groups, who should especially be vaccinated against influenza. These are small children from the age of six months, because we can vaccinate from the age of six months up to two years. This is such an already super risk group. Up to five is actually advisable. Well, and adults over, and a couple of years ago it was said over 65, and now it's said over 50. At least that's how the Americans have assessed it. That senior age as 50 years 50+.

Adam Jerzy Sybilski
There is another group that is very little talked about, talked about and not much publicised, namely pregnant women and pregnant women, or those who are planning a pregnancy, or who are pregnant or planning a pregnancy during the flu season of the so-called autumn-winter period should be vaccinated against flu.

Monika Rachtan
And we will actually talk about these groups in future episodes of Patient First. Today we will return to our symptomatic treatment of viral infections. But precisely because we don't like to vaccinate, Antibiotics are very much like to take in Poland, right?

Adam Jerzy Sybilski
It is a kind of, well, strange situation, I would say, although I mean like is also a bit of a bad word, maybe, because antibiotics are fortunately still on prescription, so you can't just go to the pharmacy and buy an antibiotic. Fortunately, yes. Fortunately there is not, and in most countries in the world that is the case. And very well.

Monika Rachtan
But there is also a black market for antibiotics and this is also a problem. And this black market is sometimes our medicine cabinet, even at home, because Poles tend to eat the antibiotic that, for example, the husband has left.

Adam Jerzy Sybilski
We hoard not only antibiotics and medicines in general. If we looked in our cupboards, we would find many, many different medicines, I don't want to say tonnes, but kilos of various medicines, some of them unfortunately still out of date. So this is our problem, that it is really ours, in the sense of our Polish society. I don't know whether this is still a result of the old times, when we used to keep everything and maybe it would come in handy or maybe we would run out. But this really is the problem. On the other hand, it is a fact that very often we get viral infections, sometimes even very trivial ones. Or we just take them. Whether parents give or adults take an antibiotic, or to some extent, which is also not good, but it happens. They kind of force doctors to prescribe an antibiotic because they think that's the only thing that will help. Well that is not a good way to go. On the other hand, if you look at the research, it's not so rosy in other countries either. It is also basically global. There is a bit of a tendency in Europe to overuse, to overuse antibiotics in different countries, different, this is also in Poland.

Monika Rachtan
We are at the forefront of abuse here.

Adam Jerzy Sybilski
There is no doubt that we are indeed using these antibiotics too often, and this is, well, detrimental.

Monika Rachtan
Well, why exactly? Because it's not just that we take the wrong medicine and it doesn't work. It's just that it's doing something to the body and it's not beneficial to us.

Adam Jerzy Sybilski
It is one thing in the body that every antibiotic or every drug has some side effects and can cause. Yet the side effect is only in a small, small percentage of patients and people who take it. So here, of course, it is some risk, but that is not the most important problem. The most important problem is another, and that is that the widespread use of some antibiotic or many antibiotics causes bacteria. Well, because an antibiotic is for bacteria and it needs to be made very clear that it is for bacteria. It either kills the bacteria or prevents them from multiplying. And these uses of such antibiotics cause the bacteria to change. This is now maybe what everybody knows, because it's been discussed very widely, so to speak, that viruses change their immunogenicity. Yes, they change all the time there is the SARS-CoV-2 coronavirus, it's constantly on this micro, on this such and such and such, mutates, mutates, mutates. So it changes immunologically and the bacteria have exactly the same trait or the same ability. And they do in such a way that they adapt so that this antibiotic doesn't work on them.

Adam Jerzy Sybilski
Well, they are living organisms that want to survive, right?

Monika Rachtan
You can tell they are getting a bit used to it and can function.

Adam Jerzy Sybilski
Well, on the contrary, they even get used to it. Well, you could say they get used to it, they produce such abilities that this antibiotic simply doesn't work on them. Well, simply the survival power of the bacteria. And this means that we are losing certain antibiotics every now and again because a large proportion or a large percentage of strains of a particular bacteria, or different bacteria in general, are immune and are resistant to the antibiotic. There is a bacterium that is resistant to the antibiotic, which means that it simply does not work.

Monika Rachtan
That is, it may be that an antibiotic that used to be used, for example, for some disease of just bacterial infection, now, if the patient takes it, it just may not work.

Adam Jerzy Sybilski
This may be because even the same bacterium that, say, 2 3 years ago was successfully killed and treated with a particular antibiotic, at the moment this can no longer be repeated because that antibiotic has simply stopped working on it. Fortunately, we try to control this somehow in the sense that we just don't prescribe antibiotics for everything, that we carry out what is called targeted antibiotic therapy. That is, when we have a culture, which means we know which bacteria is the cause. So what is it sensitive to? What antibiotic is it that we try to prescribe, but this is more in hospitals on an outpatient basis, so to speak. In outpatient clinics we don't have such possibilities, so there we treat so called empirically, that is, what we think.

Monika Rachtan
Based on experience.

Adam Jerzy Sybilski
On the basis of experience, on the basis of literature, on the basis of what we think that such, such symptoms are probably caused by such a bacterium, we give such an antibiotic, but, of course, there is no certainty and if we prescribe a lot of this antibiotic, well, after some time it really loses its potency and we notice that. If, for example, an antibiotic is particularly promoted or particularly popular among doctors and they prescribe it over a certain period of time, well, not quickly, but, let us say, 5 to 10 years, there is a big increase in the prescribing of these antibiotics, then after these 5 to 10 years, we notice that the agent simply stops working and maybe it needs to be put off for a while so that the bacteria mutate again, so that they forget about it, in inverted commas, and after another 5 to 10 years, maybe it will be effective again.

Monika Rachtan
The World Health Organisation often talks about the fact that we may run out of these antibiotics, that these antibiotics may start to really disappear in such a way that in a short while, there will be nothing to treat them in hospitals. I would like to remind you that the bacterial infections of which you spoke are only 10%. Well, if there are 90 viral infections, there are only 10 bacterial infections, and only one in 10 infections requires an antibiotic. Let us be aware of this. And what is important is that today, not we, but you today are able to differentiate these infections very well. You can actually tell in a few minutes whether we are dealing with a viral or a bacterial infection. I exaggerated a few minutes, maybe a few dozen, but there are tests that allow us, you, to determine this and then to apply the appropriate treatment. Yes.

Adam Jerzy Sybilski
Right, with a caveat of course there always has to be, but either some sort of a teaspoon of tar. It's not quite the case that we, that a patient comes in and we within 15 minutes are able to say oh, you've got a viral infection, antibacterial, that would be ideal. But that's not the case, unfortunately, because these tests that we have, I'll just say which tests I'm thinking of. Well they're firstly for either some just viruses or bacteria, or just kind of generally telling us whether we're leaning more towards a viral infection or a bacterial infection, so we're never 100 per cent sure. But indeed, taking the history, that is, how the patient is ill, two clinical examination, that is, how we examine the patient, what are the symptoms in such a physical examination, let's call plus some additional tests. These additional examinations I mean here if we do, for example, a morphology, where we can check. The most important in such infections is the white blood cell count, or leukocytes, yes. If it is high, it is more indicative of a bacterial infection.

Adam Jerzy Sybilski
If it is normal or low, it is more likely to be for a viral infection. It is. That is, leukocytosis, or morphology. The second such test is the CRP test, the so-called CRP active protein. It increases in infections, in all infections, But actually in bacterial infections this increase is, well, much greater. Although it should be noted that it depends a little bit on the patient as well, well, but generally that's it. And we also have one, for some, for a while now, actually for a few years now so commonly it's actually maybe even for a year or two. We have a test called procalcitonin. It's such a, such a parameter that shows us that if it's elevated, it means that we're probably dealing with a bacterial infection at a very high, high percentage. That is, if we have high, I mean, elevated CRP, low, low procalcitonin, normal leucocytosis, it is more likely to be a viral infection. On the other hand, if all these indicators go very high, it is rather bacterial. We also still have such rapid tests in our arsenal. The so-called rapid tests have always been for streptococcus, which detects angina.

Adam Jerzy Sybilski
They have been very and are, sorry, they have been and are very helpful to us, because that is what differentiates whether the pharyngitis that we see, which can run exactly the same in viral and bacterial infections, especially at the beginning. Well, precisely is it not bacterial? That is, does it not need to include an antibiotic, here mainly betalactam. Penicillin or derivatives thereof. And that's the quick, quick test for streptococcus. But we have now. For some time in particular. It's even reimbursed in GP surgeries now, namely rapid tests for the three viruses, that is for the influenza virus, for the virus, for the coronavirus and for RSV. Especially in children, this RSV is important. In adults rather less so, but for coronavirus and influenza we have. And these are also very important tests, well, because then they confirm to us that it is a given virus, a given virus, that it is a viral infection, and in influenza it is also an added value, well, because we have a drug for, you could say, an antibiotic or antiviral drug Hasseltamivir, which can be administered in influenza infections.

Monika Rachtan
So in fact this visit to the doctor can explain a lot to us, it can give us a lot of answers. It is very important, especially with children, to know what we are dealing with. Because in children these infections can change and progress very quickly. It is also worth coming.

Adam Jerzy Sybilski
I have a question for you now, too, because you're just asking me like that and I'm not, no, no. Do you know what we have the biggest problem with in viral infections?

Monika Rachtan
I don't have a clue, but would love to.

Adam Jerzy Sybilski
You probably know, you're just ashamed to say. It is the cough that keeps us up at night the most. And not only us, but also the parents, because a fever is a bit worse there, lack of appetite. Somehow, both parents in children and adults can cope with all this. We have excellent antipyretics, you can administer and so on. And with this cough there really is a big problem. Especially as it is often, as it were, perceived as such a worrying symptom for society.

Monika Rachtan
Truth be told, if someone is standing in a tram and coughing, everyone is so concerned.

Adam Jerzy Sybilski
He is probably ill, and seriously so.

Monika Rachtan
Sick and seriously still.

Adam Jerzy Sybilski
20 years ago he probably had TB, Now fortunately there is a little less TB, although you also have to be aware of it. On the other hand, indeed this cough is, is very much so, I would say, sleep-inducing. Why? It is also in addition to being a symptom that is considered very worrying. Rightly, wrongly. It could be debated here, because in fact this cough often manifests in a certain way that we may no longer be dealing with a trivial upper respiratory tract infection, but, for example, with a lower respiratory tract infection, i.e. pneumonia, bronchitis and so on. On the other hand, he is worrying for yet another reason, and I mean perhaps differently, affecting the quality of life of both patient and parents. It is very tiring, often awakening at night, often interfering with the patient's normal functioning. And therein lies a big, big problem. But.

Monika Rachtan
That's right, but how do you deal with this cough? Because now yes, of course I'm talking about TV commercials. Dry cough, wet cough. Is it really that important to know what kind of cough you're dealing with in the first place, so that you can use the right preparations, Because here a bit of television and advertising.

Adam Jerzy Sybilski
I have to say that I have a lot, a lot of different meetings, as well as lectures with doctors and, among other things, I very often start this lecture with this. Wet cough, dry cough. Does it matter?

Monika Rachtan
And does it matter?

Adam Jerzy Sybilski
Fundamental. And please don't believe, and I say this with all responsibility probably for the time being, that you are going to some company. Well, probably not even two. There is no medicine for wet cough and dry cough. There is no such thing. Please forget it. Because these are different mechanisms, these are different, different needs of the body. When there is a dry cough and a wet cough. And it is not the case that this cough occurs, as if to say, at the same time the same one.

Monika Rachtan
Well, because it also changes during infections.

Adam Jerzy Sybilski
This is, coughing in general is a defensive symptom. Yes, that needs to be made clear. It is, in a way, a desirable symptom. It's not that we want to eradicate this cough from our, from our lives at all. No. It is necessary.

Monika Rachtan
What is the cough needed for?

Adam Jerzy Sybilski
To clear the airways. I will say more. Cough. Every healthy person coughs.

Monika Rachtan
This is true.

Adam Jerzy Sybilski
Up to 30 times a day is the norm. For coughing, so to speak, expectorating and so on. In our respiratory tract, upper and lower, some secretion collects all the time. In general, the entire mucous membrane is covered with a certain amount of secretion and it is there all the time. And sometimes it builds up a bit more, even when we are healthy. And then we just cough it up. Sometimes we also cough when we are healthy, due to irritation, especially of the upper respiratory tract, throat and larynx.

Monika Rachtan
Air conditioning, dry air, pollution.

Adam Jerzy Sybilski
This is exactly what I want to talk about.

Adam Jerzy Sybilski
Especially in autumn and winter, when we have dryness of the air just through these different heating factors and so on. That's when the air is dry. We breathe that air and it's a bit much. Yes, I'm going a bit on the side, I'll come back to infections in a moment, but I'm still going on the side, because apart from paediatrics, I'm also a bit involved in allergology there, so I often have children coming to me, parents, but not only children, also adults, but mainly children, who have asthma. They come for two, three weeks we have asthma. And it's during this autumn and winter period, because they start coughing at night with a dry, tiring cough.

Monika Rachtan
And what is this if not asthma?

Adam Jerzy Sybilski
No drying out the airways, drying out the air.

Monika Rachtan
And what about in such a situation, Professor. Well, yes, of course you can say, you need to have humidified air, but you know, you need to.

Adam Jerzy Sybilski
That's the way it is, it's a staple for everyone, whether you cough or don't cough. In autumn and winter we should have whether a humidifier is debatable here, but somehow humidify that air. Also ventilate from time to time. Because we also have closed windows. Ventilating just brings in a bit more humid air. Well, you may not remember the old days, but I do. There were stoneware on.

Monika Rachtan
I remember.

Adam Jerzy Sybilski
On radiators and so on. These are good ways to do it. Or indeed such humidifiers are one.

Monika Rachtan
But just as there is this cough and it is bothering us.

Adam Jerzy Sybilski
This cough, well, you know, well certainly good hydration of the patient, that is to say, give them a drink. Well, but that's not always enough. So, in fact, for many, many years there have been used all sorts of, I would say, such, well, non-medical, so to speak, paramedical ways, a little bit like phytotherapy And very often there were, there were throats, for example, children, especially children brushed, whether it was on water or glycerol or some oils and so on. Well, those were the old days, but how life goes forward. As someone has seen it work well, well you'd have to maybe do something like that industrially, right? Yes, to do, to help. Well, and there have been formulations like that, which contain glycerol, which practically don't absorb, but they fill perfectly, I mean cover.

Monika Rachtan
They are padding right?

Adam Jerzy Sybilski
That's the word I missed. I'm old now, I forget words. One is just lining the airways, especially the upper airways, which keeps that dry air irritation to a minimum. Two, in a way, can also regenerate a little bit of this mucous membrane and these are great, great glycerol-based remedies, which cure asthma like the palm of your hand, in inverted commas. And that, by the way, when talking about glycerol and this dry cough, it has to be said that it is not just a matter of dry air. What you have just said and what I have continued to say here. And it's not only a question of this asthma, but also, well, in infections We at the beginning as a rule, I mean it's such a textbook, I would say, The course of the disease doesn't always look the same in every patient, but indeed statistically or epidemiologically speaking, it's actually the way it goes the first few days, some say up to four days, some say up to six days about five days in viral infections. We have a dry, agonising cough.

Monika Rachtan
That's right. And then I think we would want to stop.

Adam Jerzy Sybilski
Yes, especially as he is then sometimes we say unproductive, right?

Adam Jerzy Sybilski
Because there is no production of excessive secretions. Anyway, yes, again I will make such a digression that there, in these commercials sometimes it happens. I can't tell if it's a wet cough or a dry cough. Ladies and gentlemen, you can tell the difference. Believe me, it really isn't quite like that. If you take a good look, whether at your own cough or your child's cough, however, you can see. A dry, tiring cough is a bit different, and a wet cough is a bit different, when you can see that it is even boiling, so to speak, and you can see that it is a wet, productive cough, and in the first few days it is usually a dry, tiring cough. And it is in a way a defensive reflex, but it is unnecessary at this point, because there is no secretion. In other words, the main task of the cough, which is to clear the airways, does not apply here, because there is not that much secretion.

Monika Rachtan
It only affects the quality of life and makes it significantly worse.

Adam Jerzy Sybilski
Only and exclusively. Therefore, then indeed the use of an anti-cough medicine not for a wet cough, but for a dry cough, that is, an anti-cough medicine is of enormous importance and it seems that this is when we should use an inhibitory medicine. This we have a lot of different syrups and a lot of syrups. The most common cough medicines are in syrup, although not exclusively. They also come in tablets.

Monika Rachtan
But they also happen.

Adam Jerzy Sybilski
Yes, yes they do. For adults, on the other hand, they are mostly syrups and here we have a lot of these syrups. But I think this is generally speaking both for adults and for children. It is good if we have a medicine that does not act on the central nervous system, that is, on the system, on the cough centre. I'm not going to say anymore how this, so to speak, reflex is, because it goes from the airways to the head. The head shows that you need to cough. Well, it goes another impulse to cough, that is, mainly to the diaphragm, because it is the diaphragm that mainly causes coughing.

Monika Rachtan
Professor, but when we know that this glycerol, when we want to soothe the irritation precisely, we know that it is important and effective here. However, in the case of this dry cough that we want to suppress, what active substance should we look for, because there are many of these over-the-counter medicines. Of course, a pharmacist can advise us, but it is also good to be educated and know what to look for.

Adam Jerzy Sybilski
We can generally divide cough suppressants into two groups. Those that act centrally and those that act peripherally. Both groups are very effective. Both groups appear to be very safe with the single assumption that if we choose a medicine, even a medicine that is over-the-counter, it must be a medicine. It can't be a dietary supplement. It shouldn't be exactly, it shouldn't be a medicinal product. It should be a medicine. Why? Because medicines. If we have in the name that it is or said that it is a medicine. Such, such a substance. Such a preparation has clinical studies, it has studies of both efficacy and safety, even though it is over-the-counter, which indicates that it is a safe drug, that it can be used, well, let's say without special prescription by a doctor, even though it is safe, it is certainly effective, because there are reliable studies for that.

Monika Rachtan
Professor, so when we stand in front of the pharmacist's window and ask for that advice, it's always worth asking if she's giving me a medicine, is she giving me a dietary supplement, is it a medicinal product? And if we have supplements and medicinal products in the proposals, always ask for a medicine from a trusted company, because then we know that this research has been done and above all it goes.

Adam Jerzy Sybilski
Exactly so. Especially that when it comes to cough, but also a lot of various other preparations for other conditions, we have both medicines and just medicinal products, as well as dietary supplements. And so on and so forth and, well, the difference is not so, well, trivial or one that can somehow be overlooked. Therefore, let us try to treat with medicines even without a prescription, but with medicines.

Monika Rachtan
And if it is a wet cough, because here if there is another type of cough, other substances will probably also be effective, if only to help us get rid of this lingering secretion that we want to eradicate.

Adam Jerzy Sybilski
Well, precisely because, as I mentioned, these first few, first few days are a dry, non-productive cough that we want to suppress. On the other hand, after a few days, as a rule, such a pathophysiological process begins. This cough starts to be productive, because the amount of secretion increases. Unfortunately, this secretion is usually sticky and difficult to evacuate. And here we often say that there is a lingering secretion.

Monika Rachtan
And, Professor, it sometimes varies in colour, sometimes it's more yellow, sometimes it's more greenish, sometimes it's transparent. Does this colour also tell us something?

Adam Jerzy Sybilski
Yes, although I wouldn't get very attached to it. But indeed, if it's a white discharge or such a watery discharge and so on. This again rather indicates that there, that it is a viral infection, that there are more lymphocytes and so on. On the other hand, if it starts to turn yellow and especially green, then it seems to us, I mean we know, that there are more cells there, white cells, but these granulocytes, that is those responsible for defence against bacterial infections, and therefore such a discharge rather indicates a bacterial infection. But it varies, because sometimes this white watery discharge after some time starts to be just so yellowish again and so on. So here I would not attach much importance to it. What is worse, however, is that this secretion, which is formed during the course of an infection. This is what makes it difficult to recover. There is a great deal of research showing that the efficient evacuation of this secretion is a prerequisite for recovery and a faster return to health. Therefore, it is very important for us to evacuate this secretion quickly and effectively, in other words, to simply cough. Therefore, we cannot then inhibit the cough.

Monika Rachtan
So we have to change the medicine, we have to change the medicine.

Adam Jerzy Sybilski
Because, as I mentioned, well, there is no drug here that inhibits and at the same time stimulates, because that's what it would come down to. And now the important thing is that this discharge, as I mentioned, it is often, it can be thick, it can be sticky. Therefore, it is very important for every patient, and the child in particular. Good hydration. That is, we need to drink a lot during the infection.

Monika Rachtan
That is, this recommendation please rest and drink plenty of fluids is very relevant.

Adam Jerzy Sybilski
Absolutely the basis of treatment and the basis of recovery. Anyway, not only when it comes to coughs and secretions, but also when it comes to the effect of antipyretics. That is, drinking. But drinking alone is often not enough and you just need to stimulate. And we have such a group of medicines, the so-called mucolytic stimulants, which have different actions to assist in the evacuation of this secretion. They can be mucolytic, mucostimulating and so on. They first of all liquefy the secretion a little, there to cut various particles into smaller ones.

Monika Rachtan
It is simply a matter of making her easier to evacuate.

Adam Jerzy Sybilski
Exactly how good it is still, hydration plus is just have a so-called expectorant effect, that is, they stimulate a little bit this cough and such mucostimulant drugs are absolutely beneficial here at this point. But in addition to, well in addition to the mucolytic action, sometimes some of these drugs, the so-called mucostimulant or mucolytic drugs, we often call them mucolytic drugs. Yes, there are drugs that assist precisely this evacuation of secretions, some of these drugs. Carbo Cysteine, for example, is such an example. They still have such a little added value. This is a very favoured observation now, so to speak, or such a feature in general, that something has added value.

Monika Rachtan
And what does it consist of?

Adam Jerzy Sybilski
This is very interesting because, again, it is based on research, because Carbo Cysteine is a drug based on research on very hard data, showing that such Carbocysteine also has an antiviral effect. It can also act against a little bit of antimicrobial. That doesn't mean that it's a drug that directly acts either on viruses or on bacteria, that it kills them or something like that. It doesn't. But it supports our natural immune responses, enhances them, stimulates them.

Monika Rachtan
So does that mean that this infection just might be shorter, for example?

Adam Jerzy Sybilski
Exactly right.

Monika Rachtan
And we care about time.

Adam Jerzy Sybilski
That's right. And they still work. Still In addition to that, they have an anti-inflammatory effect a little bit and they have an antioxidant effect. These are two, again two mechanisms, another two mechanisms that help in a way. So that's the added value. So very often it's nice to have a drug that not only helps us in this evacuation, that has a mucolytic effect and so on, but that adds a little bit to that whole there etiology, to the whole basically such a causal action a little bit, not only symptomatic, but a little bit and causal.

Monika Rachtan
Professor, we were just talking about preparations that are medicines, that are dietary supplements, but we also have preparations that are prescription and non-prescription in the case of carbo cysteine, which you can reach for.

Adam Jerzy Sybilski
Well, this is a very good example of Carbo Cysteine. We have both prescription and so-called OTC (over-the-counter) preparations. It seems to me that, especially in the paediatric population, a prescription medicine is such a good way to go. Why? Because the prescription drug Carbo Cysteine has a higher concentration. This higher concentration can cause whether it causes or makes a smaller, smaller amount of syrup that we have to give to the child. This is a very important element, for the reason that children often don't like to take syrup, even when they are tasty.

Monika Rachtan
Well, yes, and we are already in the second part of this infection. the child is tired of the treatment?

Adam Jerzy Sybilski
Yes, he generally gets several medicines, so extra still syrup. So if we have the possibility that instead of five or ten millilitres we can give 2.5 millilitres with the same dose of medicine, but just a higher concentration, so a smaller amount, the amount of syrup, a smaller portion exactly, this is more beneficial, This is one thing. The other thing, which well we as doctors like it a lot, maybe parents a little bit less, and that is the medicines that we prescribe. We have control over them, we know how, what drugs, how much of these drugs, in what doses the patient is taking. And despite appearances, this is a more comfortable situation for us, but I think that many parents would also be more comfortable just knowing that this is exactly what the doctor has prescribed, exactly how much the child or adult should take, because it is exactly the same situation with adults. So it seems to me that even though at first glance that's the availability, in this case of prescription carbocysteine is a bit worse, well because it's you have to go to the doctor, take the prescription and so on and so forth. It seems to me that for treatment, for so-called compliance, that is, for adherence, as well as precisely for a certain control of this action, and on the other hand a smaller, smaller amount of a smaller portion of the drug, this is more advantageous in infectious treatment.

Monika Rachtan
And this monitoring of the doctor is also a very important factor, especially for children, but for adults, when these various infections such as COVID or influenza are present, it is worth consulting the doctor. We are, in fact, at the beginning of this cold peak and it is still difficult for us to say what it will look like, but we know for sure that everyone who will have a cold, who will have a viral infection, who will have a bacterial infection, will probably be coughing, or at least most of them. And it is worth treating that cough effectively. I think what the professor said, that there is no magic pill for everything. Yes, in the case of a cough, you have to be able to differentiate that cough and also think about what the purpose of our treatment is, because I think that's very important.

Adam Jerzy Sybilski
Exactly. Well, we have here, just to quickly recap what we have been saying here. We have three groups of drugs, as it were. We have glycerol, which is the symptomatic drug par excellence, which basically acts topically. We have cough suppressants and we have mucolytic drugs. Depending on what kind of cough we have, we can use any of these groups. I will say more that if we have a dry torturous cough that we often also cough. The coughing process itself can irritate the airways, the respiratory tract, the upper throat and so on. It can scratch our throat. Anyway, we often probably have one. When we have a dry cough, everyone remembers having a scratchy throat like that at the time. Then you can, for example, combine this glycerol with an anti-, anti-cough medicine, so that here it acts against temporarily and at the same time soothes the airways. That is, we have this glycerol for soothing we have an anti-cough medicine, which we use either in asthma caused by dry air, or in the initial incipient phase of an infection, especially a viral infection. And we have mucolytic drugs or muco stimulants or muco regulating drugs as you call it, which help us to evacuate the secretions and then there is another aspect and that is these drugs. Antitussives or glycerol. Antitussives and glycerol can also be used in the so-called post-infectious cough, because we also did not talk about that, that once the infection is over, this cough, sometimes this cough can remain for a few, a few weeks even, and then it is really unnecessary, because we are already cured, this secretion is almost gone. It is usually dry, again, sometimes tiring, sometimes more, sometimes less. Nevertheless, it is worth it.

Monika Rachtan
And which group do we return to?

Adam Jerzy Sybilski
Then we go back to cough suppressants or glycerol, because sometimes it is simple irritation.

Monika Rachtan
I think I feel prepared for the cold season. I'm hoping that no colds will get me this time, but if a cough comes on I'll definitely know what to do. I hope you will too. Today, you have learned, you have received a lot of valuable information about getting rid of a cough, because nobody wants to cough. It negatively affects our quality of life.

Adam Jerzy Sybilski
But it is needed in infections. It is needed. Well, because if there is secretion, this cough has to be there. It is a symptom that is. Is it a reflex? Maybe yes, a reflex that is needed, So we don't want it, but sometimes it is necessary.

Monika Rachtan
That is to say, let's learn to live with coughing and shorten our infections, especially viral infections. Because today we talked about viral infections, and my guest, but especially your guest, was Professor Adam Jerzy Sybilski. Thank you very much, Professor, and I remind you to subscribe to my channel on YouTube. You can also listen to us on all other podcast listening sites. I also look forward in the comments to suggesting topics for the next episode of the programme. First of all to the patient, thank you very much once again.