Athogenetic therapy of cough in ARVI and acute bronchitis: modulation of the inflammatory response using combinations of glycyrrhizic acid. A review

Acute respiratory viral infections (ARVI) and acute bronchitis are the most common respiratory tract diseases, in which cough remains the leading clinical symptom. Current understanding of the pathogenesis of these diseases places inflammation at the center, which affects damage to the respiratory epithelium, mucus hypersecretion, impairment of mucociliary clearance, and the development of cough. The aim of this review is to summarize current data on the role of inflammation in the pathogenesis of ARVI and acute bronchitis, to analyze the molecular mechanisms of virus-induced inflammation with an emphasis on the NF-κB, HMGB1, NLRP3 inflammasome signaling pathways, oxidative stress, and their role in the development of clinical manifestations and complications. Modern approaches to pathogenetic therapy based on modulation of the inflammatory response are reviewed, and the pathogenetic rationale for the use of glycyrrhizic acid is discussed. The review is presented in the format of a narrative literature review. Particular attention is given to the relationship between inflammation, cough, and impaired mucociliary clearance in the respiratory tract. Glycyrrhizic acid is a multitarget anti-inflammatory agent that acts on several key links of the inflammatory cascade, including inhibition of the HMGB1–TLR4–NF-κB signaling pathways, suppression of NLRP3 inflammasome activation, reduction of oxidative stress, and limitation of inflammation-mediated damage to respiratory tract tissues. One of the clinical implementations of this mechanism is the inclusion of glycyrrhizic acid in the combination drug Codelac Broncho. Experimental and clinical data substantiating the use of glycyrrhizic acid as part of the combination drug Codelac Broncho are presented. The mechanisms of complementary action of ambroxol and sodium glycyrrhizinate are discussed, as well as their place in modern pathogenetic therapy of patients with ARVI and acute bronchitis accompanied by non-productive or productive cough.