Lung recovery after coronavirus

Features of composition and spectrum of action

The annotation states that the thick yellowish-brown syrup has a sweetish taste and a characteristic aroma.

The composition of the medicine is presented:

• extract from licorice root;
• white crystalline sugar;
• 90% ethanol;
• purified water.

The active components of licorice root provide the necessary effectiveness:

• glycyrrhizin – accelerates the removal of sputum, has an expectorant spectrum of action;
• Liquiritoside - acts as an antispasmodic in relation to smooth muscles.

Glycyrrhizic acid and its derivatives suppress cortisol metabolism.

Nutrition for lung recovery after COVID-19

It is recommended to eat nutritious meals 5-6 times a day, in small portions.

Table 2. Required nutritional components

№	Component	Product examples
1.	Easily digestible protein	Chicken, turkey, young beef, cottage cheese, eggs.
2.	Healthy fats	Sea fish, nuts, vegetable oils.
3.	Alimentary fiber	Cereals, fresh vegetables and fruits.
4.	Slow carbohydrates	Cereals, vegetables.
5.	Probiotics	Fermented milk drinks, sauerkraut.
6.	Iron	Parsley, beef liver, buckwheat.

You need to drink 1.5–2 liters of water per day. Regular drinking water, fruit drinks, unsweetened compotes, and rosehip decoction are suitable.

Prohibited: “fast” carbohydrates - cakes, sweets, buns, fatty, hot, spicy foods, deli meats.

Indications and contraindications for therapy with licorice root syrup

The medicine is used in the complex treatment of acute respiratory infections as an expectorant. Can be used as a symptomatic medication in the treatment of dyspepsia.

Licorice syrup is contraindicated in patients:

• with individual intolerance to the component composition;
• renal, liver pathologies;
• hypertension;
• pathologies of the cardiovascular department;
• hypokalemia, alcohol dependence;
• epilepsy, diabetes;
• fructose intolerance;
• brain lesions accompanied by a reduced seizure threshold.

The medication is prohibited for minor patients, pregnant and lactating women.

Principles of pulmonary rehabilitation after COVID-19

Rehabilitation begins 20–25 days after the onset of the disease, sometimes while still in the hospital. As soon as the acute process is over, the body temperature has returned to normal, an examination is carried out. It is clarified whether there is dysfunction of the kidneys, heart, blood vessels, or other organs. The lung recovery program after COVID-19 is developed individually. Taken into account:

• the severity of the coronavirus infection;
• the nature of viral pneumonia, the degree of lung damage;
• floor;
• weight;
• age;
• associated diseases.

The duration of rehabilitation is from 2 weeks to a year. It can go continuously or in courses of 10–14 days with breaks of 5–7 days. With minimal changes, breathing exercises, physical therapy, inhalations, massage, and physiotherapy are prescribed. Regime and nutrition play an important role.

Adverse reactions and overdose

Licorice syrup can cause:

• allergic reactions due to intolerance to one of the constituent ingredients;
• a sharp increase in blood pressure, a decrease in the amount of potassium and an increase in the amount of sodium, swelling - when used for more than 1.5 months or a strong increase in the recommended dose;
• diarrhea, myopathy, myoglobinuria.

If unusual reactions occur, the patient should contact the attending physician for a consultation.

Accidentally exceeding recommended doses leads to:

• to potassium deficiency;
• increased blood pressure;
• changes in heart rate;
• brain damage due to high blood pressure.

The appearance of overdose symptoms requires seeking medical help and symptomatic therapy.

General recommendations for lung rehabilitation after COVID-19

• Maintaining a daily routine, getting a full eight hours of sleep
• Moderate physical activity (10,000 steps per day - walks in the park, forest in dry and warm weather). On a cold, windy or rainy day, it is better to stay home. For a walk, dress according to the weather; shoes should be comfortable.
• Breathing exercises
• Daily wet cleaning and ventilation of the room.
• Refusal to visit the bathhouse or sauna. You should not take hot baths.
• Prohibition on drinking alcohol and smoking.

Precautions from the instructions

The annotation for licorice syrup contains the following recommendations:

• if the condition worsens or there is no effect of therapy, a doctor’s consultation is necessary;
• to avoid the development of adverse reactions, the drug should not be combined with other products containing licorice;
• for chronic or acute diarrhea, the medicine is taken with caution;
• the medication contains 8% ethanol, which is contraindicated for persons with alcohol dependence;
• Before use, the syrup must be shaken - during storage, sediment will form in it.

Due to the alcohol content, patients undergoing treatment should refrain from driving or operating complex moving machinery.

Breathing exercises for lung recovery after COVID-19

Breathing exercises stimulate blood circulation, train the respiratory muscles, increase the elasticity of the lung tissue, and improve bronchial drainage. You need to perform gymnastics in a clean, ventilated room. Start with 30 seconds, gradually increase to a quarter of an hour. Overwork should be avoided. If you feel dizzy, take a break.

Preparatory exercises

1. While lying on your back, inhale slowly for 3–4 seconds, then exhale the same slowly for 5–6 seconds.
2. Diaphragmatic breathing, when the stomach “inflates” as you inhale.
3. Slowly inhale air, slowly exhale through a straw into a glass of water, and relax. Repeat 2-3 times, gradually increase to 10 times.

Initial exercises

1. Sit on a chair, press your back against the back of the chair, lower your arms down. As you inhale, gently raise your arms forward and then up. As you exhale, return to the starting position.
2. The same exercise, only raise your arms up to the sides.
3. Stand up, put your fingers on your shoulders. As you inhale, slowly spread your arms to the sides. Exhaling through your mouth, return to the starting position.

Basic exercises

Gymnastics by A. N. Strelnikova has proven itself well. It is difficult to master it on your own. It is necessary that the movements be shown by a person who knows the technique. Instead of this breathing exercise, your doctor may recommend another one.

Features of interaction

The instructions for licorice root syrup warn:

• that therapy with thiazide diuretics increases the likelihood of developing potassium deficiency;
• increased hypokalemia can be observed when combined with cardiotonic drugs, glucocorticosteroids, medications for the treatment of cardiac arrhythmias - their combination is prohibited;
• It is necessary to avoid taking the syrup with other medications containing ethyl alcohol.

Combined use with an alcohol component can cause redness of the skin, fever, rapid heartbeat, and vomiting. The list of drugs prohibited in joint therapy with licorice root syrup is presented:

• Disulfiram, Cefamandole, Cefoperazone;
• Latamoxef, Chloramphenicol, Chlorpropamide;
• Glibenclamide, Glipizide, Tolbutamide (other hypoglycemic drugs);
• Griseofulvin, Metronidazole, Ornidazole;
• Tinidazole, Ketoconazole, Procarbazine;
• medications responsible for suppressing the functionality of the central nervous system.

Licorice syrup is not used simultaneously with drugs intended to suppress phlegm production and suppress the cough reflex. Anti-cough medications slow down the removal of mucous secretions from the respiratory tract, impair the flow of oxygen into the lungs, and can cause inflammatory processes in the respiratory organs.

Licorice root can reduce the effectiveness of medications intended to lower blood pressure. Concomitant use with laxatives can cause serious electrolyte imbalance.

If therapy requires the use of third-party drugs, then the question of the advisability of combining them with syrup is decided by the attending physician.

Licorice syrup

Registration number: R N002779/01 dated 10/02/2009 Tradename: Licorice syrup Dosage form: Syrup

Composition
of thick licorice extract

— 4 g
Sugar syrup	— 86 g
Ethyl alcohol 90% (ethanol)	— 10 g

Description Thick brown liquid with a peculiar odor.

Pharmacotherapeutic group Expectorant of plant origin. ATX code: R05CA. Pharmacological properties The drug has an expectorant effect, primarily due to the presence of glycyrrhizin, which enhances the secretory function of the mucous membranes of the upper respiratory tract.

Indications for use Used in adults and children as an expectorant for diseases of the upper respiratory tract, accompanied by cough, mainly in the presence of poorly separated, thick and viscous secretions (especially in children and the elderly). Contraindications: Increased individual sensitivity to the components of the drug, pregnancy, lactation, bronchial asthma, gastritis, peptic ulcer of the stomach and duodenum during exacerbation. With caution: liver disease, alcoholism, traumatic brain injury, brain disease, diabetes mellitus, childhood.

Directions for use and dosage: Orally for adults and children over 12 years of age, 1 teaspoon (previously diluted in ½ glass of water) 3 times a day. Children under 2 years old – 1-2 drops (previously diluted in 1 teaspoon of water) 3 times a day; Children from 2 to 6 years old – 2-10 drops (previously diluted in 1 teaspoon of water) 3 times a day; Children from 6 to 12 years old – 50 drops (previously diluted in ½ glass of water) 3 times a day. The course of treatment is 7-10 days. The advisability of a second course of treatment is determined by the doctor. In the presence of poorly separated sputum and to facilitate expectoration, drinking plenty of warm fluids is recommended.

Side effects Allergic reactions are possible; in some cases, dyspepsia (diarrhea) may occur. With long-term use, hypokalemia, increased blood pressure, and the appearance of peripheral edema are possible due to impaired water-electrolyte metabolism.

Overdose When using the drug in doses exceeding the recommended ones, side effects may increase. Treatment: symptomatic.

Interaction with other drugs The drug can be prescribed simultaneously with other drugs used in the treatment of bronchopulmonary diseases. It should not be used simultaneously with drugs containing codeine and other antitussive drugs, as this makes it difficult to cough up liquefied sputum.

Special instructions Information for patients with diabetes: one teaspoon of the drug contains 0.11 bread units (XE), 1 drop – 0.01 XE. The maximum single dose of the drug for adults contains 0.43 g of absolute alcohol, the maximum daily dose is 1.3 g of absolute alcohol, 1 drop (for children) is 0.0043 g.

Effect on the ability to drive a car and operate equipment . No effect.

Release form : Syrup. 50 and 100 g each in orange glass bottles with a screw neck, sealed with polymer caps or screw caps, or polyethylene stoppers and plastic screw caps, or aluminum caps with perforations. The bottles, along with an equal number of instructions, are placed in a group package.

Storage conditions : Protected from light at a temperature not exceeding 25 °C. Keep out of the reach of children.

Shelf life: 2 years. Do not use after the expiration date.

Conditions for dispensing from pharmacies Without a prescription.

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Pharmacological properties of the drug Licorice root syrup

The roots of licorice glabra contain glycyrrhizin, potassium and calcium salts of glycyrrhizic acid, flavone glycosides (liquiritin, liquiritigenin, liquiritoside). The expectorant effect of licorice preparations is due to the content of glycyrrhizin, which stimulates the activity of the ciliated epithelium of the trachea and bronchi and enhances the secretory function of the mucous membrane of the upper respiratory tract. The antispasmodic effect of the drug on the smooth muscle tissue of the respiratory tract is due to the presence of flavone compounds, among which liquiritoside is the most active, and the anti-inflammatory (corticosteroid-like) effect is due to the presence of glycyrrhizic acid, released during the hydrolysis of glycyrrhizin.

Fibrosis – as a consequence for the lungs after COVID-19

Signs of pulmonary fibrosis on CT (computed tomography) indicate that part of the lung tissue is replaced by scar tissue. Fibrosis does not develop in a few days. This usually takes up to 6 months. Fortunately, fatal pulmonary fibrosis leading to severe respiratory failure is not common, and for most people who survive coronavirus infection, the remaining changes in the lungs will not affect their health. In most cases, a control study shows a clear positive trend. Signs of fibrosis decrease or disappear. Normal lung tissue is restored.

Therefore, it is so important to consult a doctor in time and begin proper treatment for COVID-19, which will help avoid serious complications and reduce the recovery time after lung damage from SARS-CoV-2.

Once fibrosis has truly formed, it is irreversible. In this case, doctors try to create optimal conditions for the functioning of the remaining lung tissue. This can often be done, since the compensatory capabilities of the respiratory system are great. But simple methods are not enough for this. It is necessary to involve serious therapy, including medications and respiratory support.

Physiotherapy after coronavirus

Table 3. Popular physiotherapeutic procedures

№	Name	Action
1.	SMT therapy	Sinusoidal modulated currents eliminate bronchospasms and improve drainage.
2.	Laser therapy	Improves blood circulation, has a resolving and anti-inflammatory effect.
3.	Polychromatic polarized light	Accelerates the resorption of infiltrate, improves bronchial patency.
4.	Magnetotherapy	Eliminates inflammation, swelling, pain.
5.	Ultrasound therapy	Removes phlegm, prevents the development of fibrosis.