Immediate efforts to decrease mucous build-up in infected patients may be the best path forward in decreasing need for advanced emergency medical care and fatalities among CoVid-19 infected patients.
We cannot make ventilators fast enough to meet the immediate need and near-term future needs but we can decrease the ultimate need of ventilators. Social Isolation is the single most important approach to saving lives and decreasing peak of acute care needed.
I am presenting a rational based on news of autopsy studies in China. This article will give links to important articles. Many abstracts and news reports will be included.
My interest was piqued by this article “Covid-19 autopsy shows lungs full of mucus, different from SARS ” (1)
“In response to the anatomy of the general situation of patients with Covid-19, Zhong Nanshan, an academician of the Continental Academy of Engineering, revealed that “there is no severe fibrosis and there is a lot of mucus.” The lungs of patients with Covid-19 are different from those infected by the SARS virus.”
This disease is different than previous respiratory disorders!
THE DIFFERENCE IS LARGE AMOUNTS OF STICKY MUCOUS!
WE CAN DECREASE MASSIVE MUCOUS, A COUPLE OF METHODS SPG BLOCKS AND GUAFINISEN DISCUSSED BELOW.
“The fibrosis in the lungs is not as severe as we expected. The final results have not come out yet. It seems that some alveoli are still there, but the inflammation is very severe and there is a lot of sticky mucus.
THIS ARTICLE ALSO SPELLS OUT THE PROBLEMS THAT NEEDS ADDRESSING:
Coronavirus vaccine breakthrough? Findings from first COVID-19 autopsies stuns doctors (2)
THEY DESCRIBE THE CONDITIONS:
According to the leading professor from the Tongji Medical College team in Beijing, they found “a large amount of mucus in the lungs”.
He told Bloomberg: “The secretion is very sticky. It attaches to the lung like paste.
STICKY SECRETION LIKE PASTE!
“The mucus was in the deep-seated airway. If we don’t give targeted treatment, it may be counter-productive.
DEEP SEATED AIRWAY…..NEED TARGETED TREATMENT!
“A normal lung touches like a sponge because it contains air. But an infected lung doesn’t touch like this.”
He continued: “Something else refilled in the lung. You must know what the pathological change is and give targeted treatment.
“Otherwise it will be useless like delivering oxygen through a blocked path.”
VENTILATORS ARE NOT TARGETED! WHAT can we do to better target issues?
THIS DOES NOT MEAN WE DON’T NEED VENTILATORS!
LOOKING FOR SCIENCE TAKES US TO PUBMED: I WILL INCLUDE LINKS:
IT BECOMES INCREDIBLY IMPORTANT TO UNDERSTAND HOW MUCOUS IS CLEARED!
Muco-ciliary clearance: A review of modelling techniques.(3)
Such interaction between the cilia and mucus is called ‘muco-ciliary clearance’ (MCC) which is essential to clear the respiratory airways from the inhaled toxic particles deposited on the mucus. THIS IS KEY!
ASTHMA CAN BE LOOKED AT AS A MODEL ($)
Respiratory tract mucous membrane microecology and asthma.(4)
Short-Term Appraisal of the Effects and Safety of Manual Versus Ventilator Hyperinflation in an Animal Model of Severe Pneumonia.(5)
WHAT ARE VENTILATORS DOING? DO WE NEED NEW BEST PRACTICES WITH COVID 19?
“In patients on mechanical ventilation, lung hyperinflation is often performed to reverse atelectasis and clear retained mucus.”
Atelectasis (at-uh-LEK-tuh-sis) is a complete or partial collapse of the entire lung or area (lobe) of the lung. It occurs when the tiny air sacs (alveoli) within the lung become deflated or possibly filled with alveolar fluid. Atelectasis is one of the most common breathing (respiratory) complications after surgery (6)
CONCLUSIONS: In an animal model of severe P. aeruginosa pneumonia, neither manual hyperinflation nor ventilator hyperinflation improved mucus clearance. If confirmed in comprehensive clinical experimentations, these findings should promote reappraisal of indications for both manual hyperinflation and ventilator hyperinflation as a therapeutic technique for mucus clearance and atelectasis reversal. (5)
TREATMENT OF COVID 19 SHOULD LOOK AT CLEARANCE OF MUCOUS AS BEING AS IMPORTANT AS USE OF VENTILATORS! WE NEED TO LOOK AT MUCOUS CLEARANCE ON THE CYSTIC FIBROSIS MODEL!
Airway clearance techniques for cystic fibrosis: an overview of Cochrane systematic reviews. (7)
THE AUTHORS’ CONCLUSIONS: There is little evidence to support the use of one airway clearance technique over another. People with cystic fibrosis should choose the airway clearance technique that best meets their needs, after considering comfort, convenience, flexibility, practicality, cost, or some other factor. More long-term, high-quality randomized controlled trials comparing airway clearance techniques among people with cystic fibrosis are needed.
NO SPECIFIC TECHNIQUES SO WE MUST CONSIDER ALL OF THEM ON THE BASIS OF EXPERIENCE AND ABILITY TO OBTAIN AND PERFORM TECHNIQUES!
THESE ARE SOME OF METHODS FROM THE ARTICLE. Cochrane Reviews of randomized or quasi-randomised controlled trials (including cross-over trials) that evaluated an airway clearance technique (conventional chest physiotherapy, positive expiratory pressure (PEP) therapy, high-pressure PEP therapy, active cycle of breathing techniques, autogenic drainage, airway oscillating devices, external high frequency chest compression devices and exercise) in people with cystic fibrosis.
THIS EXCELLENT ARTICLE HELPS EXPLAIN THE PROBLEMS:
Airway Mucus Function and Dysfunction (8)
PLEASE SEE FIGURE 4 (BELOW IMMEDIATELY BEFORE REFERENCES) FROM THIS ARTICLE.. THE MASSIVE MUCOUS PLUGS ARE THE PROBLEM AND SHOULD BE ADDRESSED!
THE USE OF AGENTS TO THIN THE MUCOUS PRODUCED MAY BE THE BEST PREVENTATIVE AFTER SOCIAL ISOLATION TO PREVENT THE MOST SEVERE CONDITIONS REQUIRING VENTILATORS AND MAKE VENTILATORS MORE EFFECTIVE.
GUAFINISEN IS A NATURAL PRODUCT USED TO DECREASE MUCOUS PRODUCTION /ACCUMULATION
The Guaifenesin Story: A Centuries-Old Bark Extract Used For Clearing The Airways – Now Key To A Popular FM Symptom-Reversal Protocol(9)
“Guaifenesin is a substance that helps loosen and liquefy mucus, and as such is a common component of many nonprescription cold and cough remedies. It is derived from a tree bark extract called guaiacum, historically appreciated for its expectorant qualities in the Caribbean region and adopted by European explorers in the 1500’s.
Some 400 years later, in 1952, guaiacum was approved for use as an expectorant by the Food and Drug Administration. And 20 years ago the extract was synthesized, pressed into tablets, and named Guaifenesin.
How Guaifenesin Works
Guaifenesin works by drawing water into the bronchi – the air passages branching into our lungs. The released water both thins the mucus and lubricates the airway, facilitating the removal of cold, flu and allergy-associated mucus from the chest by coughing, and making it easier to breathe.
Guaifenesin is also considered helpful for thinning postnasal drainage from the sinuses and reducing nasal congestion,(1) and so may relieve sinus pressure/ headache. As Dr. Sarah Myhill comments, “Whoever designed the human body needs a black mark for putting in sinuses! They are cavities in the bones of the face with only one entry and exit hole which is easily blocked by catarrh or swollen mucus membranes.” When this occurs, less oxygen can enter the sinuses, promoting bacterial overgrowth and causing sinusitis.
Here again, Guaifenesin can help to relieve congestion by increasing the clearance of secretions, helping with the mucus membrane’s natural job of washing away invading viruses, bacteria, pollen and other potential allergens – “the first level of immune defense.”
Guaifenesin also enjoys a popular reputation as ‘the opera singer’s friend.’ Terming it their ‘wonder drug,’ singers have traditionally used Guaifenesin to improve the state of their vocal folds in extremes of humidity (very dry or very humid), after flying long distances, and during mild allergies, for its ability to promote ‘secondary mucosal secretion’ – the thinner, lubricating mucus that occurs on the vocal folds naturally when they are healthy and well hydrated.
Patients with chronic obstructive pulmonary disease (COPD) may find Guaifenesin’s thinning and lubricating action helpful at times when they experience particular difficulty coughing up the thick or sticky mucus that can block their damaged airways.
Similarly, Guaifenesin can assist by thinning ‘sticky’ mucus to help expel inhaled particles that can exacerbate asthma symptoms.
Importantly, whether used to ease the congestion of colds, flu, or rhinosinusitis, or to support healthy vocal folds, Guaifenesin works best if one drinks plenty of water, as extra fluids increase the flow of water and mucus.
As with many complex herbal compounds used in traditional medicine, exactly how Guaifenesin encourages healthy mucus flow is not yet completely understood. But based on its long history – if taken as instructed on the package or as suggested by a pharmacist or healthcare provider – Guaifenesin has at most minor side effects and is generally considered safe for use even by youngsters over 12 years of age.*
Guaifenesin: 7 things you should know (9)
Guaifenesin: 7 things you should know (10)
Medically reviewed by C. Fookes, BPharm Last updated on Aug 30, 2019.
1. How it works
Guaifenesin is an expectorant that increases the volume and reduces the viscosity (stickiness) of respiratory tract secretions. This makes coughing out these secretions easier.
- Guaifenesin is used as an expectorant (a substance that promotes mucus secretion in the airways).
- Usually used in combination with other ingredients.
- Use to relieve chest congestion that occurs as a result of a cold, the flu, or allergies.
- Makes a cough more productive. Guaifenesin will not stop coughing; however, coughing is important as it is the body’s way to remove excess mucus.
- Guaifenesin is generally well tolerated.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side affects you are more likely to experience include:
- Nausea and vomiting are the most commonly reported side effects; constipation, dizziness, headache, and a rash are reported rarely. Side effects are generally mild at low dosages.
- Do not use in children younger than 4.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- Guaifenesin does not need to be taken with food; however, it can be taken with food if it upsets your stomach.
- Take exactly as directed by your doctor or on the label. Do not increase the dosage or take for longer than is recommended. Use a properly calibrated measuring spoon to measure liquid Guaifenesin dosages.
- Do not open, crush, break, or chew Guaifenesin delayed-release capsules or tablets because this may cause too much of the drug to be released at once.
- Drink extra fluids while you are taking guaifenesin to help loosen congestion and lubricate the throat.
- Do not drive, operate machinery or perform other hazardous tasks until you know how Guaifenesin affects you.
- Protect Guaifenesin liquid from light.
6. Response and Effectiveness
Some effects of Guaifenesin should be noticed within 30 minutes of taking it orally; however, up to two days of regular dosing may be needed before the full effects are seen. Liquid Guaifenesin lasts for approximately four to six hours. Delayed-release capsules or tablets last for up to 12 hours.
Guaifenesin has no known drug interactions
ANOTHER POSSIBLE APPROACH IS THE USE OF SELF-ADMINISTERED SPHENOPALATINE GANGLION BLOCKS WITH TRANS-NASAL COTTON-TIPPED CATHETERS TO DECREASE VASO-MOTOR RHINITIS / MUCOUS PRODUCTION. THESE BLOCKS CAN ALSO BE DONE BY PHYSICIANS TRANS-NASALLY WITH SPHENOCATH OR TX360 OR BY INJECTION. THEY ARE NORMALLY UTILIZED FOR SEVERE HEADACHES AND/OR MIGRAINES BUT ARE ALSO HELPFUL FOR ANXIETY WHICH MIGHT BE HELPFUL. (11)
Neuromuscular dentistry and the role of the autonomic nervous system: Sphenopalatine ganglion blocks and neuromodulation. An International College of Cranio Mandibular Orthopedics (ICCMO) position paper. (11)
Vasomotor Rhinitis and Sphenopalatine Ganglion Block (12)
THERE IS A GREAT DEL OF INFORMATION ON USE OF SELF-ADMINISTERED SPG BLOCKS AT SPHENOPALATINE GANGLION BLOCKS.COM
Vasomotor Rhinitis Treatment with SPG Block (Sphenopalatine Ganglion Blocks) (14,13)
PERSONALLY THERE ARE OTHER HOME REMEDIES TO REDUCE PLEGM AND MUCOUS: THIS IS AN ARTICLE FROM MEDICAL NEWS TODAY (15)
THE USE OF NITRIC OXIDE PRECURSORS CAN BE HELPFUL AS CAN NASAL BREATHING. I UTILIZE NEO40 (16)
Immediate available drug for Cystic Fibrosis could be utilized to save lives in Covid-19 crisis (17, 18)
The Alginate oligosaccharide OligoG CF-5/20 may be an immediate low risk trial Covid-19. It is a drug being tested for Cystic Fibrosis.
The alginate oligosaccharide OligoG CF-5/20 dry powder for inhalation (OligoG DPI) represents a novel therapeutic approach for patients with cystic fibrosis (CF). OligoG has been shown to release stagnant mucus, modulate sputum rheology and disrupt the biofilm formation often typically observed in CF. These properties will in turn facilitate mucus clearance and promote effectiveness of antibiotic therapy against the chronic pulmonary infections characteristic of CF.
The design will be a randomised, blinded, placebo-controlled pilot study for proof of concept that OligoG DPI can improve lung function in adult CF patients. Study medication will be given twice daily for twelve weeks on top of standard of care (SOC). Thirty-three patients will be included, out of which twenty-two shall receive OligoG, and eleven shall receive placebo.
After all patients have completed the 12 week double blind treatment period, all patients will be offered open-label OligoG twice daily, in addition to standard of care, for 12 months.
The primary endpoint will be absolute change i percent predicted FEV1
Exploratory parameters will include sputum microbiology.
7. (ABSTRACT) https://www.ncbi.nlm.nih.gov/pubmed/30676656?fbclid=IwAR0a_VoWZYDrtGIbBnvqjTvl4fIFpbEyReBeX2AZR3Rus2Vm9iIkDCIyNgA
7. (FULL TEXT) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6353051/
11. FULL TEXT https://www.tandfonline.com/doi/abs/10.1080/08869634.2019.1592807?journalCode=ycra20
14. https://www.sleepandhealth.com/vasomotor-rhinitis-treatment-spg-block-sphenopalatine-ganglion-blocks/ (14)