The use of ambroxol (bromhexine metabolite VIII) in the prevention and treatment of hyaline membrane disease (HMD)

Ambroxol in the Treatment of Idiopathic Respiratory Distress Syndrome

“…It should, however, be re called that the infants in the present study had very low weights and gestational ages and had very severe IRDS, whereas other studies might have included subjects with mild forms of IRDS, pretreated with arti ficial surfactant [17], A very interesting point in the present study is the improvement in the biochemi cal indexes of pulmonary maturity. This is a clinical confirmation to the experimen tal observations made and agrees well with the effects of the drug in improving the fetal pulmonary maturity indexes, de tectable in the amniotic fluids of patients treated with ambroxol for threatened premature labor [18][19][20].…”

Antenatal Ambroxol Effects on Surfactant Pool Size and Postnatal Lung Function in Preterm Ventilated Rabbits

“…Although maternal corticosteroid treat ments are well tested and accepted as a way to decrease the incidence and severity of RDS [22], other agents such as ambroxol and TRH also have been evaluated [ an effect by inducing pulmonary surfactant synthesis and secretion, and that long-term antenatal use of large doses of ambroxol may prevent respiratory distress syndrome caused by surfactant deficiency [1][2][3]. However, few in vivo studies have reported surfactant pool size measurements in conjunction with mea surements of lung function.…”

“…Several clinical trials indicated that this drug decreased the incidence of neo with that of Cerutti and Kapanci [6], Ambroxol enhanced surfactant synthesis as eval uated by the increased incorporation of pal mitic acid and choline into cultured type II alveolar epithelial cells [1,3] in adult rat and rabbit lung tissue [7] in vitro, and by the increased production of total phosphatidyl choline in adult rabbit lung in vivo [8], An increase in the lectithin/sphingomyelin ratio in amniotic fluid was reported in sheep [9] and in the humans [4,10], Increased lamellar structures were noted in fetal rat lungs [11], These changes were interpreted as indicating a transplacental effect of ambroxol on the fetal lung after maternal administration. However, other investigators have reported few changes in fetal mouse or rat lung matura tion with ambroxol [12][13][14], Any changes in lung maturation induced by ambroxol were assumed to result from effects of the drug on surfactant synthesis.…”

“…Ambroxol, a metabolite of bromhexine with a high affinity for lung tissue [1], is used clinically as an alternative drug to maternal corticosteroids to enhance fetal lung develop ment [1][2][3]. Several clinical trials indicated that this drug decreased the incidence of neo with that of Cerutti and Kapanci [6], Ambroxol enhanced surfactant synthesis as eval uated by the increased incorporation of pal mitic acid and choline into cultured type II alveolar epithelial cells [1,3] in adult rat and rabbit lung tissue [7] in vitro, and by the increased production of total phosphatidyl choline in adult rabbit lung in vivo [8], An increase in the lectithin/sphingomyelin ratio in amniotic fluid was reported in sheep [9] and in the humans [4,10], Increased lamellar structures were noted in fetal rat lungs [11], These changes were interpreted as indicating a transplacental effect of ambroxol on the fetal lung after maternal administration.…”

An alternative to steroids for prevention of respiratory distress syndrome (RDS): multicenter controlled study to compare ambroxol and betamethasone

“…Ambroxol readily crossess the placental barrier and concentrates electively in the fetal lungs and liver [13]; 4) and it has been demonstrated that ambroxol lowers the incidence of RDS in preterm infants born of treated mothers compared to mothers given placebo [8,20].…”