COUGH AND BRONCHIAL

ASTHMAArijit Chakraborty

M.Pharm (Pharmacology)

19/02/2013

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COUGH

Cough is a protective reflex, its purpose being expulsion

Of respiratory secretion or foreign particles from air passages. It occurs due to stimulation of chemoreceptor's in throat, respiratory passage or stretch receptors in the lungs.

Cough is two type; useful and useless, useful (productive) Cough serves to drain the airway, its suppression is not desirable, may even be harmful but Useless (Unproductive) cough should be suppressed.

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COUGH

Cause:Cold and flu.Allergic rhino-sinusitis (inflammation

of the nose or sinuses).Asthma.Smoking.Lung infections such as pneumonia

or acute bronchitis.3

DRY COUGH

Dry cough is a type of cough that does not produce sputum or phlegm.

It can be triggered by, 1. infections and cold (the most common

causes of dry cough), 2. allergic reactions, 3. traumas, 4. lung cancer, 5. airway obstruction, and other

abnormalities.

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SYMPTOMS OF DRY COUGH

Flu-like symptoms (fatigue, fever, sore throat, headache, aches and pain)

Nausea Runny nose (nasal congestion) Vomiting Wheezing (whistling sound made with

breathing) Loss of appetite

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CAUSES OF DRY COUGH

Airway irritation (bronchospasm)Asthma and allergiesChronic obstructive pulmonary disease

(COPD, includes emphysema and chronic bronchitis)

Congestive heart failureLung cancerPleurisy (inflammation of the lining

around the lungs and chest)Smoking

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WET COUGH

The medical term for a wet cough is productive cough. Wet cough is a common symptom of,

1. respiratory infection,  2. allergies, and heart conditions.

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SYMPTOMS OF WET COUGH

Absence of breathing.Chest pain or pressure.Cough that gets more severe over time.Coughing up blood.Coughing up clear, yellow, light brown, or

green mucus.Coughing up pink frothy mucus.Rapid breathing (tachypnea).Wheezing (whistling sound made with

breathing).8

CAUSES OF WET COUGH

Acute bronchitis.Bronchiectasis (destruction and widening

of the airways)Bronchiolitis (inflammation of the smallest

airways in the lungs)Common cold (viral respiratory infection)Cystic fibrosis (thick mucus in the lungs or

digestive tract)Influenza (flu).Tuberculosis (serious infection affecting the

lungs and other organs).9

MECHANISM OF COUGH

Stimulation of chemoreceptor's (throat, respiratory passages or stretch receptors in lungs)

Afferent impulses to cough centre (medulla)

Efferent impulses via parasympathetic & motor nerves to diaphragm, intercostals muscles & lung

Increased contraction of diagrammatic, abdominal & intercostals (ribs) muscles noisy

expiration (cough)10

TREATMENT OF COUGH

Primary medication: Cough drops, syrup etc.

Expectorants (Mucokinetics): a) Bronchial secretion enhance:

Potassium iodide, balsum of tolu. b) Mucolytics: Bromhexine,

Ambroxol, Acetyl cysteine.

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TREATMENT OF COUGH

Antitussives (Cough centre suppressants): a) Opoids: Codeine, Pholcodeine b) Nonopoids: Dextromethophan,

Noscapine c) Antihistamines: Chlorpherinamine,

Promethazine Adjuvant antitissuve: Bronchodilators: Salbutamol,

Terbutaline

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BRONCHIAL ASTHMA

Asthma is a Chronic inflammatory disorder of the airways.

Chronically inflamed airways are hyper responsive.

They become obstructed and airflow is limited by bronchoconstriction, mucus plugs, and increased inflammation when airways are exposed to various risk factors.

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BRONCHIAL ASTHMA

ETIOLOGY: Triggers factors tend to participate

and/or aggravate asthma exacerbation. 1. Allergens e.g. pollens, air pollution,

dust. 2. Irritants e.g. Tobacco smoke,

sprays. 3. Exercise. 4. Temperature and weather change. 5. Expose to infection.

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CONT…… 6. Animals e.g. cats , dogs,

rodents etc. 7. Strong emotion, e.g. fear ,

laughing.

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Characteristic of Asthma

Asthmatic patients experience intermittent attacks of wheezing, shortness of breath-with difficulty especially in breathing out, and sometimes cough. As explained above, acute attacks are reversible, but the underlying pathological disorder can progress in older patients to a chronic state superficially resembling COPD. It is characterized by,

a) Inflammation of the airways b) Bronchial hyper-reactivity c) Reversible airways obstruction

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PATHOPHYSIOLOGY OF ASTHMA

Asthma trigger

- Inflammation & edema of the mucous membranes.

- Accumulation of tenacious secretions from mucous glands.

- Spasm of the smooth muscle of the bronchi & bronchioles

decreases the caliber of the bronchioles.

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PATHOPHYSIOLOGY OF ASTHMA

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Relaxation Constriction

Normal

Asthma

Airway narrowing

Exaggeratedairway

narrowing

muscle constriction 35 %

muscle constriction 35 %

Pathological changes of asthma

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Epithelium

Normal airway

airway wall remodeling

Basement membrane

Smooth muscle

Mucus glands (hyperplasia)

DRUG THERAPY

2 types of drug categories are used:

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ANTIINFLAMATORY DRUG BRONCHODIALETORS

hormone-containing (corticosteroids)

nonhormone-containing (leukotriene

receptor antagonists)

2-agonists

anticholinergic drugs

methylxanthines

DRUG THERAPY

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Anti-inflammatory drug

Corticosteroids (Hydrocortisone, Beclomethasone)

Leukotrienes antagonist(Montelukast)

Bronchodilators

2-agonists(Salbutamol, Terbutalin)

Anticholinargic drug(Ipratropium

bromide)

Methyxanthine(Theophylline, Aminophylline)

DRUG THERAPY

Anti-inflammatory drug: a) Corticosteroids: (Hydrocortisone,

Beclomethasone) i) Cell membrane stabilization. ii) Inhibition of inflammatory mediators.

iii) Restoring the sensivity of β2- receptors.

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DRUG THERAPY

Anti-inflammatory drug: a) Leukotrienes receptor antagonist:

(e.g. montelukast) are third-line drugs for asthma.

They: – competitively antagonize cysteinyl

leukotrienes at CysLT1 receptors

– are used mainly as add-on therapy to inhaled corticosteroids and long-acting β2 agonists

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DRUG THERAPY

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BRONCHODIALETORS

-agonists

Stimulates

2-adrenergic

receptors of bronchi

Smooth muscle

relaxation

Smooth muscle

relaxation

Anticholinergic drugs

reduce tones

of vagus

Methylxanthinesinhibit non-

selective phosphodiesterase

DRUG THERAPY

β2-Adrenoceptor agonists (e.g. Salbutamol) are first-line drugs. It is increase the Heart rate.– They act as physiological antagonists of the

spasmogenic mediators but have little or no effect on the bronchial hyper-reactivity.

– Salbutamol is given by inhalation; its effects start immediately and last 3-5 hours, and it can also be given by intravenous infusion in status asthmatics.

– Salmeterol or formoterol are given regularly by inhalation; their duration of action is 8-12 hours.

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DRUG THERAPY

Methyxanthine: (Theophylline, Aminophylline)

– inhibits phosphodiesterase and blocks adenosine receptors

– has a narrow therapeutic window: unwanted effects include cardiac dysrhythmia, seizures and gastrointestinal disturbances

– is given intravenously (by slow infusion) for status asthmatics, or orally (as a sustained-release preparation) as add-on therapy to inhaled corticosteroids and long-acting β2 agonists

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DRUG THERAPY

Anti-cholinergic drug: ( Atropine, ipratropium bromide, troventol)

They are used in predominantly in nighttime asthma and in elderly patient because of the least cardiotoxic effect.

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REFERANCE

1. Essentials of Medical Pharmacology, K.D. Tripathi.

2. Pharmacology, Rang and Dale. 3. Internet Source.

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