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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