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Bromoxyl Bromoxyl Presentation Transcript

  • Bromoxyl Role in respiratory Infections
  • Bromoxyl
    • A combination of:
      • Amxycillin + Bromhexine
      • Antibacterial + Mucolytic
    • What is the add-vantage of such a combination?
    • What are the indications where its use would be superior?
    • Let us peep into the background of the pathophysiology of the respiratory tract to understand this …
  • RTI Organisms
    • Viruses – influenza, parainfluenza, measles, varicella-zoster, respiratory syncytial virus (RSV). Common, often self limiting but can be complicated
    • Bacteria
    • Chlamydia, mycoplasma
    • Fungi
  • Respiratory tract defences
    • Ventilatory flow
    • Cough
    • Mucociliary clearance mechanisms
    • Mucosal immune system
  • The Lungs: Function Lung Clearance What do the Lungs do? Exchange of gases How do they do it? Mucus Clearance Effect of Disease Retention Adverse Effects Diagnosis Treatment
  • Closer understanding based on Burri & Weibel 1973
  • Closer understanding The cilia on the right side are damaged as occurs in chronic bronchitis, giving rise to decreased clearance of the mucus secretions and difficulty in expectoration Bronchial Epithelium (seen in cross-section) This is what cilia look like ??? Or like this ???
  • Interaction of cilia and mucus Knowles and Boucher, J Clin Invest, 2002: 109: 571-7 Tarran et al. J Gen Physiol 2001: 118: 223-36 Mucus transport - as seen by time-lapse photos in cell culture experiments
  • Mucus clearance & retention
    • Mucus Clearance is dependent on Mucociliary function & Cough reflex,
    • Clearance from whole Lung and Tracheobronchial would be different
    • Dependence on Deposition Distribution
    • Mucus composition with relation to Salt and Water or temperature makes a difference
    • Medication / Physiotherapy effect outcomes
  • Mucus clearance & retention Pavia 1985
  • Mucus retention in chronic bronchitis Pavia 1985
  • Mucokinetics
    • Drugs that increase and aid clearance of respiratory tract secretions
      • Hypoviscosity agents (Wetting agents)
      • Mucolytics
      • Expectorants (Bronchomucotropics)
  • Muco-ciliary Blanket
    • 95% water, 2% glycoproteins
    • Gel layer-high viscosity from goblet cells
    • Sol layer – low viscosity from submucosal bronchial glands
  • Muco-ciliary Blanket
    • Both goblet cells and bronchial sub-mucosal glands increase secretion when irritated.
    • Vagal stimulation will also increase bronchial sub-mucosal gland secretion.
      • Increased goblet cell secretion = increased sputum viscosity.
      • Increased bronchial sub-mucosal gland secretion = decreased sputum viscosity
  • Need for Mucokinetics when secretions increase in amount and/or viscosity
  • Mucolytics
    • Aid mucokinesis by breaking up bonds in mucus
    • Bromhexine is an oral mucolytic agent with a low level of associated toxicity.
  • Mucolytics: Bromhexine
    • Causes Bronchorrhea
    • It acts on the mucus at the formative stages in the glands, within the mucus-secreting cells.
    • Bromhexine disrupts the structure of acid mucopolysaccharide fibres in mucoid sputum and produces less viscous mucus, which is easier to expectorate.
  • Expectorants (Bronchomucotropics)
    • Usually stimulate sol layer production by direct irritation or indirect through vagal stimulation
      • Remember, ↑ sol means decreased viscosity!
    • Smoke is a bronchomucotropic!
      • Unfortunately, it’s irritation stimulates the bronchial submcosal glands AND the goblet cells so there is in ↑ mucus production & viscosity
    • Spicy food ↑ sol due to vagal stimulation!
    • Expectorants include guaphenesin, ammonium chloride
  • Expectorants (Bronchomucotropics)
    • Guaifenesin
    • Vagal stimulation like without foul taste or severe side effects
      • Active ingredient in many “cough” medicines.
      • Very effective expectorant for chronic bronchitis
    • Ammonium Chloride
    • Vagal stimulation only
    • Found in many children’s “cough” syrups because it is easy to flavor
    • Side effects are like SSKI and Guaifenesin
      • Also may cause metabolic acidosis
  • Bromoxyl
    • Better than most respiratory antibacterials especially where sensitivity is assured;
    • Time tested and trusted antibacterial,
    • Bonus effects of mucolytic
    • Eliminates the need for expectorants
    • 2 benefits at the price of 1
      • Antibacterial + mucokinesis