Cough is a protective reflex, its purpose
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
Cough is two type; useful and useless,
useful (productive) Cough serves to drain
the airway, its suppression is not desirable,2
Cold and flu.
Allergic rhino-sinusitis (inflammation of the
nose or sinuses).
Lung infections such as pneumonia or
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,
4. lung cancer,
5. airway obstruction, and other
SYMPTOMS OF DRY COUGH
Flu-like symptoms (fatigue, fever, sore
throat, headache, aches and pain)
Runny nose (nasal congestion)
Wheezing (whistling sound made with
Loss of appetite
CAUSES OF DRY COUGH
Airway irritation (bronchospasm)
Asthma and allergies
Chronic obstructive pulmonary disease
(COPD, includes emphysema and chronic
Congestive heart failure
Pleurisy (inflammation of the lining around
the lungs and chest)
The medical term for a wet cough is
productive cough. Wet cough is a common
1. respiratory infection,
2. allergies, and heart conditions.
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
Coughing up pink frothy mucus.
Rapid breathing (tachypnea).
Wheezing (whistling sound made with 8
CAUSES OF WET COUGH
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
Tuberculosis (serious infection affecting 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)
TREATMENT OF COUGH
Primary medication: Cough drops, syrup
a) Bronchial secretion enhance:
Potassium iodide, balsum of tolu.
b) Mucolytics: Bromhexine,
Ambroxol, Acetyl cysteine.
TREATMENT OF COUGH
Antitussives (Cough centre suppressants):
a) Opoids: Codeine, Pholcodeine
b) Nonopoids: Dextromethophan,
Asthma is a Chronic inflammatory
disorder of the airways.
Chronically inflamed airways are hyper
They become obstructed and airflow is
limited by bronchoconstriction, mucus plugs,
and increased inflammation when airways
are exposed to various risk factors.
Triggers factors tend to participate
and/or aggravate asthma exacerbation.
1. Allergens e.g. pollens, air
2. Irritants e.g. Tobacco smoke,
4. Temperature and weather 14
6. Animals e.g. cats , dogs, rodents
7. Strong emotion, e.g. fear ,
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 16
- Inflammation & edema of the mucous
- Accumulation of tenacious secretions from
- Spasm of the smooth muscle of the
bronchi & bronchioles
Pathological changes of asthma
Normal airway airway wall remodeling
2 types of drug categories are used:
ANTIINFLAMATORY DRUG BRONCHODIALETORS
a) Corticosteroids: (Hydrocortisone,
i) Cell membrane stabilization.
ii) Inhibition of inflammatory mediators.
iii) Restoring the sensivity of β2- receptors.
a) Leukotrienes receptor antagonist:
(e.g. montelukast) are third-line drugs for
– competitively antagonize cysteinyl
leukotrienes at CysLT1 receptors
– are used mainly as add-on therapy to inhaled
corticosteroids and long-acting β2 agonists 24
receptors of bronchi
Methylxanthines inhibit non-selective
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
– Salmeterol or formoterol are given regularly
Methyxanthine: (Theophylline, Aminophylline)
– inhibits phosphodiesterase and blocks
– has a narrow therapeutic window: unwanted
effects include cardiac dysrhythmia, seizures
and gastrointestinal disturbances
– is given intravenously (by slo w infusion) for
status asthmatics, or orally (as a sustained-
release preparation) as add-on therapy to
inhaled corticosteroids and long-acting β2
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.
1. Essentials of Medical Pharmacology,
2. Pharmacology, Rang and Dale.
3. Internet Source.