Cough and bronchial asthma

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Cough and bronchial asthma

  1. 1. COUGH AND BRONCHIAL ASTHMA Arijit Chakraborty M.Pharm (Pharmacology) 19/02/2013 1
  2. 2. 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,2
  3. 3. 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
  4. 4. 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. 4
  5. 5. 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 5
  6. 6. CAUSES OF DRY COUGH  Airway irritation (bronchospasm) Asthma and allergies Chronic obstructive pulmonary disease (COPD, includes emphysema and chronic bronchitis) Congestive heart failure Lung cancer Pleurisy (inflammation of the lining around the lungs and chest) Smoking 6
  7. 7. 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. 7
  8. 8. 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 8
  9. 9. 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 9
  10. 10. 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
  11. 11. 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. 11
  12. 12. TREATMENT OF COUGH Antitussives (Cough centre suppressants): a) Opoids: Codeine, Pholcodeine b) Nonopoids: Dextromethophan, Noscapine c) Antihistamines: Chlorpherinamine, Promethazine  Adjuvant antitissuve: Bronchodilators: Salbutamol, Terbutaline 12
  13. 13. 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. 13
  14. 14. 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 14
  15. 15. CONT…… 6. Animals e.g. cats , dogs, rodents etc. 7. Strong emotion, e.g. fear , laughing. 15
  16. 16. 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
  17. 17. 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 17
  18. 18. PATHOPHYSIOLOGY OF ASTHMA 18
  19. 19. 19 Relaxation Constriction Normal Asthma Airway narrowing Exaggerated airway narrowing muscle constriction 35 % muscle constriction 35 %
  20. 20. Pathological changes of asthma 20 Epithelium Normal airway airway wall remodeling Basement membrane Smooth muscle Mucus glands (hyperplasi a)
  21. 21. DRUG THERAPY  2 types of drug categories are used: 21 ANTIINFLAMATORY DRUG BRONCHODIALETORS hormone-containing (corticosteroids) nonhormone-containing (leukotriene receptor antagonists) β2-agonists anticholinergic drugs methylxanthines
  22. 22. DRUG THERAPY 22 Anti-inflammatory drug Corticosteroids (Hydrocortisone, Beclomethasone) Leukotrienes antagonist (Montelukast) Bronchodilators β2-agonists (Salbutamol, Terbutalin) Anticholinargic drug (Ipratropium bromide) Methyxanthine (Theophylline, Aminophylline)
  23. 23. 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. 23
  24. 24. 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 24
  25. 25. DRUG THERAPY 25 BRONCHODIALETORS β2-agonists Stimulates β2-adrenergic receptors of bronchi Smooth muscle relaxation Smooth muscle relaxation Anticholinergic drugs reduce tones of vagus Methylxanthines inhibit non-selective phosphodiesterase
  26. 26. 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 26
  27. 27. 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 slo w infusion) for status asthmatics, or orally (as a sustained- release preparation) as add-on therapy to inhaled corticosteroids and long-acting β2 27
  28. 28. 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. 28
  29. 29. REFERANCE 1. Essentials of Medical Pharmacology, K.D. Tripathi. 2. Pharmacology, Rang and Dale. 3. Internet Source. 29
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