1
2
Anatomy of Respiratory SystemAnatomy of Respiratory System
• NoseNose
• Pharynx (throat)Pharynx (throat)
• Larynx (Voice b...
Upper Resp. TtractUpper Resp. Ttract
Nose
Pharynx
Lower Resp. TractLower Resp. Tract
Larynx
Trachea
Bronchi
Lungs
4
5
66
7
Respiratory
Bronchiole
Alveolar
Sac
Acinus
Alveolar
Duct
8
Lower Respiratory TractLower Respiratory Tract
9
Respiratory Function:
Air is warmed,
moistened & filtered
Olfactory function
• Citated columar epithelium
• Mucus secreting goblet cells
10
• Nasal partNasal part
• Oral PartOral Part
• Laryngeal PartLaryngeal Part
11
Functions of Pharynx:Functions of Pharynx:
R...
Principles of Anatomy & Physiology, Tortora, 1996, pg 708
Lies in front of pharynx.Lies in front of pharynx.
After puberty...
Speech consists of manipulation of sound produced
by vocal cords, tongue, cheeks.
13
• Passage way for air between pharynx & trachea (air
further moistened, filtered, warmed)
• Vocal cords produce sounds of ...
Trachea :Trachea :
12 cm long12 cm long
Diameter 2 .5 cmDiameter 2 .5 cm
15
 Cartilages keep the air passages open, allowing forCartilages keep the air passages open, allowing for
unobstructed pass...
 Contraction & relaxation of muscles in the wallContraction & relaxation of muscles in the wall
regulate the volume of ai...
18
19
20
21
22
• 15 times/ min
• Inspiration
• Expiration
• Pause
23
Diaphragam Intercostals
24
25
 Coughing
 Sneezing
 Sighing
 Yawning
 Sobbing
 Crying
 Laughing
 Hiccuping
26
The process of respiration is
carried out by the help of a
large number of muscles:
1)Diaphragm
2)Intercostal muscles
3)Ac...
Structure of a BronchioleStructure of a Bronchiole
SmoothSmooth
MuscleMuscle
Cilia
Mucous
Layer
Mucus
Gland
Goblet
Cell
Ma...
Respiration:
 External
 Internal
 Tissue
29
30
31
32
Pharyngitis: Inflammation of pharynxInflammation of pharynx
Laryngitis: Inflammation of larynxInflammation of larynx
Trach...
Common cold: Is associated with running nose i.e.Is associated with running nose i.e.
rhinorrhoea, congestion, sneezingrhi...
Bronchiectasis: Localised, chronic and irreversibleLocalised, chronic and irreversible
dilatation of the bronchi.dilatatio...
Sinusitis: Inflammation of the mucus membraneInflammation of the mucus membrane
lining the various sinus cavities in theli...
•Sinuses:Sinuses:
hollow cavities within thehollow cavities within the
facial bones.facial bones.
•Sinus infections:Sinus ...
 Nasal congestion,Nasal congestion,
 Greenish nasal phlegm (discharge),Greenish nasal phlegm (discharge),
 Night-time c...
 Runny nose , Nasal congestionRunny nose , Nasal congestion
 SneezingSneezing
 Sore throat , CoughSore throat , Cough
...
 Cough: with orCough: with or
without mucus ,without mucus ,
 Nasal dischargeNasal discharge
 Headache , muscleHeadache...
 Cough: mucus (sputum), bloodCough: mucus (sputum), blood
streakedstreaked
 Shortness of breathShortness of breath
 Fre...
 The presence of chronicThe presence of chronic
productive cough for 3 months,productive cough for 3 months,
 In each of...
 Cough: mucus-like, greenish,Cough: mucus-like, greenish,
or pus-like sputumor pus-like sputum
 Fever: chills with shaki...
 Chronic cough: largeChronic cough: large
amounts of foul-amounts of foul-
smelling sputumsmelling sputum
productionprodu...
 Sore throat: accompanied byaccompanied by
fever, headache, swollenfever, headache, swollen
lymph nodes in the neck.lymph...
 Cough,Cough,
 Wheezing, shortness of breath, or difficultyWheezing, shortness of breath, or difficulty
breathing,breath...
Normal LungNormal Lung BronchiolitisBronchiolitis
47
BronchiolitisBronchiolitis
48
What is cough?What is cough?
CoughCough is a protectiveprotective and
physiologicalphysiological reflex aimed
at maintaini...
Coughing is under voluntaryvoluntary and involuntaryinvoluntary control
and consists of 33 phases.
InspiratoryInspiratory ...
51
Act of CoughingAct of Coughing
Cough
Cancer Smoking
Acute LVF
Psychogenic
Infections
URTI, LRTI, TB
Chemicals
Drugs (ACEI)
Dust
Pollens
Bronchial Asthma
...
53
Classification of Cough:
A cough can be classified by its -
Duration,
Character,
Quality, and
Timing.
Classification as...
1. Acute Cough1. Acute Cough
Cough which comes all of a sudden,Cough which comes all of a sudden,
1. Dry cough
2. Producti...
55
Cough is present between 3 and 8 weeks.
The most common causes:
Post infectious Cough.
Acute Sinusitis.
Asthma.
2. Sub-...
Cough lasting for more than 3 weeks.Cough lasting for more than 3 weeks.
Most Important Causes :Most Important Causes :
•S...
FindingsFindings
 Patient is a smoker
 Purulent sputum
 TB exposure
 Wheezing
 Cough worse at work
 Cough after URTI...
 Step 1Step 1:: Initial evaluation + Diagnosis + Rx.
Cough = Symptomatic treatment
 Step 2Step 2:: Treatment for postnas...
 Troublesome type of cough,Troublesome type of cough,
 Tends to aggravate because of rapid flow ofTends to aggravate bec...
Patient spits out a lot of sputum.Patient spits out a lot of sputum.
 Secretions may be thick or watery.Secretions may b...
Associated withAssociated with
bronchospasm,bronchospasm,
Common in asthmaCommon in asthma
patients & chronicpatients & ch...
62
Characteristics of Cough Originating at
Various Levels of Respiratory Tract:
Origin Causes Characteristics
PharynxPhary...
63
Cough
Running Nose,
Nasal & Chest Congestion
Breathlessness
Sore Throat
Sinusitis, Common Cold
Influenza (Flu), Pharyngiti...
Resp. Mucous Membrane:
Lined by respiratory epithelium
Ciliated columnar cells
Goblet cells
Cilia - propel foreign particl...
Water 95% - secreted by bronchialWater 95% - secreted by bronchial
glandsglands
Glycoproteins - thickGlycoproteins - thick...
Together - Muco-ciliary blanket
It has two layers:It has two layers:
Sol layer :Sol layer : watery layer in which cilia ba...
The respiratory tract fluid and muco-ciliaryThe respiratory tract fluid and muco-ciliary
equilibrium:equilibrium:
Resp. Fl...
Respiratory tract fluid - increases duringRespiratory tract fluid - increases during
infectionsinfections
During RTIs or w...
When respiratory tract is contaminated by –When respiratory tract is contaminated by –
Oropharyngeal cells, bacteria, food...
71
72
Drugs Used In CoughDrugs Used In Cough
Centrally Acting:Centrally Acting:
Excessive Cough Bouts -Excessive Cough Bouts - CentralCentral
AntitussiveAntitussive
Pe...
74
Actions of Anti-Cough PreparationsActions of Anti-Cough Preparations
Mucolysis Mucokinesis Expectoration
Breaking down ...
Mucokinesis is responsible for removal of secretionsMucokinesis is responsible for removal of secretions
from respiratory ...
Drugs which suppress cough centre situated in theDrugs which suppress cough centre situated in the
medulla.medulla.
(Latin...
In addition to cough suppressing
action, they have properties like -
Powerful analgesia ,
Sedation, and
Psychic effects,.
...
Nausea, vomiting, constipation, skin rashes, drowsiness,Nausea, vomiting, constipation, skin rashes, drowsiness,
addiction...
These are a group ofThese are a group of centrally actingcentrally acting anti-tussivesanti-tussives
withoutwithout thethe...
80
Class Drug Name Action
AntihistaminesAntihistamines Cetirizine, Levocetrizine, Diphenhydramine,Cetirizine, Levocetrizin...
 Blocks H1 histamine receptor and thus inhibits theBlocks H1 histamine receptor and thus inhibits the
actions of histamin...
 Antihistamine, antagonises the actions of histamine at
the receptor sites.
 Reduces allergic reactions produced due to ...
83
DecongestantsDecongestants
84
Anti-pyretic - AnalgesicsAnti-pyretic - Analgesics
Menthol:Menthol:
 Soothening action, produces cooling sensation andSoothening action, produces cooling sensation and
has ...
86
Composition: Each 5 ml containsComposition: Each 5 ml contains
  
PhenylephrinePhenylephrine 55 mgmg
ParacetamolParacetamo...
 Synthetic sympathomimetic agent,
 Stimulate α receptors,
 Very minimal effect on β-receptor,
 Vasoconstrictor,
 Vaso...
89
1.1. Phenylephrine … cont.Phenylephrine … cont.
Powerful Vasoconstrictor Cardiac Safety
Blood Vessels: Cutaneous, limb,...
 Very potent decongestant,Very potent decongestant,
 Constricts (shrinks) blood vessels (veins and arteries),Constricts ...
 Adults & adolescents > 12 yr.:Adults & adolescents > 12 yr.: 10-20 mg 4 hrly10-20 mg 4 hrly
 Children 6 to 12 yr. :Chil...
2. Paracetamol2. Paracetamol
(Anti-Pyretic)(Anti-Pyretic)
92
 Histamine in Nature Present in:
 Plants
 Venom and stings
 Synthesized by bacteria and certain fungi
3. Chlorpheniram...
CPM: Synthesis and Metabolism
Histidine Histamine
L-histidine
carboxylase
Methylhistamine
N – methylimidazole acetic acid
...
 H-1:H-1: GI & bronchial SM contraction.GI & bronchial SM contraction.
 H-2:H-2: Cardiac stimulation, Gastric secretion....
96
Action Histamine Receptor
Bronchial contractionBronchial contraction H-1H-1
GI contractionGI contraction H-1H-1
HeartHe...
Smooth muscle
antihistamines
Histamine,
PG’s, 5-HT, PAF
Drug
Protein
IgE antibody
IgE-Sensitized Cell
Histamine Release fr...
 H-1 blockers
 1st
generation or classical (older)
 2nd
generation or non-sedating (newer)
 H-2 blockers
 gastric aci...
1. Block H-1 receptors competitively.
2. Reduce local response to intradermal histamine.
3. Antagonize the vasoconstrictor...
 Developed in France pre-WWII
 More sedating
 Penetrate the CNS and generally have CNS effects
 Significant anticholin...
 Less sedating - less CNS penetration.
 Almost no anticholinergic effects.
 Produce cardiac toxicity: Removed from the ...
1.Common cold: Symptomatic relief.
2.Local allergic manifestations:
Urticaria, rhinitis, rhinorrhea.
3. Motion sickness: N...
 Soothing action, produces cooling sensation andSoothing action, produces cooling sensation and
has a mild anesthetic act...
 Menthol in Cough Syrups often soothe and cool
sore throats by relieving inflammation.
 It can also help clear stuffy si...
ZEDEX - IndicationsZEDEX - Indications
105
ZEDEX - Dosage and AdministrationZEDEX - Dosage and Administration
106
DiagnosisDiagnosis
URTI
Flu (Influenza)
Rhinitis
Common cold0
Sinusitis
Pharyngitis
Coryza
Sore throat
Bronchitis
Pneumoni...
Cough with sputum
MostMost
CommonCommon
SymptomsSymptoms
Chronic
coughing
Shortness of
breath
Difficult to cough
out sputu...
Sinuses & Throat Pain
(Paracetamol)
Most Effective
Treatment
Fever
(Paracetamol)
Difficult to cough out
sputum
(Decongesta...
Cough
Formula
Antihistamine
(CPM)
Decongestant
(Phenylephrine)
Anti-pyretic +
Analgesic
(Paracetamol)
Soothing AgentSoothi...
ZEDEX - Product DescriptionZEDEX - Product Description
PackagingPackaging
Bottle
Shipper pack
Stockiest Price
Retailer Pri...
Product Positioning :Product Positioning :
Product Differential :Product Differential :
ZEDEX - Marketing AspectsZEDEX - M...
ZEDEX – Target Doctors and IndicationsZEDEX – Target Doctors and Indications
115
ZEDEX – Communication StrategyZEDEX – Communication Strategy
116
ZEDEX – Input PlansZEDEX – Input Plans
117
119
Cold Cough Syrup – Brand TrendsCold Cough Syrup – Brand Trends
120
Thank YouThank You
121
Zedex cold cough syrup   tr slides 01
Zedex cold cough syrup   tr slides 01
Upcoming SlideShare
Loading in …5
×

Zedex cold cough syrup tr slides 01

21,564 views

Published on

0 Comments
7 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
21,564
On SlideShare
0
From Embeds
0
Number of Embeds
8
Actions
Shares
0
Downloads
375
Comments
0
Likes
7
Embeds 0
No embeds

No notes for slide
  • Anatomy & Physiology in Health & Illness, Ross & Wilson, 1990, pg 128
  • Anatomy & Physiology in Health & Illness, Ross & Wilson, 1990, pg 130
  • Anatomy & Physiology in Health & Illness, Ross & Wilson, 1990, pg 130
  • Medical Research Council. Lancet 1965
  • Zedex cold cough syrup tr slides 01

    1. 1. 1
    2. 2. 2
    3. 3. Anatomy of Respiratory SystemAnatomy of Respiratory System • NoseNose • Pharynx (throat)Pharynx (throat) • Larynx (Voice box)Larynx (Voice box) • Trachea (Wind pipe)Trachea (Wind pipe) • BronchiBronchi • LungsLungs • Muscles of Respiration :Muscles of Respiration : Intercostal musclesIntercostal muscles DiaphragmDiaphragm 3
    4. 4. Upper Resp. TtractUpper Resp. Ttract Nose Pharynx Lower Resp. TractLower Resp. Tract Larynx Trachea Bronchi Lungs 4
    5. 5. 5
    6. 6. 66
    7. 7. 7
    8. 8. Respiratory Bronchiole Alveolar Sac Acinus Alveolar Duct 8 Lower Respiratory TractLower Respiratory Tract
    9. 9. 9 Respiratory Function: Air is warmed, moistened & filtered Olfactory function
    10. 10. • Citated columar epithelium • Mucus secreting goblet cells 10
    11. 11. • Nasal partNasal part • Oral PartOral Part • Laryngeal PartLaryngeal Part 11 Functions of Pharynx:Functions of Pharynx: Respiratory:Respiratory: Air passes thru the nasal & oral parts.Air passes thru the nasal & oral parts. Air is further warned & moistenedAir is further warned & moistened Digestive:Digestive: Food passes thru, oral & laryngeal partsFood passes thru, oral & laryngeal parts
    12. 12. Principles of Anatomy & Physiology, Tortora, 1996, pg 708 Lies in front of pharynx.Lies in front of pharynx. After puberty, grows larger in the male which explainsAfter puberty, grows larger in the male which explains the prominence of the ‘the prominence of the ‘Adam’s appleAdam’s apple’ and deeper voice.’ and deeper voice. 12
    13. 13. Speech consists of manipulation of sound produced by vocal cords, tongue, cheeks. 13
    14. 14. • Passage way for air between pharynx & trachea (air further moistened, filtered, warmed) • Vocal cords produce sounds of various loudness & pitch • During swallowing larynx moves upwards occluding the opening into it from the pharynx 14
    15. 15. Trachea :Trachea : 12 cm long12 cm long Diameter 2 .5 cmDiameter 2 .5 cm 15
    16. 16.  Cartilages keep the air passages open, allowing forCartilages keep the air passages open, allowing for unobstructed passage of airunobstructed passage of air  Sticky mucus lining the membranes filters airSticky mucus lining the membranes filters air  Wave motion of cilia & lining membrane waftWave motion of cilia & lining membrane waft mucus and adherent particles towards the throat.mucus and adherent particles towards the throat. 1616
    17. 17.  Contraction & relaxation of muscles in the wallContraction & relaxation of muscles in the wall regulate the volume of air entering the lungsregulate the volume of air entering the lungs  Cells (lymphocytes, plasma cells, PMNs, macrophages)Cells (lymphocytes, plasma cells, PMNs, macrophages) protect against infection and inhaled foreign particles.protect against infection and inhaled foreign particles.  Air warmed (or cooled) and moistenedAir warmed (or cooled) and moistened 17
    18. 18. 18
    19. 19. 19
    20. 20. 20
    21. 21. 21
    22. 22. 22
    23. 23. • 15 times/ min • Inspiration • Expiration • Pause 23
    24. 24. Diaphragam Intercostals 24
    25. 25. 25
    26. 26.  Coughing  Sneezing  Sighing  Yawning  Sobbing  Crying  Laughing  Hiccuping 26
    27. 27. The process of respiration is carried out by the help of a large number of muscles: 1)Diaphragm 2)Intercostal muscles 3)Accessory muscles of respiration 27
    28. 28. Structure of a BronchioleStructure of a Bronchiole SmoothSmooth MuscleMuscle Cilia Mucous Layer Mucus Gland Goblet Cell MastMast CellsCells Epithelium Sub-Mucosa 28
    29. 29. Respiration:  External  Internal  Tissue 29
    30. 30. 30
    31. 31. 31
    32. 32. 32
    33. 33. Pharyngitis: Inflammation of pharynxInflammation of pharynx Laryngitis: Inflammation of larynxInflammation of larynx Tracheitis: Inflammation of tracheaInflammation of trachea Bronchitis Inflammation of bronchiInflammation of bronchi Bronchiolitis: Inflammation of bronchioleInflammation of bronchiole Otitis Medium: Inflammation of middle earInflammation of middle ear 33
    34. 34. Common cold: Is associated with running nose i.e.Is associated with running nose i.e. rhinorrhoea, congestion, sneezingrhinorrhoea, congestion, sneezing etc.etc. It is the inflammation of the nasalIt is the inflammation of the nasal mucus membranemucus membrane Cough: It is a protective and physiologicalIt is a protective and physiological reflexreflex which is responsible forwhich is responsible for expelling any foreign matterexpelling any foreign matter entering the respiratory tract.entering the respiratory tract. 34
    35. 35. Bronchiectasis: Localised, chronic and irreversibleLocalised, chronic and irreversible dilatation of the bronchi.dilatation of the bronchi. Pneumonia: Inflammation and consolidation ofInflammation and consolidation of the lung tissue (parenchyma).the lung tissue (parenchyma). Empyema: Accumulation of pus in pleural cavity.Accumulation of pus in pleural cavity. 35
    36. 36. Sinusitis: Inflammation of the mucus membraneInflammation of the mucus membrane lining the various sinus cavities in thelining the various sinus cavities in the skull.skull. Tonsillitis: Inflammation of the tonsils.Inflammation of the tonsils. Lung abscess: Collection of pus in the lungs.Collection of pus in the lungs. Adenitis: Inflammation of the adenoids.Inflammation of the adenoids. 36
    37. 37. •Sinuses:Sinuses: hollow cavities within thehollow cavities within the facial bones.facial bones. •Sinus infections:Sinus infections: most frequently maxillarymost frequently maxillary and frontal sinuses.and frontal sinuses. 37 SinisitisSinisitis
    38. 38.  Nasal congestion,Nasal congestion,  Greenish nasal phlegm (discharge),Greenish nasal phlegm (discharge),  Night-time cough.Night-time cough.  Fever, malaise (feeling ill), bad breathFever, malaise (feeling ill), bad breath  Sore throat,Sore throat,  Facial and/or dental pain, eye pain, headache.Facial and/or dental pain, eye pain, headache. 38 Classic Symptoms of Acute SinusitisClassic Symptoms of Acute Sinusitis
    39. 39.  Runny nose , Nasal congestionRunny nose , Nasal congestion  SneezingSneezing  Sore throat , CoughSore throat , Cough  Muscle aches , HeadacheMuscle aches , Headache  FeverFever 39 Common Cold - SymptomsCommon Cold - Symptoms
    40. 40.  Cough: with orCough: with or without mucus ,without mucus ,  Nasal dischargeNasal discharge  Headache , muscleHeadache , muscle aches and stiffnessaches and stiffness  Shortness of breathShortness of breath  Stuffy, congestedStuffy, congested nose , nose - bleednose , nose - bleed  Sore throatSore throat 40 Flu (influenza) - SymptomsFlu (influenza) - Symptoms
    41. 41.  Cough: mucus (sputum), bloodCough: mucus (sputum), blood streakedstreaked  Shortness of breathShortness of breath  Frequent RTI(colds)Frequent RTI(colds)  WheezingWheezing  Fatigue, HeadachesFatigue, Headaches  Reddish mucous membranesReddish mucous membranes 41 Bronchitis- SymptomsBronchitis- Symptoms
    42. 42.  The presence of chronicThe presence of chronic productive cough for 3 months,productive cough for 3 months,  In each of 2 successive years.In each of 2 successive years.  In a patient in whom otherIn a patient in whom other causes of chronic cough havecauses of chronic cough have been excluded.been excluded. 42 Chronic BronchitisChronic Bronchitis
    43. 43.  Cough: mucus-like, greenish,Cough: mucus-like, greenish, or pus-like sputumor pus-like sputum  Fever: chills with shakingFever: chills with shaking  Chest pain: sharp or stabbing,Chest pain: sharp or stabbing, increased by deep breathing,increased by deep breathing, increased by coughingincreased by coughing  HeadacheHeadache  General discomfort:General discomfort: uneasiness / ill feelinguneasiness / ill feeling (malaise)(malaise) 43 Pneumonia - SymptomsPneumonia - Symptoms
    44. 44.  Chronic cough: largeChronic cough: large amounts of foul-amounts of foul- smelling sputumsmelling sputum productionproduction  Coughing up bloodCoughing up blood  Cough worsened byCough worsened by lying on one sidelying on one side  Shortness of breathShortness of breath worsened by exerciseworsened by exercise  WheezingWheezing  Weight loss ,FatigueWeight loss ,Fatigue 44 Brochiectasis - SymptomsBrochiectasis - Symptoms
    45. 45.  Sore throat: accompanied byaccompanied by fever, headache, swollenfever, headache, swollen lymph nodes in the neck.lymph nodes in the neck.  Viral Pharyngitis: associatedassociated with runny nose (rhinorrhea)with runny nose (rhinorrhea) and postnasal dischargeand postnasal discharge  Severe Pharyngitis: accompanied by difficultyaccompanied by difficulty swallowing and difficultyswallowing and difficulty breathing.breathing. 45 Pharyngitis - SymptomsPharyngitis - Symptoms
    46. 46.  Cough,Cough,  Wheezing, shortness of breath, or difficultyWheezing, shortness of breath, or difficulty breathing,breathing,  Bluish skin due to lack of oxygen (cyanosis),Bluish skin due to lack of oxygen (cyanosis),  Rapid breathing (tachypnea),Rapid breathing (tachypnea),  Nasal flaring(swelling) in infants,Nasal flaring(swelling) in infants,  Fever.Fever. 46 Bronchiolitis - SymptomsBronchiolitis - Symptoms
    47. 47. Normal LungNormal Lung BronchiolitisBronchiolitis 47 BronchiolitisBronchiolitis
    48. 48. 48
    49. 49. What is cough?What is cough? CoughCough is a protectiveprotective and physiologicalphysiological reflex aimed at maintaining an open airway. Cough involves rapid expulsion of air at high velocity from the respiratory airway which expel irritants and excessive secretions from respiratory tract. CoughCough 49
    50. 50. Coughing is under voluntaryvoluntary and involuntaryinvoluntary control and consists of 33 phases. InspiratoryInspiratory : initiated by taking a deep breathe PhasePhase and results in maximal dilation of the lungs. CompressiveCompressive : closure of the glottis followed by phasephase contraction of thoracic and abdominal muscles against a fixed diaphragm. Expiratory : sudden glottis opening results in phase the explosive release air. 50 Cough - PhysiologyCough - Physiology
    51. 51. 51 Act of CoughingAct of Coughing
    52. 52. Cough Cancer Smoking Acute LVF Psychogenic Infections URTI, LRTI, TB Chemicals Drugs (ACEI) Dust Pollens Bronchial Asthma 52 Cough - Aetiology (Causes)Cough - Aetiology (Causes)
    53. 53. 53 Classification of Cough: A cough can be classified by its - Duration, Character, Quality, and Timing. Classification as per the Duration of Cough: Acute (of sudden onset): Present < 3 weeks, Subacute: Present between 3 and 8 wks, Chronic: Lasting > 8 weeks. Types of CoughTypes of Cough
    54. 54. 1. Acute Cough1. Acute Cough Cough which comes all of a sudden,Cough which comes all of a sudden, 1. Dry cough 2. Productive cough 3. Bronchospastic / Asthmatic cough Most commonly relates to -Most commonly relates to - 1. Viral – induced lower respiratory tract infections. 2. Post-nasal drip resulting from rhinitis or sinusitis. 3. Throat - clearing secondary to laryngitis or pharyngitis. 54 Types of CoughTypes of Cough
    55. 55. 55 Cough is present between 3 and 8 weeks. The most common causes: Post infectious Cough. Acute Sinusitis. Asthma. 2. Sub-acute Cough:2. Sub-acute Cough:
    56. 56. Cough lasting for more than 3 weeks.Cough lasting for more than 3 weeks. Most Important Causes :Most Important Causes : •SmokingSmoking •Post-nasal DripPost-nasal Drip •AsthmaAsthma •GERDGERD •Chronic bronchitisChronic bronchitis •BronchiectasisBronchiectasis •Occupation environmentOccupation environment •Psychogenic coughPsychogenic cough •LVFLVF (left ventricular failure)(left ventricular failure) •TuberculosisTuberculosis •Lung CancerLung Cancer •Intestinal lung diseaseIntestinal lung disease 5656 3. Chronic Cough … cont.3. Chronic Cough … cont.
    57. 57. FindingsFindings  Patient is a smoker  Purulent sputum  TB exposure  Wheezing  Cough worse at work  Cough after URTI  Facial / tooth pain  Wt loss Possible DiagnosisPossible Diagnosis  Tobacco induced bronchitis  Pneumonia, Bronchitis  Pulmonary TB  Asthma  Occupational cause  Postnasal drip  Sinusitis  Cancer, TB 57 Chronic Cough: DiagnosisChronic Cough: Diagnosis
    58. 58.  Step 1Step 1:: Initial evaluation + Diagnosis + Rx. Cough = Symptomatic treatment  Step 2Step 2:: Treatment for postnasal drip. Rx = Antihistamine + decongestant  Step 3Step 3:: Add treatment for Asthma. Cough= Symptomatic Rx + Bronchodilator  Step 4Step 4:: Lab. Investigations (x-ray, CT scan) Rx = Cough formula till cough subsides. 58 Chronic Cough: TreatmentChronic Cough: Treatment
    59. 59.  Troublesome type of cough,Troublesome type of cough,  Tends to aggravate because of rapid flow ofTends to aggravate because of rapid flow of air, further irritating the trachea andair, further irritating the trachea and pharyngeal mucosa.pharyngeal mucosa.  There is no sputum or secretions are too thickThere is no sputum or secretions are too thick and viscid.and viscid. 59 4. Dry cough4. Dry cough
    60. 60. Patient spits out a lot of sputum.Patient spits out a lot of sputum.  Secretions may be thick or watery.Secretions may be thick or watery.  It is usually the result of an allergic response or RTI.It is usually the result of an allergic response or RTI. •Productive cough are coughs that produce phlegm, in contrast to dry coughs. •Productive cough is associated with tuberculosis, bacterial pneumonia, and bronchitis . •The loose productive cough is a sign of chest congestion or infection due to colds or flu. 60 5. Productive Cough5. Productive Cough
    61. 61. Associated withAssociated with bronchospasm,bronchospasm, Common in asthmaCommon in asthma patients & chronicpatients & chronic bronchitis.bronchitis. It frequently wakes upIt frequently wakes up the patient during thethe patient during the night or the early hours ofnight or the early hours of the morning.the morning. 61 6. Bronchospastic (Asthmatic) Cough6. Bronchospastic (Asthmatic) Cough
    62. 62. 62 Characteristics of Cough Originating at Various Levels of Respiratory Tract: Origin Causes Characteristics PharynxPharynx Post nasal dripPost nasal drip Usually Persistent.Usually Persistent. LarynxLarynx Laryngitis, tumor,Laryngitis, tumor, whooping cough, croupwhooping cough, croup Harsh, barking, painful, persistent,Harsh, barking, painful, persistent, often associated with strider.often associated with strider. TracheaTrachea TracheitisTracheitis PainfulPainful BronchiBronchi Acute Bronchitis andAcute Bronchitis and COPDCOPD Asthma.Asthma. Bronchial CarcinomaBronchial Carcinoma Dry or Productive, , worse in mornings.Dry or Productive, , worse in mornings. Dry or productive, worse at night.Dry or productive, worse at night. Persistent often with haemoptysis.Persistent often with haemoptysis. LungLung ParenchymaParenchyma TuberculosisTuberculosis PneumoniaPneumonia BronchiectasisBronchiectasis Pulmonary edemaPulmonary edema Interstitial FibrosisInterstitial Fibrosis Productive, often with haemoptysis.Productive, often with haemoptysis. Initially Dry, Productive later.Initially Dry, Productive later. ProductiveProductive Often at night ( may be productive)Often at night ( may be productive) Dry, irritant and distressing.Dry, irritant and distressing.
    63. 63. 63
    64. 64. Cough Running Nose, Nasal & Chest Congestion Breathlessness Sore Throat Sinusitis, Common Cold Influenza (Flu), Pharyngitis, Bronchitis Pneumonia, Bronchiolitis Bronchiectasis Most Common Symptoms in …. 64
    65. 65. Resp. Mucous Membrane: Lined by respiratory epithelium Ciliated columnar cells Goblet cells Cilia - propel foreign particles upwards Respiratory Tract FluidsRespiratory Tract Fluids 65
    66. 66. Water 95% - secreted by bronchialWater 95% - secreted by bronchial glandsglands Glycoproteins - thickGlycoproteins - thick mucopolysaccharides secreted bymucopolysaccharides secreted by Goblet cellsGoblet cells FatsFats Proteinaceous material is calledProteinaceous material is called mucusmucus 66 Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.
    67. 67. Together - Muco-ciliary blanket It has two layers:It has two layers: Sol layer :Sol layer : watery layer in which cilia bathe freelywatery layer in which cilia bathe freely Gel layer :Gel layer : above the sol layer contains mucusabove the sol layer contains mucus relatively thicker and stickierrelatively thicker and stickier 67 Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.
    68. 68. The respiratory tract fluid and muco-ciliaryThe respiratory tract fluid and muco-ciliary equilibrium:equilibrium: Resp. Fluid gradually propelled upwards into theResp. Fluid gradually propelled upwards into the pharynx where it is swallowed without awareness.pharynx where it is swallowed without awareness. 68 Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.
    69. 69. Respiratory tract fluid - increases duringRespiratory tract fluid - increases during infectionsinfections During RTIs or when lungs are exposed to foreignDuring RTIs or when lungs are exposed to foreign particles secretion increase in order to:particles secretion increase in order to: Dilute irritants, if any,Dilute irritants, if any, Drive away foreign bodies and unwanted particles,Drive away foreign bodies and unwanted particles, Trap micro-organisms.Trap micro-organisms. 69 Respiratory Tract FluidsRespiratory Tract Fluids
    70. 70. When respiratory tract is contaminated by –When respiratory tract is contaminated by – Oropharyngeal cells, bacteria, food particles andOropharyngeal cells, bacteria, food particles and saliva, … it is called sputum.saliva, … it is called sputum. What is Sputum?What is Sputum? 70 ⁺Phlegm is a sticky material from patient’s mucous membranes in the respiratory system. During Cold it might be yellowish brown. During an infection, it might be greenish brown. Normal phlegm is usually clear.
    71. 71. 71
    72. 72. 72 Drugs Used In CoughDrugs Used In Cough
    73. 73. Centrally Acting:Centrally Acting: Excessive Cough Bouts -Excessive Cough Bouts - CentralCentral AntitussiveAntitussive Peripherally Action:Peripherally Action: Increased Respiratory Tract Fluid -Increased Respiratory Tract Fluid - ExpectorantExpectorant Breakdown Thick Mucus -Breakdown Thick Mucus - MucolyticMucolytic Decreased Bronchoconstriction -Decreased Bronchoconstriction - BronchodilatorBronchodilator Decreased Congestion -Decreased Congestion - DecongestantDecongestant Decreased Allergy -Decreased Allergy - AntihistamineAntihistamine 7373 Anti-Cough Drugs - Mechanism of ActionAnti-Cough Drugs - Mechanism of Action
    74. 74. 74 Actions of Anti-Cough PreparationsActions of Anti-Cough Preparations Mucolysis Mucokinesis Expectoration Breaking down of the long, complex, muco polysaccharide fibers to facilitate better expectoration. Upwards movement of the mucous (mainly, gel layer of the Respiratory Tract Fluid). Driving away of respiratory tract fluid, done by liquefying the secretions so that extraneous (foreign particles, bacteria and the line) material can easily be thrown out
    75. 75. Mucokinesis is responsible for removal of secretionsMucokinesis is responsible for removal of secretions from respiratory tract.from respiratory tract. If defectiveIf defective:: Mucus retention occurs resulting in …Mucus retention occurs resulting in … Impairment in the distribution of inspired air,Impairment in the distribution of inspired air, Worsening of gas exchange at alveoli,Worsening of gas exchange at alveoli, Development of bronhcietasis and atelectasis,Development of bronhcietasis and atelectasis, Reduction in the ability of the lung to resistReduction in the ability of the lung to resist infection.infection. 75 How Important is Mucokinesis?How Important is Mucokinesis?
    76. 76. Drugs which suppress cough centre situated in theDrugs which suppress cough centre situated in the medulla.medulla. (Latin(Latin tussistussis = Cough).= Cough). There are two types of these drugs :There are two types of these drugs : NarcoticsNarcotics Non-NarcoticsNon-Narcotics 76 Anti-tussivesAnti-tussives
    77. 77. In addition to cough suppressing action, they have properties like - Powerful analgesia , Sedation, and Psychic effects,. Codeine,Codeine, Hydrocodeine,Hydrocodeine, Ethylmorphine,Ethylmorphine, DihydrocodeineDihydrocodeine ,, OxycodeineOxycodeine 77 Anti-tussives (Narcotics)Anti-tussives (Narcotics) NOT the drugs of first choice because of addiction properties.NOT the drugs of first choice because of addiction properties.
    78. 78. Nausea, vomiting, constipation, skin rashes, drowsiness,Nausea, vomiting, constipation, skin rashes, drowsiness, addiction, confusion, headache, palpitation,addiction, confusion, headache, palpitation, convulsions, sweating, vertigo, shockconvulsions, sweating, vertigo, shock RarelyRarely : Respiratory failure and coma, leading to death: Respiratory failure and coma, leading to death Reduce ciliary motility of respiratory tract.Reduce ciliary motility of respiratory tract. Interact withInteract with alcohol, antipsychotics, anti-depressants,alcohol, antipsychotics, anti-depressants, anti-histaminics and anti-cholinergics.anti-histaminics and anti-cholinergics. Contra-indicatedContra-indicated in respiratory, liver, cerebral diseasesin respiratory, liver, cerebral diseases and endocrine disorders.and endocrine disorders. 7878 Anti-tussives (Narcotics) – Side EffectsAnti-tussives (Narcotics) – Side Effects
    79. 79. These are a group ofThese are a group of centrally actingcentrally acting anti-tussivesanti-tussives withoutwithout thethe narcoticnarcotic properties which include –properties which include – Noscapine andNoscapine and Dextromethorphan .Dextromethorphan . 79 Non- Narcotic Anti- TussiveNon- Narcotic Anti- Tussive
    80. 80. 80 Class Drug Name Action AntihistaminesAntihistamines Cetirizine, Levocetrizine, Diphenhydramine,Cetirizine, Levocetrizine, Diphenhydramine, Chlorpheniramine maleate (CPM)Chlorpheniramine maleate (CPM) Block effects of histamine inBlock effects of histamine in allergic cough.allergic cough. Anti-tussiveAnti-tussive (Cough(Cough suppressants)suppressants) Codeine, Pholcodeine,Codeine, Pholcodeine, Noscapine, DextromethorphanNoscapine, Dextromethorphan To suppress the cough reflex.To suppress the cough reflex. DemulcentsDemulcents (Soothing Agents)(Soothing Agents) Lozenges, cough drops, linctuses containing syrup.Lozenges, cough drops, linctuses containing syrup. (glycerin, liquorice), and(glycerin, liquorice), and mentholmenthol (local action)(local action) To sooth the respiratoryTo sooth the respiratory mucosa.mucosa. ExpectorantsExpectorants Reflexly acting - Ammonium chloride (local action),Reflexly acting - Ammonium chloride (local action), Potassium chloride.Potassium chloride. Directly- Guaiphenesin (local action), Sodium andDirectly- Guaiphenesin (local action), Sodium and Potassium citrate, Potassium iodide.Potassium citrate, Potassium iodide. To increase mucus clearance.To increase mucus clearance. MucolyticsMucolytics Bromhexine (local action), CarbocisteineBromhexine (local action), Carbocisteine to liquefy the respiratoryto liquefy the respiratory secretions for easysecretions for easy expectoration.expectoration. DecongestantDecongestant Ephedrine,Ephedrine, phenylephrinephenylephrine, and topical drugs like, and topical drugs like oxymetazoline, xylometazoline are widely used asoxymetazoline, xylometazoline are widely used as decongestants. Phenylephrine HCL a syntheticdecongestants. Phenylephrine HCL a synthetic sympathomimetic agent,sympathomimetic agent, Sympathomimetic agents are aSympathomimetic agents are a vasoconstrictor and pressorvasoconstrictor and pressor drug chemically related todrug chemically related to epinephrine and ephedrine.epinephrine and ephedrine. Drug Therapy of CoughDrug Therapy of Cough
    81. 81.  Blocks H1 histamine receptor and thus inhibits theBlocks H1 histamine receptor and thus inhibits the actions of histamine.actions of histamine.  Prevents allergic manifestations of cough.Prevents allergic manifestations of cough.  Well absorbed from GIT and penetrates the CNS.Well absorbed from GIT and penetrates the CNS.  Side EffectsSide Effects: drowsiness, nausea and vomiting.: drowsiness, nausea and vomiting. 81 AntihistaminesAntihistamines
    82. 82.  Antihistamine, antagonises the actions of histamine at the receptor sites.  Reduces allergic reactions produced due to histamine in the respiratory tract.  Drowsiness and anticholinergic side effects are common. 82 AntihistaminesAntihistamines
    83. 83. 83 DecongestantsDecongestants
    84. 84. 84 Anti-pyretic - AnalgesicsAnti-pyretic - Analgesics
    85. 85. Menthol:Menthol:  Soothening action, produces cooling sensation andSoothening action, produces cooling sensation and has a mild anesthetic actionhas a mild anesthetic action  Side effects are mild hypersensitivity reactionsSide effects are mild hypersensitivity reactions 85 Soothing AgentsSoothing Agents
    86. 86. 86
    87. 87. Composition: Each 5 ml containsComposition: Each 5 ml contains    PhenylephrinePhenylephrine 55 mgmg ParacetamolParacetamol 250250 mgmg ChlorpheniramineChlorpheniramine MaleateMaleate (CPM)(CPM) 11 mgmg MentholMenthol 1.251.25 mgmg 87
    88. 88.  Synthetic sympathomimetic agent,  Stimulate α receptors,  Very minimal effect on β-receptor,  Vasoconstrictor,  Vaso-presser drug. 88 1.1. Phenylephrine (Decongestant)Phenylephrine (Decongestant)
    89. 89. 89 1.1. Phenylephrine … cont.Phenylephrine … cont. Powerful Vasoconstrictor Cardiac Safety Blood Vessels: Cutaneous, limb, kidney, spleen Coronary blood flow increased Pulmonary Blood vessels constricted In nasal mucosa: Very minimal effects on β-receptors of heart Stimulate α-receptors in the Blood vessels, which constricts & stop secretions. Complete lack of action on heart
    90. 90.  Very potent decongestant,Very potent decongestant,  Constricts (shrinks) blood vessels (veins and arteries),Constricts (shrinks) blood vessels (veins and arteries),  Constriction leads to drainage of supplied areas,Constriction leads to drainage of supplied areas,  Decreases congestion & swelling of mucus membrane,Decreases congestion & swelling of mucus membrane,  Site of action: Nose & Sinuses.Site of action: Nose & Sinuses. Phenylephrine in RTI :Phenylephrine in RTI : •Opens airwaysOpens airways •Decreases amount of fluid in RTDecreases amount of fluid in RT •Make easier to breathMake easier to breath 90 Phenylephrine- Place in TherapyPhenylephrine- Place in Therapy
    91. 91.  Adults & adolescents > 12 yr.:Adults & adolescents > 12 yr.: 10-20 mg 4 hrly10-20 mg 4 hrly  Children 6 to 12 yr. :Children 6 to 12 yr. : 10 mg 4 hrly10 mg 4 hrly  Children < 6 yr. :Children < 6 yr. : 5 mg 4 hrly5 mg 4 hrly 91 Phenylephrine- Dosage & AdministrationPhenylephrine- Dosage & Administration
    92. 92. 2. Paracetamol2. Paracetamol (Anti-Pyretic)(Anti-Pyretic) 92
    93. 93.  Histamine in Nature Present in:  Plants  Venom and stings  Synthesized by bacteria and certain fungi 3. Chlorpheniramine Maleate (CPM)3. Chlorpheniramine Maleate (CPM) Human Tissue: 1. Cells: Mast cells, Basophils, Neurons, Cells in the stomach. 2. Tissues: Skin, Lung, Gastrointestinal tract. 93
    94. 94. CPM: Synthesis and Metabolism Histidine Histamine L-histidine carboxylase Methylhistamine N – methylimidazole acetic acid histamine methyl transferase 94
    95. 95.  H-1:H-1: GI & bronchial SM contraction.GI & bronchial SM contraction.  H-2:H-2: Cardiac stimulation, Gastric secretion.Cardiac stimulation, Gastric secretion.  H-1 & H-2:H-1 & H-2: Dilation of arterioles and veins.Dilation of arterioles and veins.  H-3:H-3: Mainly in the CNS,Mainly in the CNS, Preterminal and autoreceptors,Preterminal and autoreceptors, Not considered further.Not considered further. 95
    96. 96. 96 Action Histamine Receptor Bronchial contractionBronchial contraction H-1H-1 GI contractionGI contraction H-1H-1 HeartHeart H-2, H-1 (AV node)H-2, H-1 (AV node) large artery contractionlarge artery contraction H-1H-1 Microvessel dilationMicrovessel dilation H-1 & H-2H-1 & H-2 Venule permeabilityVenule permeability H-1 & H-2 (?)H-1 & H-2 (?) Gastric acid secretionGastric acid secretion H-2H-2 CNS arousalCNS arousal H-1H-1
    97. 97. Smooth muscle antihistamines Histamine, PG’s, 5-HT, PAF Drug Protein IgE antibody IgE-Sensitized Cell Histamine Release from Mast CellsHistamine Release from Mast Cells Mast Cell Allergen 97
    98. 98.  H-1 blockers  1st generation or classical (older)  2nd generation or non-sedating (newer)  H-2 blockers  gastric acid blockers 98
    99. 99. 1. Block H-1 receptors competitively. 2. Reduce local response to intradermal histamine. 3. Antagonize the vasoconstrictor, and to a lesser extent, the vasodilator effects of histamine. 4. Antagonize histamine-induced bronchospasm. 5. Inhibit GI smooth muscle contractions. 99
    100. 100.  Developed in France pre-WWII  More sedating  Penetrate the CNS and generally have CNS effects  Significant anticholinergic effects  Example: CPM: Sedative action, available OTC. Diphenhydramine:highly sedating, available OTC. Hydroxyzine: used frequently for urticaria. Promethazine (Phenergan):anti-motion sickness activity  used by NASA for space motion sickness 100
    101. 101.  Less sedating - less CNS penetration.  Almost no anticholinergic effects.  Produce cardiac toxicity: Removed from the market (Terfenadine , Astemizole).  Loratidine – no apparent cardiac toxicity  Fexofenadine - active metabolite of Terfenadine, safer than parent compound  Cetirizine, Levocetrizine – Used for Non-sedative properties. 101
    102. 102. 1.Common cold: Symptomatic relief. 2.Local allergic manifestations: Urticaria, rhinitis, rhinorrhea. 3. Motion sickness: Nausea and vomiting. 4. Sedative/hypnotic: In sleep remedies (1st generation). 102
    103. 103.  Soothing action, produces cooling sensation andSoothing action, produces cooling sensation and has a mild anesthetic action.has a mild anesthetic action.  Action: Stimulation of the mucous membranes cold receptors.  Produce a cooling effect when inhaled or come in contact with mucous membrane  Use: Relieve sore throat, or nasal congestion, headache, cold, or sore throat. Products that commonly contain menthol include toothpaste, cough syrups, lip balm, mouthwash, gum, and cigarettes. 103
    104. 104.  Menthol in Cough Syrups often soothe and cool sore throats by relieving inflammation.  It can also help clear stuffy sinus passages and break up chest congestion.  This usually helps a person to cough less and breathe easier.  The combination of menthol in cough syrup is often an easy treatment that can be given to a person of almost any age. 104
    105. 105. ZEDEX - IndicationsZEDEX - Indications 105
    106. 106. ZEDEX - Dosage and AdministrationZEDEX - Dosage and Administration 106
    107. 107. DiagnosisDiagnosis URTI Flu (Influenza) Rhinitis Common cold0 Sinusitis Pharyngitis Coryza Sore throat Bronchitis Pneumonia Bronchitis Bronchiolitis Bronchiectasis Bronchopneumonia LRTI ZEDEX Rational 107
    108. 108. Cough with sputum MostMost CommonCommon SymptomsSymptoms Chronic coughing Shortness of breath Difficult to cough out sputumSore throat Nose & Throat congestion Nasal Discharge Red & swollen mucus membrane 108
    109. 109. Sinuses & Throat Pain (Paracetamol) Most Effective Treatment Fever (Paracetamol) Difficult to cough out sputum (Decongestant) Sore throat (Menthol) Nose & Throat congestion (Antihistamine + Decongestant Nasal Discharge (Antihistamine + Decongestant) Red & swollen mucus membrane (Antihistamine + Decongestant) 109
    110. 110. Cough Formula Antihistamine (CPM) Decongestant (Phenylephrine) Anti-pyretic + Analgesic (Paracetamol) Soothing AgentSoothing Agent (Menthol)(Menthol) 110
    111. 111. ZEDEX - Product DescriptionZEDEX - Product Description PackagingPackaging Bottle Shipper pack Stockiest Price Retailer Price 112
    112. 112. Product Positioning :Product Positioning : Product Differential :Product Differential : ZEDEX - Marketing AspectsZEDEX - Marketing Aspects 113
    113. 113. ZEDEX – Target Doctors and IndicationsZEDEX – Target Doctors and Indications 115
    114. 114. ZEDEX – Communication StrategyZEDEX – Communication Strategy 116
    115. 115. ZEDEX – Input PlansZEDEX – Input Plans 117
    116. 116. 119
    117. 117. Cold Cough Syrup – Brand TrendsCold Cough Syrup – Brand Trends 120
    118. 118. Thank YouThank You 121

    ×