1. PHARMACOTHERAPY for RESPIRATORY
DISEASES
Presented by
Miss. Ghadage Priyanka K.

2. Contents
Anatomy and Physiology Of Human
Respiratory System
Respiratory Diseases
Asthma
Chronic Obstructive Pulmonary Disease
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3. Anatomy and Physiology Of
Human Respiratory system
What is respiration?
Respiration is the act of breathing:
 inhaling (inspiration) - taking in oxygen
 exhaling (expiration) - giving off carbon dioxide
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4. Respiratory System (cont…)
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Functional anatomy of
the respiratory system:
Conducting Zone
-nose
-nasal cavity
-pharynx
-larynx
-trachea
-bronchi
Respiratory Zone
-respiratory bronchioles
-alveolar ducts

5. Respiratory system
(Cont..)
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6. Respiratory System (Cont…)
Basic functions :-
Gas exchange
Protection
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7. RESPIRATORY DISEASES COPDASTHMA
PNEUMONIA
RESPIRATORY TUMORS
PULMONARY HAEMORRHAGE
PULMONARY EDEMA PULMONARY EMBOLISM
PNEUMOTHORAX
CYSTIC FIBROSIS
TUBERCULOSIS
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8. 8
ASTHMA

9. What is Asthma..???
Chronic inflammatory disease of the
airways.
Characterized by reversible airflow
obstruction and bronchospasm.
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10. Symptoms of Asthma
 The clinical hallmarks of Asthma
 Coughing,
 Shortness of breath,
 Chest tightness,
 Wheezing
 The Symptom of Asthma
 Smooth muscle contraction
 Vascular congestion
 Bronchial wall edema
 Thick, tenacious secretion
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11. Causes of Asthma
Environmental And Genetic Factors
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13. Pathophysiology of asthma
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14. Diagnosis of Asthma
Based on
Response to therapy
Pattern of symptoms
 Response to therapy
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15. Diagnosis of Asthma (cont..)
 Pattern of symptoms
List of indicators:
 Wheezing
 history of any of the following:
 Cough, worse particularly at night
 Recurrent wheeze
 Recurrent difficulty in breathing
 Recurrent chest tightness
 Symptoms occur or worsen in the presence of:
 Exercise
 Viral infection
 Animals with fur or hair
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16. Diagnosis of Asthma (cont..)
House-dust mites
Mold
Smoke (tobacco, wood)
Pollen
Changes in weather
Strong emotional expression (laughing or crying hard)
Airborne chemicals or dusts
Menstrual cycles
 Symptoms occur or worsen at night, awakening the
patient
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17. Treatment for Asthma
Non-pharmacological treatment
Pharmacological treatment
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18. Non-pharmacological treatment
for Asthma
 Risk factor reduction
 Pulmonary rehabilitatation
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19. Non-pharmacological treatment
for Asthma (cont..)
 Bronchial thermoplasty
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20. Pharmacological treatment for
Asthma
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21. Drugs used in asthma
A. Bronchodilators
 β2 Adrenergic Receptor Agonist: Salbutamol,
Terbutaline, Bambuterol, Salmeterol , Formoterol,
Ephedrine.
 Methylxanthine:Theophylline, Aminophylline, Chonine
theophyllinate, Hydroxyethyl theophylline, Theophylline
ethanolate of piperazine, Doxophylline.
 Anticholinergics: Ipratropium bromide, Tiotropium
bromide.
B. Glucocorticoids
 Systemic: Hydrocortisone, Prednisolone, and others.
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22. Drugs used in asthma (cont..)
 Inhalational: Beclomethasone dipropionate, Budesonide,
Fluticasone propionate, Flunisolide, Ciclesonide.
C. Leukotriene-Receptor Antagonists and Leukotriene-
Synthesis Inhibitors
 Montelucast , Zafirlucast, Zileuton.
D. Anti-IgE antibody
 Omalizumab
E. Mast cell stabilizers
 Cromolyn sodium, Nedocromil sodium
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23. A. Bronchodilators
 β2 Adrenergic Receptor Agonist
 Methylxanthine
 Anticholinergic Agents
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24. Actions of Bronchodilators
 Stimulate beta-2 receptor sites
 Relax smooth muscle in airway walls
 Dilate airways
 Lower resistance to air flow
 Decrease respiratory effort
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25. Mechanism of action of
bronchodilators
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26. β2 Adrenergic Receptor Agonist
 Short-Acting β2 Adrenergic Receptor Agonists:-
Albuterol , levalbuterol, metaproterenol, terbutaline,
and pirbuterol.
 Long-Acting β2 Adrenergic Receptor Agonists:-
Salmeterol xinafoate and formoterol
 Oral therapy with β2 Adrenergic Receptor
Agonists:-
Albuterol, metaproterenol, terbutaline
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27. Cont………
Pharmacological Effects
 Inhibit microvascular leakage
 Increase mucociliary transport
 Affecting the mucus secretions
 Increasing ciliary activity
Toxicities
 Cardiac arrhythmias,
 Hypoxemia acutely,
 Tolerance.
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28. Methylxanthine
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29. Anticholinergic drugs
Anticholinergics:
Ipratropium bromide, Tiotropium bromide.
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30. B. Glucocorticoids
Anti-inflammatory activity
 Block leukotriene synthesis
 Inhibit cytokine production
 Reduction of mucosal edema
 Up- regulate β2 adrenoreceptor
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31. B. Glucocorticoids (cont..)
 Inhalational: Beclomethasone dipropionate,
Budesonide, Fluticasone propionate, Flunisolide,
Ciclesonide.
Toxicity of inhaled corticoid
 Oropharyngeal Candidiasis
 Systemic: Hydrocortisone, Prednisolone, and others.
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32. B. Glucocorticoids (cont..)
Side effects
 Metabolic effects,
 Growth suppression,
 Fluid retention, osteoporosis,
 Increase susceptibility to infection,
 Cataract, GI symptoms,
 Adrenal suppression
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33. C. Leukotriene-Receptor Antagonists
and Leukotriene-Synthesis Inhibitors
Leukotriene-Receptor Antagonists
 Zafirlukast,
 Montelukast
Leukotriene-Synthesis Inhibitors
 Zileuton
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34. Mechanism of action
• Selective and
competitive
receptor antagonist
of Leukotriene
D4 and E4
(LTD4 and LTE4),
components of
slow-reacting
substance
of anaphylaxis
(SRSA).
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35. D. Anti-IgE antibody
Omalizumab(Anti-IgEMab)
 Recombinant humanized monoclonal antibody
targeted against IgE.
 Directed against cytokines (IL-4, IL-5, and IL-13
 Inhibits the binding of IgE to mast cells.
 Reduced exacerbations 88%
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36. Mechanism Of Action of Omalizumab
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37. E. Mast cell stabilizers
Cromolyn & Nedocromil Sodium
Mechanism of Action:
 Inhibit mast cells degranulation
 Little inhibitory from basophils
 Inhibiting parasympathetic & cough reflex
 Inhibit leukocyte trafficking in asthmatic airways
 Inhibition inflammatory response
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38. E. Mast cell stabilizers (cont..)
Clinical Use
blocks the Bronchoconstriction
 by antigen inhalation
 by exercise
 by aspirin
 by allergen
Adverse/Side effects:
 Throat irritation, Cough, Wheezing,
 Mouth dryness, Chest tightness ,
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39. Inhaled asthma medication
Drugs used for inhalation:-
 β2 Adrenergic Receptor Agonist
 Anticholinergics
 Cromoglycate
 Glucocorticoids
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40. Devices used for inhalation
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41. Devices used for inhalation
(cont..)
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42. Use of spacer in asthma
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43. Chronic obstructive pulmonary
disease
 Refers to chronic bronchitis and
emphysema
 Airways become narrowed
 Limitation of the flow
of air causing shortness of breath
 Airway obstruction largely irreversible
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44. Symptoms of COPD
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45. Causes
of COPD
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46. Pathophysiology of COPD
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47. Diagnosis Of COPD
Spirometry
Other tests
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48. Treatment For COPD
 Non-pharmacological treatment
 Pharmacological treatment
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49. Non-pharmacological treatment
For COPD
 Risk factor reduction
 Supplemental oxygen
 Pulmonary rehabilitation
 Nutrition
 Surgery
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50. Pharmacological treatment For
COPD
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52. CONCLUSIONS…
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53. References
 Tripathi KD. Essentials of Medical Pharmacology. 6th ed. Jaypee Brothers Medical
Publishers (P) Ltd. 2008. 213-227.
 Waugh Anne, Grant Allison, Ross and Wilson Anatomy and Physiology in Health and
Illness. 9th ed. churchill livingstone ; 2001.82-91.126-127.
 Mohan Harsh, Textbook of Pathology; Jaypee Brothers Medical Publishers (P) Ltd. 4th
ed. Aug 2000.299-300,447-457.
 Dipiro Joseph T. Talbert RL. Yees GC. Matzke GR. Wells BG. Pharmacotherapy, a
physiologic approach. Mc Graw Hill medical. 6th ed. 2015-2027.
 Goodman & Gilman's. The Pharmacological basis of therapeutics Mcgraw-Hill
Medical publishing division; 11th ed. 2006.720-731.
 Rang H.P., Dale M.M., Ritter J.M., Moore P.K.; Pharmacology, 5th ed.,Churchill
Livingstone; 2003. 356-366.
 Lippincott, Modern Pharmacology With Clinical Application 6th ed. 458-466.
 "http://en.wikipedia.org/wiki/Chronic_obstructive_pulmonary_disease"
 "http://en.wikipedia.org/wiki/Asthma"
 www.google.com
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