Cough

2. Cough
 A cough is a sudden, usually involuntary,
expulsion of air from the lungs with a
characteristic and easily recognizable sound.

3. Cough
 A cough is your body's way of responding when
something irritates your throat or airways.
 An irritant stimulates nerves that send a message to
your brain.
 The brain then tells muscles in your chest and
abdomen to push air out of your lungs to force out
the irritant.
 An occasional cough is normal and healthy.

4. Cough

5. Types of Cough
 Dry Cough. This cough actually sounds dry
nothing comes up with the cough and these coughs
are considered “unproductive”. ...
 Wet Cough. A wet cough usually produces some
sort of mucus as you cough and these coughs are
considered “productive”. ...

6. Cough
 Protective reflex.
 Intended to remove irritants and accumulated secretion.
 Types of cough:
1. Productive cough: helps to clear the airway,
suppression is harmful may leads to infection.
2. Non productive cough: Useless and should be
suppressed.

7. Physiology of the cough reflex
 The cough reflex is complex, involving the central and
peripheral nervous systems as well as the smooth
muscle of the bronchial tree.
 Chemical or mechanical irritation of the epithelium
within bronchial mucosa causes broncho-constriction,
which in turn stimulates cough receptors located within
the tracheo-bronchial tree.

8. Cough

9. Antitussives and demulcents
 Antitussives are cough suppressants. They relieve
your cough by blocking the cough reflex.
 Demulcent: An agent that forms a soothing,
protective film when administered onto a mucous
membrane surface and relieving minor pain and
inflammation ... Pharyngeal demulcents Lozenges
- Strepsils

10. Mucolytics and expectorant
 Mucolytics are medicines that make the
mucus less thick and sticky and easier to
cough up.
 An expectorant is a type of cough medicine
used to help clear mucus (phlegm) from
your airway.

11. Anti-cough agents
 Antitussives (cough center suppressants): codeine.
Pholcodeine, noscapine, dextromethorphan, antihistamines,
benzonate.
 Pharyngeal demulcents: logenges, linctuses, liquorice.
 Expectorants: sodium and potassium citrate, potassium
iodide, guaiphansin, ammonium chloride.
 Mucolytics: bromhexine, acetylcysteine, carbocisteine,
ambroxol.

12. Antitussives
 Inhibits cough reflex by suppressing cough center in
medulla.
 Used for symptomatic treatment of dry unproductive cough.
Codeine:
1. Cough center suppressant effects.
2. Cause mild CNS depression.
3. Constipation by decreasing intestinal movements.
4. Should be avoided in children and asthmaticus.
5. Administered orally, mild analgesic, less addiction.

13. Antitussives…
Pholcodeine:
1. Similar action as codeine
2. No analgesic.
3. No addiction liability.
4. Administered orally.
5. Has long duration of action.
Noscapine:
1. Opium alkaloid.
2. Potent antitussive effect.
3. Useful in spasmodic cough. (Chronic dry coughs)
4. No analgesic effect.
5. Does’t cause constipation, CNS depression or addiction
6. Side effects are nausea and headache.

14. Antitussives…
Dextromethorphan:
1. Centrally acting antitussive agent.
2. No analgesic property.
3. Does’t cause constipation and addiction; mucuciliary
function is not affected.
Antihistamines:
Diphenhydramine, chlorpheniramine, promethazine are
useful in cough because:
1. Sedative, antiallergic, anticholinergic effects.
2. Produce symptomatic relief in cold and cough associated
with allergic condition of respiratory tract.

15. Antitussives…
Benzonatate
1. It is a peripherally acting cough suppressant and
chemically related to local anesthetic procaine.
2. Acts on the pulmonary stretch receptors.

16. Pharyngeal demulcents
 Cough Syrups
 Logenges
 liquorice
 Linctuses: A linctus is a medicine in the form of a
syrup, taken to relieve coughs and sore throats.
 These are uses when cough arises due to irritation
above larynx.
 Increase salivation.
 Produce protective soothing effect on inflamed
mucosa.

17. Demulcents
 Demulcents are sometimes referred to as
mucoprotective agents.
 Demulcents such as pectin, glycerin, honey, and
syrup are common ingredients in cough mixtures and
cough drops.
 Examples of synthetic demulcents are methylcellulose,
propylene glycol, and glycerine.

18. Expectorants
 A medication that helps bring up mucus and other
material from the lungs, bronchi, and trachea.
 These loosen or thin the mucus in the chest, making it
easier to cough it up.
 Drinking extra fluids can also help.
 For example Guaifenesin, Pseudo-ephedrine and
phenylephrine

19. Expectorants (mucokinetics)
 Increase volume of bronchial secretion. Reduce
viscosity of the sputum.
 So cough becomes less tiring and productive.
 Includes: iodides, chlorides, bicarbonates, acetates,
volatile oils.
 They are used in the chronic cough.

20. Mucolytics
 These agents break the thick tenacious sputum.
 Lowers viscosity of sputum.
 So the sputum comes out easily with less effort.

21. Mucolytics
Bromhexine:
• Bromhexine is a mucolytic, a medicine used to break up excessive
or thick phlegm associated with a chesty cough.
• A chesty cough (productive or wet cough) is one that produces
mucus and may cause feelings of congestion in the chest.
• It is used for a variety of respiratory conditions associated with
increased mucus secretion.

22. Mucolytics
Bromhexine:
• it is derived from the Adhatoda vasica plant and aids in the
clearance of excess mucus, improving breathing and reducing
cough.
• Side effects are rhinorrhoea and lacrimation.

23. Mucolytics…
 Acetyl-cysteine and carbo-cysteine
 Used as aerosol in the treatment of cough
 Carbocisteine and acetylcysteine are cysteine derivatives
indicated for use as mucolytic agents.
 They reduce mucus viscosity and thus promoting
expectoration.
 Side effects are nausea, vomiting.