1. 1

2. 2

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. Upper Resp. TtractUpper Resp. Ttract
Nose
Pharynx
Lower Resp. TractLower Resp. Tract
Larynx
Trachea
Bronchi
Lungs
4

5. 5

6. 66

7. 7

8. Respiratory
Bronchiole
Alveolar
Sac
Acinus
Alveolar
Duct
8
Lower Respiratory TractLower Respiratory Tract

9. 9
Respiratory Function:
Air is warmed,
moistened & filtered
Olfactory function

10. • Citated columar epithelium
• Mucus secreting goblet cells
10

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. 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. Speech consists of manipulation of sound produced
by vocal cords, tongue, cheeks.
13

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. Trachea :Trachea :
12 cm long12 cm long
Diameter 2 .5 cmDiameter 2 .5 cm
15

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.  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

19. 19

20. 20

21. 21

22. 22

23. • 15 times/ min
• Inspiration
• Expiration
• Pause
23

24. Diaphragam Intercostals
24

25. 25

26.  Coughing
 Sneezing
 Sighing
 Yawning
 Sobbing
 Crying
 Laughing
 Hiccuping
26

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. Structure of a BronchioleStructure of a Bronchiole
SmoothSmooth
MuscleMuscle
Cilia
Mucous
Layer
Mucus
Gland
Goblet
Cell
MastMast
CellsCells
Epithelium Sub-Mucosa 28

29. Respiration:
 External
 Internal
 Tissue
29

30. 30

31. 31

32. 32

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. 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. 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. 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. •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.  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.  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.  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.  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.  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.  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.  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.  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.  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. Normal LungNormal Lung BronchiolitisBronchiolitis
47
BronchiolitisBronchiolitis

48. 48

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. 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
Act of CoughingAct of Coughing

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
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. 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
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. 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. 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.  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.  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. 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. 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
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

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. Resp. Mucous Membrane:
Lined by respiratory epithelium
Ciliated columnar cells
Goblet cells
Cilia - propel foreign particles
upwards
Respiratory Tract FluidsRespiratory Tract Fluids
65

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. 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. 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. 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. 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

72. 72
Drugs Used In CoughDrugs Used In Cough

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
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. 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. 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. 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. 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. 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
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.  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.  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
DecongestantsDecongestants

84. 84
Anti-pyretic - AnalgesicsAnti-pyretic - Analgesics

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

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.  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
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.  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.  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. 2. Paracetamol2. Paracetamol
(Anti-Pyretic)(Anti-Pyretic)
92

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. CPM: Synthesis and Metabolism
Histidine Histamine
L-histidine
carboxylase
Methylhistamine
N – methylimidazole acetic acid
histamine methyl transferase
94

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
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. 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.  H-1 blockers
 1st
generation or classical (older)
 2nd
generation or non-sedating (newer)
 H-2 blockers
 gastric acid blockers
98

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.  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.  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. 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.  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.  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. ZEDEX - IndicationsZEDEX - Indications
105

106. ZEDEX - Dosage and AdministrationZEDEX - Dosage and Administration
106

107. DiagnosisDiagnosis
URTI
Flu (Influenza)
Rhinitis
Common cold0
Sinusitis
Pharyngitis
Coryza
Sore throat
Bronchitis
Pneumonia
Bronchitis
Bronchiolitis
Bronchiectasis
Bronchopneumonia
LRTI
ZEDEX Rational
107

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. 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. Cough
Formula
Antihistamine
(CPM)
Decongestant
(Phenylephrine)
Anti-pyretic +
Analgesic
(Paracetamol)
Soothing AgentSoothing Agent
(Menthol)(Menthol)
110

112. ZEDEX - Product DescriptionZEDEX - Product Description
PackagingPackaging
Bottle
Shipper pack
Stockiest Price
Retailer Price
112

113. Product Positioning :Product Positioning :
Product Differential :Product Differential :
ZEDEX - Marketing AspectsZEDEX - Marketing Aspects
113

114. ZEDEX – Target Doctors and IndicationsZEDEX – Target Doctors and Indications
115

115. ZEDEX – Communication StrategyZEDEX – Communication Strategy
116

116. ZEDEX – Input PlansZEDEX – Input Plans
117

118. 119

119. Cold Cough Syrup – Brand TrendsCold Cough Syrup – Brand Trends
120

120. Thank YouThank You
121