1. COUGH AND
BRONCHIAL
ASTHMA
Arijit Chakraborty
M.Pharm (Pharmacology)
19/02/2013
1

2. COUGH
Cough is a protective reflex, its purpose
being expulsion
Of respiratory secretion or foreign particles
from air passages. It occurs due to
stimulation of chemoreceptor's in throat,
respiratory passage or stretch receptors in
the lungs.
Cough is two type; useful and useless,
useful (productive) Cough serves to drain
the airway, its suppression is not desirable,2

3. COUGH
Cause:
Cold and flu.
Allergic rhino-sinusitis (inflammation of the
nose or sinuses).
Asthma.
Smoking.
Lung infections such as pneumonia or
acute bronchitis.
3

4. DRY COUGH
Dry cough is a type of cough that does
not produce sputum or phlegm.
It can be triggered by,
1. infections and cold (the most
common causes of dry cough),
2. allergic reactions,
3. traumas,
4. lung cancer,
5. airway obstruction, and other
abnormalities. 4

5. SYMPTOMS OF DRY COUGH
 Flu-like symptoms (fatigue, fever, sore
throat, headache, aches and pain)
 Nausea
 Runny nose (nasal congestion)
 Vomiting
 Wheezing (whistling sound made with
breathing)
 Loss of appetite
5

6. CAUSES OF DRY COUGH
 Airway irritation (bronchospasm)
Asthma and allergies
Chronic obstructive pulmonary disease
(COPD, includes emphysema and chronic
bronchitis)
Congestive heart failure
Lung cancer
Pleurisy (inflammation of the lining around
the lungs and chest)
Smoking 6

7. WET COUGH
The medical term for a wet cough is
productive cough. Wet cough is a common
symptom of,
1. respiratory infection,
2. allergies, and heart conditions.
7

8. SYMPTOMS OF WET COUGH
 Absence of breathing.
Chest pain or pressure.
Cough that gets more severe over time.
Coughing up blood.
Coughing up clear, yellow, light brown, or
green mucus.
Coughing up pink frothy mucus.
Rapid breathing (tachypnea).
Wheezing (whistling sound made with 8

9. CAUSES OF WET COUGH
Acute bronchitis.
Bronchiectasis (destruction and widening
of the airways)
Bronchiolitis (inflammation of the smallest
airways in the lungs)
Common cold (viral respiratory infection)
Cystic fibrosis (thick mucus in the lungs or
digestive tract)
Influenza (flu).
Tuberculosis (serious infection affecting 9

10. MECHANISM OF COUGH
Stimulation of chemoreceptor's (throat, respiratory
passages or stretch receptors in lungs)
Afferent impulses to cough centre (medulla)
Efferent impulses via parasympathetic & motor nerves
to diaphragm, intercostals muscles & lung
Increased contraction of diagrammatic, abdominal &
intercostals (ribs) muscles ⇒noisy expiration (cough)
10

11. TREATMENT OF COUGH
 Primary medication: Cough drops, syrup
etc.
 Expectorants (Mucokinetics):
a) Bronchial secretion enhance:
Potassium iodide, balsum of tolu.
b) Mucolytics: Bromhexine,
Ambroxol, Acetyl cysteine.
11

12. TREATMENT OF COUGH
Antitussives (Cough centre suppressants):
a) Opoids: Codeine, Pholcodeine
b) Nonopoids: Dextromethophan,
Noscapine
c) Antihistamines:
Chlorpherinamine, Promethazine
 Adjuvant antitissuve:
Bronchodilators: Salbutamol,
Terbutaline 12

13. BRONCHIAL ASTHMA
 Asthma is a Chronic inflammatory
disorder of the airways.
 Chronically inflamed airways are hyper
responsive.
 They become obstructed and airflow is
limited by bronchoconstriction, mucus plugs,
and increased inflammation when airways
are exposed to various risk factors.
13

14. BRONCHIAL ASTHMA
ETIOLOGY:
Triggers factors tend to participate
and/or aggravate asthma exacerbation.
1. Allergens e.g. pollens, air
pollution, dust.
2. Irritants e.g. Tobacco smoke,
sprays.
3. Exercise.
4. Temperature and weather 14

15. CONT……
6. Animals e.g. cats , dogs, rodents
etc.
7. Strong emotion, e.g. fear ,
laughing.
15

16. Characteristic of Asthma
Asthmatic patients experience
intermittent attacks of wheezing, shortness
of breath-with difficulty especially in
breathing out, and sometimes cough. As
explained above, acute attacks are
reversible, but the underlying pathological
disorder can progress in older patients to a
chronic state superficially resembling COPD.
It is characterized by,
a) Inflammation of the airways 16

17. PATHOPHYSIOLOGY OF
ASTHMA
Asthma trigger
- Inflammation & edema of the mucous
membranes.
- Accumulation of tenacious secretions from
mucous glands.
- Spasm of the smooth muscle of the
bronchi & bronchioles
17

18. PATHOPHYSIOLOGY OF
ASTHMA
18

19. 19
Relaxation Constriction
Normal
Asthma
Airway
narrowing
Exaggerated
airway
narrowing
muscle constriction
35 %
muscle constriction
35 %

20. Pathological changes of asthma
20
Epithelium
Normal airway airway wall remodeling
Basement
membrane
Smooth
muscle
Mucus
glands
(hyperplasi
a)

21. DRUG THERAPY
 2 types of drug categories are used:
21
ANTIINFLAMATORY DRUG BRONCHODIALETORS
hormone-containing
(corticosteroids)
nonhormone-containing
(leukotriene
receptor antagonists)
β2-agonists
anticholinergic drugs
methylxanthines

22. DRUG THERAPY
22
Anti-inflammatory drug
Corticosteroids
(Hydrocortisone,
Beclomethasone)
Leukotrienes antagonist
(Montelukast)
Bronchodilators
β2-agonists
(Salbutamol,
Terbutalin)
Anticholinargic drug
(Ipratropium
bromide)
Methyxanthine
(Theophylline,
Aminophylline)

23. DRUG THERAPY
 Anti-inflammatory drug:
a) Corticosteroids: (Hydrocortisone,
Beclomethasone)
i) Cell membrane stabilization.
ii) Inhibition of inflammatory mediators.
iii) Restoring the sensivity of β2- receptors.
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24. DRUG THERAPY
 Anti-inflammatory drug:
a) Leukotrienes receptor antagonist:
(e.g. montelukast) are third-line drugs for
asthma.
They:
– competitively antagonize cysteinyl
leukotrienes at CysLT1 receptors
– are used mainly as add-on therapy to inhaled
corticosteroids and long-acting β2 agonists 24

25. DRUG THERAPY
25
BRONCHODIALETORS
β2-agonists
Stimulates
β2-adrenergic
receptors of bronchi
Smooth
muscle
relaxation
Smooth
muscle
relaxation
Anticholinergic
drugs
reduce tones
of vagus
Methylxanthines inhibit non-selective
phosphodiesterase

26. DRUG THERAPY
β2-Adrenoceptor agonists (e.g.
Salbutamol) are first-line drugs. It is
increase the Heart rate.
– They act as physiological antagonists of the
spasmogenic mediators but have little or no
effect on the bronchial hyper-reactivity.
– Salbutamol is given by inhalation; its effects
start immediately and last 3-5 hours, and it
can also be given by intravenous infusion in
status asthmatics.
– Salmeterol or formoterol are given regularly
26

27. DRUG THERAPY
 Methyxanthine: (Theophylline, Aminophylline)
– inhibits phosphodiesterase and blocks
adenosine receptors
– has a narrow therapeutic window: unwanted
effects include cardiac dysrhythmia, seizures
and gastrointestinal disturbances
– is given intravenously (by slo w infusion) for
status asthmatics, or orally (as a sustained-
release preparation) as add-on therapy to
inhaled corticosteroids and long-acting β2
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28. DRUG THERAPY
 Anti-cholinergic drug: ( Atropine,
ipratropium bromide, troventol)
They are used in predominantly in
nighttime asthma and in elderly patient
because of the least cardiotoxic effect.
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29. REFERANCE
1. Essentials of Medical Pharmacology,
K.D. Tripathi.
2. Pharmacology, Rang and Dale.
3. Internet Source.
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