Upload
muhammad-ahmad
View
72
Download
3
Tags:
Embed Size (px)
Citation preview
Dr. Kashif Hussain
COUGHProtective mechanismForceful expiration to remove foreign body,mucus or
secretions
Cough Reflex
1) cough receptors
airways,pleura, upper GIT,pericardium,ears and diaphragm
2) afferent nerve
3) cough center
4) efferent nerves
5) effectors
Types of CoughDry Cough
Productive cough
Acute cough < 3 wks ( acute RTI)
Subacute cough3-8 wks( BHR )
Chronic cough
> 8 wks (asthma,GERD,PND)
Goals of Therapy
1.Treat underlying cause of cough
2.productive cough( Mucolytics & Expectorants)
3.suppress dry cough (Anti-tussives)
4.Bronchodilators
5.ICS
Antitussives
Central acting
Decrease sensitivity of cough center to peripheral stimuli and decrease mucosal secretion
1. OPIATES
Codeine ( GOLD STANDARD )
Pholcodine
Morphine and methadone for intractable
cough due to lung cancer
Antitussive effect occur at doses lower than those required for analgesia therefore S/E are less common but still occur and include:
1. Constipation
2. dysphoria
3. fatigue
4. addictive potential
2.Opioid derivatives
Dextromethorphan
Noscapine
Levopropoxyphene
Dextromethorphan• Synthetic derivative of morphine• Central acting• No analgesic effect in antitussive doses• Low addictive profile
• Less constipation than codeine• Significantly better S/E profile than codeine• Equally effective as codeine for cough
suppression
2.PERIPHERAL ACTING
Benzonatate
local anesthetic effect in respiratory tract and pleura
Thalidomide
Cough due to IPF(idiopathic pulmonary fibrosis).Serious S/E is teratogenicity
OTHERS
Diphenhydramine (Antihistamine)
EXPECTORANTS increase bronchial secretions and help in
expulsion of sputum
CLASSIFICATION
1.Drugs that reflexly irritate bronchial mucosa Guaifenesin (Only expectorant approved by
FDA ) Ammonium chloride Ammonium bicarbonate
2. Drugs that directly irritate bronchial mucosa
Sodium IodidePotassium Iodide
MUCOLYTICS
decrease sputum viscosity
They cause depolymerization of mucopolysaccharide protein fibers
They are useful in COPD
N-Acetylcysteine Erdosteine Bromhexine Carbocysteine in COPD Methylcysteine DNAase 1 ( dornase alfa ) in Cystic fibrosis