1

2

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 musclesDiaphragm Diaphragm

3

Upper Resp. Upper Resp. TtractTtract

Nose Pharynx

Lower Resp. Lower Resp. TractTract

LarynxTracheaBronchiLungs

4

5

66

7

RespiratoryBronchiole

AlveolarSac

Acinus

AlveolarDuct

8

Lower Respiratory TractLower Respiratory Tract

9

Respiratory Function:

Air is warmed, moistened & filtered

Olfactory function

• Citated columar epithelium

• Mucus secreting goblet cells

10

• Nasal partNasal part• Oral PartOral Part• Laryngeal PartLaryngeal Part

11

Functions of Pharynx:Functions of Pharynx:

Respiratory: Respiratory: Air passes thru the nasal & Air passes thru the nasal & oral parts.oral parts.

Air is further warned & moistenedAir is further warned & moistened

Digestive: Digestive: Food passes thru, oral & Food passes thru, oral & laryngeal partslaryngeal parts

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 After puberty, grows larger in the male which explains the prominence of the ‘explains the prominence of the ‘Adam’s appleAdam’s apple’ ’ and deeper voice. and deeper voice.

12

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

13

• 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

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

15

Cartilages keep the air passages open, Cartilages keep the air passages open, allowing for unobstructed passage of air allowing for unobstructed passage of air

Sticky mucus lining the membranes Sticky mucus lining the membranes filters airfilters air

Wave motion of cilia & lining membrane Wave motion of cilia & lining membrane waft mucus and adherent particles waft mucus and adherent particles towards the throat.towards the throat.

1616

Contraction & relaxation of muscles in the wall Contraction & 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

19

20

21

22

• 15 times/ min

• Inspiration

• Expiration

• Pause

23

Diaphragam Intercostals

24

25

Coughing Sneezing Sighing Yawning

Sobbing Crying Laughing Hiccuping

26

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

Structure of a BronchioleStructure of a Bronchiole

SmoothSmoothMuscleMuscle

CiliaCilia

MucousLayerMucousLayer

MucusGlandMucusGland

GobletCellGobletCell

Mast Mast CellsCells

Epithelium Sub-Mucosa 28

Respiration: External Internal Tissue

29

30

31

32

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 Inflammation of middle earear

33

Common cold: Is associated with running nose Is associated with running nose

i.e. i.e. rhinorrhoea, congestion, rhinorrhoea, congestion,

sneezing sneezing etc. etc.

It is the inflammation of the It is the inflammation of the

nasal nasal mucus membranemucus membrane

Cough: It is a protective and It is a protective and

physiological physiological reflex reflex which is which is

responsible for responsible for expelling any expelling any

foreign matter foreign matter entering the entering the

respiratory tract.respiratory tract.

34

Bronchiectasis: Localised, chronic and Localised, chronic and

irreversible irreversible dilatation of the dilatation of the

bronchi.bronchi.

Pneumonia: Inflammation and consolidation of Inflammation and consolidation of

the lung tissue (parenchyma).the lung tissue (parenchyma).

Empyema: Accumulation of pus in pleural Accumulation of pus in pleural

cavity.cavity.

35

Sinusitis: Inflammation of the mucus Inflammation of the mucus

membrane membrane lining the lining the

various sinus cavities in 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

•Sinuses: Sinuses:

hollow cavities within hollow cavities within the facial bones. the facial bones.

•Sinus infections: Sinus infections:

most frequently most frequently maxillary and frontal maxillary and frontal sinuses.sinuses.

37

SinisitisSinisitis

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, Facial and/or dental pain, eye pain,

headache.headache.

38

Classic Symptoms of Acute Classic Symptoms of Acute SinusitisSinusitis

Runny nose , Nasal congestion Runny nose , Nasal congestion Sneezing Sneezing

Sore throat , Cough Sore throat , Cough

Muscle aches , Headache Muscle aches , Headache FeverFever

39

Common Cold - SymptomsCommon Cold - Symptoms

Cough: with or Cough: with or without mucus ,without mucus ,

Nasal discharge Nasal discharge

Headache , muscle Headache , muscle aches and stiffness aches and stiffness

Shortness of Shortness of breath breath

Stuffy, congested Stuffy, congested nose , nose - bleed nose , nose - bleed

Sore throat Sore throat

40

Flu (influenza) - SymptomsFlu (influenza) - Symptoms

Cough: mucus (sputum), Cough: mucus (sputum), blood streakedblood streaked

Shortness of breath Shortness of breath Frequent RTI(colds) Frequent RTI(colds)

Wheezing Wheezing Fatigue, Headaches Fatigue, Headaches Reddish mucous membranes Reddish mucous membranes

41

Bronchitis- SymptomsBronchitis- Symptoms

The presence of chronic The presence of chronic

productive cough for 3 productive cough for 3 months,months,

In each of 2 successive In each of 2 successive years.years.

In a patient in whom other In a patient in whom other causes of chronic cough causes of chronic cough have been excluded.have been excluded.

42

Chronic BronchitisChronic Bronchitis

Cough: mucus-like, Cough: mucus-like, greenish, or pus-like greenish, or pus-like sputum sputum

Fever: chills with shaking Fever: chills with shaking

Chest pain: sharp or Chest pain: sharp or stabbing, increased by stabbing, increased by deep breathing, increased deep breathing, increased by coughingby coughing

Headache Headache

General discomfort: General discomfort: uneasiness / ill feeling uneasiness / ill feeling (malaise) (malaise) 43

Pneumonia - SymptomsPneumonia - Symptoms

Chronic cough: Chronic cough: large amounts of large amounts of foul-smelling foul-smelling sputum production sputum production

Coughing up blood Coughing up blood Cough worsened by Cough worsened by

lying on one side lying on one side

Shortness of breath Shortness of breath worsened by worsened by exercise exercise

Wheezing Wheezing Weight loss ,Fatigue Weight loss ,Fatigue

44

Brochiectasis - SymptomsBrochiectasis - Symptoms

Sore throat: accompanied accompanied by fever, headache, by fever, headache, swollen lymph nodes in the swollen lymph nodes in the neck. neck.

Viral Pharyngitis: associated with runny nose associated with runny nose (rhinorrhea) and postnasal (rhinorrhea) and postnasal discharge discharge

Severe Pharyngitis: accompanied by difficulty accompanied by difficulty swallowing and difficulty swallowing and difficulty breathing.breathing.

45

Pharyngitis - SymptomsPharyngitis - Symptoms

Cough, Cough, Wheezing, shortness of breath, or Wheezing, shortness of breath, or

difficulty breathing, difficulty breathing,

Bluish skin due to lack of oxygen Bluish skin due to lack of oxygen (cyanosis),(cyanosis),

Rapid breathing (tachypnea),Rapid breathing (tachypnea),

Nasal flaring(swelling) in infants, Nasal flaring(swelling) in infants, Fever.Fever.

46

Bronchiolitis - SymptomsBronchiolitis - Symptoms

Normal LungNormal Lung BronchiolitisBronchiolitis

47

BronchiolitisBronchiolitis

48

What is cough?What is cough?

CoughCough is a protective protective 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

Coughing is under voluntaryvoluntary and involuntaryinvoluntary control and consists of 3 3 phases.

InspiratoryInspiratory : initiated by taking a deep breathe PhasePhase and results in maximal dilation of

the lungs.

CompressiveCompressive : closure of the glottis followed byphasephase 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

Act of CoughingAct of Coughing

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

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

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

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:

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

•LVF LVF (left (left ventricular failure)ventricular failure)

•TuberculosisTuberculosis

•Lung CancerLung Cancer

•Intestinal lung Intestinal lung diseasedisease 5656

3. Chronic Cough … cont.3. Chronic Cough … cont.

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

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

Troublesome type of cough,Troublesome type of cough,

Tends to aggravate because of rapid Tends to aggravate because of rapid flow of air, further irritating the flow of air, further irritating the trachea and pharyngeal mucosa. trachea and pharyngeal mucosa.

There is no sputum or secretions are There is no sputum or secretions are too thick and viscid.too thick and viscid.

59

4. Dry cough4. Dry cough

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 It is usually the result of an allergic response or RTI.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

Associated with Associated with bronchospasm, bronchospasm,

Common in asthma Common in asthma patients & chronic patients & chronic bronchitis. bronchitis.

It frequently wakes It frequently wakes up the patient up the patient during the night or during the night or the early hours of the early hours of the morning.the morning.

61

6. Bronchospastic (Asthmatic) 6. Bronchospastic (Asthmatic) CoughCough

62

Characteristics of Cough Originating at Various Levels of Respiratory Tract:

Origin Causes CharacteristicsPharynx Pharynx Post nasal dripPost nasal drip Usually Persistent.Usually Persistent.

LarynxLarynx Laryngitis, tumor, Laryngitis, tumor,

whooping cough, croupwhooping cough, croupHarsh, barking, painful, persistent, Harsh, barking, painful, persistent,

often associated with strider.often associated with strider.

TracheaTrachea TracheitisTracheitis PainfulPainful

BronchiBronchi Acute Bronchitis and Acute Bronchitis and

COPDCOPD

Asthma. Asthma.

Bronchial Carcinoma Bronchial 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.

Lung Lung

ParenchymaParenchymaTuberculosisTuberculosis

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

CoughRunning Nose,

Nasal & Chest CongestionBreathlessness

Sore Throat

Sinusitis, Common ColdInfluenza (Flu), Pharyngitis, Bronchitis

Pneumonia, BronchiolitisBronchiectasis

Most Common Symptoms in ….

64

Resp. Mucous Membrane:

Lined by respiratory epithelium

Ciliated columnar cells

Goblet cells

Cilia - propel foreign particles upwards

Respiratory Tract FluidsRespiratory Tract Fluids

65

Water 95% - secreted by Water 95% - secreted by bronchial glandsbronchial glands

Glycoproteins - thick Glycoproteins - thick mucopolysaccharides mucopolysaccharides secreted by Goblet cellssecreted by Goblet cells

FatsFats

Proteinaceous material is Proteinaceous material is called mucuscalled mucus

66

Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.

Together - Muco-ciliary blanket

It has two layers:It has two layers:

Sol layer :Sol layer : watery layer in which cilia bathe watery layer in which cilia bathe freelyfreely

Gel layer :Gel layer : above the sol layer contains above the sol layer contains mucus mucus

relatively thicker and stickier relatively thicker and stickier

67

Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.

The respiratory tract fluid and The respiratory tract fluid and muco-ciliary equilibrium:muco-ciliary equilibrium:

Resp. Fluid gradually propelled upwards Resp. Fluid gradually propelled upwards into the pharynx where it is swallowed into the pharynx where it is swallowed without awareness. without awareness.

68

Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.

Respiratory tract fluid - increases Respiratory tract fluid - increases

during infectionsduring infections

During RTIs or when lungs are exposed to During RTIs or when lungs are exposed to

foreign particles secretion increase in order foreign particles secretion increase in order

to:to:

Dilute irritants, if any,Dilute irritants, if any,

Drive away foreign bodies and unwanted Drive away foreign bodies and unwanted

particles, particles,

Trap micro-organisms.Trap micro-organisms. 69

Respiratory Tract FluidsRespiratory Tract Fluids

When respiratory tract is When respiratory tract is

contaminated by –contaminated by –

Oropharyngeal cells, bacteria, food Oropharyngeal cells, bacteria, food

particles and 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

72

Drugs Used In CoughDrugs Used In Cough

Centrally Acting:Centrally Acting:

Excessive Cough Bouts - Excessive Cough Bouts - Central Central

Antitussive Antitussive

Peripherally Action:Peripherally Action:

Increased Respiratory Tract Fluid - Increased Respiratory Tract Fluid - ExpectorantExpectorantBreakdown Thick Mucus - Breakdown Thick Mucus - MucolyticMucolyticDecreased Bronchoconstriction - Decreased Bronchoconstriction - BronchodilatorBronchodilatorDecreased Congestion - Decreased Congestion - DecongestantDecongestantDecreased Allergy - Decreased Allergy - AntihistamineAntihistamine

7373

Anti-Cough Drugs - Mechanism of Action Anti-Cough Drugs - Mechanism of Action

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

Mucokinesis is responsible for removal of Mucokinesis is responsible for removal of secretions from respiratory tract.secretions from respiratory tract.

If defectiveIf defective: : Mucus retention occurs resulting in …Mucus retention occurs resulting in … Impairment in the distribution of inspired Impairment in the distribution of inspired

air,air, Worsening of gas exchange at alveoli,Worsening of gas exchange at alveoli, Development of bronhcietasis and Development of bronhcietasis and

atelectasis,atelectasis, Reduction in the ability of the lung to Reduction in the ability of the lung to

resist infection.resist infection.

75

How Important is Mucokinesis?How Important is Mucokinesis?

Drugs which suppress cough centre situated Drugs which suppress cough centre situated

in the medulla.in the 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

In addition to cough suppressing action, they have properties like -

Powerful analgesia ,

Sedation, and

Psychic effects,.

Codeine, Codeine, HydrocodeinHydrocodein

e, e, EthylmorphinEthylmorphin

e, e, DihydrocodeiDihydrocodei

ne, ne, OxycodeineOxycodeine

77

Anti-tussives (Narcotics)Anti-tussives (Narcotics)

NOT the drugs of first choice because of addiction NOT the drugs of first choice because of addiction

properties.properties.

Nausea, vomiting, constipation, skin rashes, Nausea, vomiting, constipation, skin rashes, drowsiness, addiction, confusion, headache, drowsiness, addiction, confusion, headache, palpitation, convulsions, sweating, vertigo, palpitation, convulsions, sweating, vertigo, shock shock

RarelyRarely : Respiratory failure and coma, : Respiratory failure and coma, leading to deathleading to death

Reduce ciliary motility of respiratory tract.Reduce ciliary motility of respiratory tract.

Interact with Interact with alcohol, antipsychotics, anti-alcohol, antipsychotics, anti-depressants, anti-histaminics and anti-depressants, anti-histaminics and anti-cholinergics.cholinergics.

Contra-indicatedContra-indicated in respiratory, liver, in respiratory, liver, cerebral diseases and endocrine disorders.cerebral diseases and endocrine disorders.

7878

Anti-tussives (Narcotics) – Side Anti-tussives (Narcotics) – Side EffectsEffects

These are a group of These are a group of centrally actingcentrally acting anti-anti-

tussives tussives withoutwithout the the narcoticnarcotic properties properties

which include –which include –

Noscapine and Noscapine and

Dextromethorphan .Dextromethorphan .

79

Non- Narcotic Anti- TussiveNon- Narcotic Anti- Tussive

80

Class Drug Name Action

AntihistaminesAntihistamines Cetirizine, Levocetrizine, Diphenhydramine, Cetirizine, Levocetrizine, Diphenhydramine,

Chlorpheniramine maleate (CPM)Chlorpheniramine maleate (CPM)Block effects of histamine in Block effects of histamine in

allergic cough.allergic cough.

Anti-tussive Anti-tussive

(Cough (Cough

suppressants)suppressants)

Codeine, Pholcodeine, Codeine, Pholcodeine,

Noscapine, DextromethorphanNoscapine, DextromethorphanTo 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 respiratory To 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 and Directly- 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 respiratory to liquefy the respiratory

secretions for easy secretions for easy

expectoration.expectoration.

DecongestantDecongestant Ephedrine, Ephedrine, phenylephrinephenylephrine, and topical drugs like , and topical drugs like

oxymetazoline, xylometazoline are widely used as oxymetazoline, xylometazoline are widely used as

decongestants. Phenylephrine HCL a synthetic decongestants. Phenylephrine HCL a synthetic

sympathomimetic agent, sympathomimetic agent,

Sympathomimetic agents are a Sympathomimetic agents are a

vasoconstrictor and pressor vasoconstrictor and pressor

drug chemically related to drug chemically related to

epinephrine and ephedrine.epinephrine and ephedrine.

Drug Therapy of CoughDrug Therapy of Cough

Blocks H1 histamine receptor and thus Blocks H1 histamine receptor and thus inhibits the actions of histamine.inhibits the actions of histamine.

Prevents allergic manifestations of Prevents allergic manifestations of

cough.cough.

Well absorbed from GIT and penetrates Well absorbed from GIT and penetrates

the CNS.the CNS.

Side EffectsSide Effects: drowsiness, nausea and : drowsiness, nausea and

vomiting.vomiting.81

AntihistaminesAntihistamines

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

DecongestantsDecongestants

84

Anti-pyretic - AnalgesicsAnti-pyretic - Analgesics

Menthol:Menthol:

Soothening action, produces cooling Soothening action, produces cooling

sensation and has a mild anesthetic sensation and has a mild anesthetic actionaction

Side effects are mild hypersensitivity Side effects are mild hypersensitivity reactionsreactions

85

Soothing AgentsSoothing Agents

86

Composition: Each 5 ml containsComposition: Each 5 ml contains

  

Phenylephrine Phenylephrine 55 mgmg

Paracetamol Paracetamol 250250 mgmg

Chlorpheniramine Chlorpheniramine Maleate (CPM) Maleate (CPM) 11

mgmg

Menthol Menthol 1.25 1.25 mgmg

87

Synthetic sympathomimetic agent,

Stimulate receptors, Very minimal effect on -receptor,

Vasoconstrictor, Vaso-presser drug.

88

1.1. Phenylephrine (Decongestant)Phenylephrine (Decongestant)

89

1.1. Phenylephrine … cont.Phenylephrine … cont.

Powerful Vasoconstrictor

Cardiac Safety

Blood Vessels: Cutaneous, limb, kidney, spleen

Coronary blood flow increased

Pulmonary Blood vessels constrictedIn nasal mucosa:

Very minimal effects on -receptors of heart

Stimulate -receptors in the Blood vessels, which constricts & stop secretions.

Complete lack of action on heart

Very potent decongestant, Very potent decongestant, Constricts (shrinks) blood vessels (veins and Constricts (shrinks) blood vessels (veins and

arteries), arteries), Constriction leads to drainage of supplied areas, Constriction leads to drainage of supplied areas, Decreases congestion & swelling of mucus Decreases congestion & swelling of mucus

membrane,membrane, Site of action: Nose & Sinuses.Site of action: Nose & Sinuses.

Phenylephrine in RTI : Phenylephrine in RTI :

•Opens airwaysOpens airways•Decreases amount of fluid Decreases amount of fluid in RTin RT•Make easier to breath Make easier to breath

90

Phenylephrine- Place in TherapyPhenylephrine- Place in Therapy

Adults & adolescents > 12 yr.:Adults & adolescents > 12 yr.: 10-20 mg 4 10-20 mg 4 hrlyhrly

Children 6 to 12 yr. : Children 6 to 12 yr. : 10 mg 4 10 mg 4 hrlyhrly

Children < 6 yr. : Children < 6 yr. : 5 mg 4 hrly5 mg 4 hrly

91

Phenylephrine- Dosage & Phenylephrine- Dosage & Administration Administration

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

92

Histamine in Nature Present in: Plants Venom and stings Synthesized by bacteria and certain

fungi

3. Chlorpheniramine Maleate 3. Chlorpheniramine Maleate (CPM)(CPM)

Human Tissue:1. Cells: Mast cells, Basophils, Neurons, Cells in the stomach.

2. Tissues: Skin, Lung, Gastrointestinal tract.

93

CPM: Synthesis and Metabolism

Histidine HistamineL-histidine

carboxylase

Methylhistamine

N – methylimidazole acetic acid

histamine methyl transferase

94

H-1: H-1: GI & bronchial SM GI & bronchial SM contraction.contraction.

H-2: H-2: Cardiac stimulation, Gastric Cardiac stimulation, Gastric secretion.secretion.

H-1 & H-2: H-1 & H-2: Dilation of arterioles and Dilation of arterioles and veins.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

Action Histamine Receptor

Bronchial Bronchial contractioncontraction

H-1H-1

GI contractionGI contraction H-1H-1

HeartHeart H-2, H-1 (AV node)H-2, H-1 (AV node)

large artery large artery contractioncontraction

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 Gastric acid secretionsecretion

H-2H-2

CNS arousalCNS arousal H-1H-1

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

H-1 blockers 1st generation or classical (older) 2nd generation or non-sedating

(newer)

H-2 blockers gastric acid blockers

98

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

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

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

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

Soothing action, produces cooling Soothing action, produces cooling sensation and has a mild anesthetic sensation and has a mild anesthetic action.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

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

ZEDEX - IndicationsZEDEX - Indications

105

ZEDEX - Dosage and AdministrationZEDEX - Dosage and Administration

106

DiagnosisDiagnosis

URTIFlu (Influenza) Rhinitis Common cold0

SinusitisPharyngitisCoryzaSore throat

BronchitisPneumoniaBronchitis

BronchiolitisBronchiectasisBronchopneumonia

LRTI

ZEDEX Rational

107

Cough with sputum

Most Most Common Common

SymptomsSymptoms

Chronic coughin

gShortness of

breath

Difficult to cough out sputum

Sore throat

Nose & Throat congestion

Nasal Dischar

ge

Red & swollen mucus

membrane

108

Sinuses & Throat Pain (Paracetamol)

Most Effective

Treatment

Fever(Paracetamol)

Difficult to cough out sputum

(Decongestant)Sore

throat (Menthol

)

Nose & Throat congestion

(Antihistamine +

DecongestantNasal Discharge

(Antihistamine +

Decongestant)

Red & swollen mucus membrane

(Antihistamine +

Decongestant)109

Cough Formula

Antihistamine (CPM)

Decongestant (Phenylephrin

e)

Anti-pyretic + Analgesic

(Paracetamol)

Soothing AgentSoothing Agent(Menthol)(Menthol)

110

ZEDEX - Product DescriptionZEDEX - Product Description

PackagingPackagingBottle

Shipper pack

Stockiest Price

Retailer Price

112

Product Positioning :Product Positioning :

Product Differential :Product Differential :

ZEDEX - Marketing AspectsZEDEX - Marketing Aspects

113

ZEDEX – Target Doctors and IndicationsZEDEX – Target Doctors and Indications

115

ZEDEX – Communication StrategyZEDEX – Communication Strategy

116

ZEDEX – Input PlansZEDEX – Input Plans

117

119

Cold Cough Syrup – Brand TrendsCold Cough Syrup – Brand Trends

120

Thank YouThank You

121