it is about drugs used for respiratory problems, except tuberculosis

1. RESPIRATORY SYSTEM

2. INTERESTING FACTS ABOUT RESPIRATORY
SYSTEM

3. The surface area of the lungs is roughly the same
size as a tennis court.

4. The capillaries in the lungs would extend 1,600
kilometres if placed end to end.

5. A person at rest usually breathes between 12 and
15 times a minute.

6. The breathing rate is faster in children and
women than in men.

8. PULMONARY
PHARMACOLOGY
Dr. V.SATHYANARAYANAN M.D
PROFESSOR OF PHARMACOLOGY

9. PULMONARY
PHARMACOLOGY
 Effects of drugs on the airways and the
therapy of airway obstruction.
 Pharmacotherapy of Asthma , COPD ( most
common chronic diseases )
 Pharmacotherapy of cough ( most common
Respiratory symptom )
 O2, respiratory stimulants
 Pulmonary hypertension

10. DRUGS FOR BRONCHIAL
ASTHMA

12. BRONCHIAL ASTHMA
 Hyper responsiveness of tracheo-bronchial
smooth muscle
 resulting in narrowing of bronchial tree
 Wheezing attacks
 polygenic
 Primarily inflammatory condition

19. Mediators in Asthma
 Mediators released are > 100 in number
 histamine, TNFa - immediate
 Prostaglandins, leukotrienes, PAF –
within min
 Interleukins, TNFa – /over hrs

22. Symptoms of Asthma
• Wheezing
• Cough, especially at night
• Chest tightness
• Shortness of breath
• Characteristically occur or worsen at night,
with exercise, with viral infections, or with
exposure to dust, animals, or smoke

27. TYPES
 EXTRINSIC ASTHMA – Commonest,
episodic, allergens involved. Atopic ,
immediate (type I) hypersensitivity reaction is
invlved
 INTRINSIC ASTHMA – without allergens,
Perennial
 EXERCISE INDUCED ASTHMA – asthma
following exercise, cold air, airway drying
 ASTHMA ASSOCIATED WITH COPD

30. APPROACHES TO
TREATMENT
 PREVENTION OF EXPOSURE TO
ALLERGEN(S)
Avoid Grasses, Pollens, Animals
HISTORY
RAST test
Intradermal skin prick test
 NEUTRALISATION OF IgE - omalizumab

32. APPROACHES TO
TREATMENT
 REDUCTION OF BRONCHIAL
INFLAMMATION & HYPERREACTIVITY
 Glucocorticoids
 Sodium cromoglicate
 Nedocromil sodium
 Ketotifen
 PAF antagonists

34. APPROACHES TO
TREATMENT
 DILATATION OF NARROWED BRONCHI
 Physiological antagonism of bronchial muscle
contraction
 BETA2 receptor agonists
 Methyl xanthines
 Antimuscarinic bronchodilators
 Leukotriene receptor antagonists

36. BETA2 AGONISTS
 Salbutamol (Albuterol )
 Terbutaline
 Bambuterol
 Salmeterol
 Formeterol

37. SALBUTAMOL
 Beta2 stimulation  inc.cyclic AMP
relaxation, prevent bronchoconstriction,
decreases mediator release
 Fastest acting , within 5 min, lasts for 2-4 hrs
 Relieves symptoms
 Used to abort acute attacks of asthma
 ADR – tremors, palpitation, restlessness, ankle
edema, hypokalemia, hypoxemia
 Orally in severe asthma
 Regular use – down regulation of receptors

43. TERBUTALINE
 Similar to salbutamol
 Used only for symptomatic relief

44. BAMBUTEROL
 Prodrug
 Hydrolysed by pseudocholinesterase into
active drug
 Release over 24 hrs
 Indicated in chronic bronchial asthma
 Single evening dose 10 -20 mg

46. SALMETEROL
 Long acting beta2 agonist
 Slow onset of action
 Used by inhalation
 Twice a day schedule
 For maintenance therapy and nocturnal
asthma

47. FORMOTEROL
 Long acting beta2 agonist
 Acts for 12 hrs when inhaled
 Faster than salmeterol.
 Used as a Regular twice a day schedule for
round the clock bronchodilatation.

48. FUTURE DEVELOPEMENTS
 Beta2 agonists continue to be 1st choice –
effective in all, few or no side effects in low
doses
 LABA – very useful control of asthma, COPD
 LABA only for patients receiving ICS
 Once daily drugs – indacaterol, carmoterol –
under trials

49. OTHER BETA AGONISTS
 Adrenaline, ephedrine, isoprenaline
 Less safe – cause cardiac arrhythmias

51. THEOPHYLLINE
 Methyl Xanthine
 Inhibit phosphodiesterase, release Ca, block
adenosine receptors, increases IL -10 release
 CNS stimulant, increases HR, Diuretic,
increases acid secretion, dilate bronchi
 Also used in COPD (as effective on smaller
airways and has anti-inflammatory action)
 Use has declined because of safety

55. THEOPHYLLINE - ADR
 Insomnia, nervousness, flushing
 Tremors
 At high therapeutic doses  nausea, diarrhea
 IN OVERDOSE –
 Vomiting, Palpitation, Arrhythmias,
hypotension, hypokalemia, seizures
 Tt – potassium replacement , diazepam

63. THEOPHYLLINE – DRUG
INTERACTIONS
 Microsomal enzyme inhibitors ( ciprofloxacin,
erythromycin ) increases toxicity
 Enzyme inducers decrease levels
 Theophylline enhances the effects of
furosemide, sympathomimetics,
hypoglycemics
 PK – elimination changes 1st order to 0 order
 Has low therapeutic index – need monitoring

65. USES
 Inexpensive  cost friendly  wider use in
India
 Low efficacy
 Frequent side effects
 Use sustained release preparations, S.R OD
drugs
 Minority of patients still benefited
 Bronchial asthma – severe, nocturnal asthma,
steroid sparing action
 COPD  more severe cases
 Apnoea in premature infant

66. I.V. AMINOPHYLLINE
 ACUTE SEVERE ASTHMA – 6mg/kg
 COPD--Less effective, high incidence of ADR

67. FUTURE DEVELOPMENTS
 Usage declining
 Oral theophylline  difficult asthma
 Plasma levels of 5-15 mg/L are recommended
 Low dose T + ICS combination
 Reverses corticosteroid resistance in COPD
 Low dose T  Anti inflammatory effect 
Prevents progression COPD

69. ANTIMUSCARINIC
BRONCHODILATORS
 Ipratropium bromide, oxitropium, tiotropium
( effects last for up to 24 hrs )
 Block M3 receptors
 Inhaled  less systemic effects
 Slower response
 Better suited for regular prophylactic use
 Less effective than salbutamol
 Useful in COPD, refractory asthma, acute
severe asthma

72. CLINICAL USES
 In asthma Not controlled by LABA
 Elderly with fixed narrowing
 COPD- bronchodilators of choice, as effective
as BA or even superior
 Less systemic side effects, bitter taste,
glaucoma (nebulised form)
 Ipratropium bromide –MDI
 Combivent – in COPD
 Tiotropium – long acting  od dose as a DPI

73. NOVEL BRONCHODILATORS
 Magnesium sulfate  acute severe asthma
 K+ channel openers – (cromakalim)- CVS side
effects
 Atrial Natriuretic Peptides – different
mechanism –useful in acute severe asthma
not responding
 Vasoactive Intestinal Poly Peptide analogs 
vasodilator side effects
More studies are needed before
routine use

75. CORTICOSTEROIDS
 Suppress inflammatory response
 Mainstay ( 1st line therapy ) of asthma
treatment
 Slowly and Gradually reduce bronchial hyper
reactivity
 Do not dilate bronchi
 Afford complete & sustained relief
 Decrease disease progression
 Inhaled steroids – only few ADR
 Long term systemic therapy – more ADR

76. CORTICOSTEROIDS
 Prednisolone – given orally 30-40mg/day single
dose in the morning
INHALED STEROIDS
 Beclomethasone dipropionate – given BD
 Budesonide -Better than beclomethasone
 Fluticasone propionate – less systemic effects,
BD
 Ciclesonide – 80-160 micg OD, novel approach
drug with oral BA<1%, extensively bound to
plasma proteins

77. Effects of Inhaled
Corticosteroids on
Inflammation
Laitinen et al. J Allergy Clin Immunol 1992;90:32-
42
Compromis
ed
Epithelium
TThhiicckkeenneedd BBMM
IInnffllaammmmaattoorryy CCeellllss Intact
Epithelium
¯
Inflammatory
Cells

79. INHALED STEROIDS
 High topical activity
 Indicated if beta2 agonist required daily
 ADR – hoarseness of voice, dysphonia,
oropharyngeal candidiasis, sore throat
 Safe during pregnancy
 > 600 micrograms/day  systemic effects
 C/I - Infection

84. COMBINATION INHALERS
 A LABA + CORTICOSTEROID –
(salmeterol /fluticasone, formoterol/budesonide
 Has complementary synergistic actions
 More convenient
 Allows beneficial molecular interaction

85. FUTURE DEVELOPMENTS
 Early treatment with ICS in adults and children
may improve lung function greatly
 For persistent asthma and chronic symptoms
 Soft steroids ( butixocort ) proved
disappointing
 Dissociated steroids ( selective ) difficult
 Corticosteroid resistance – major barrier

87. MAST CELL STABILIZERS
 Sodium cromoglycate, nedocromil
 Alternative to inhaled steroids
 Inhibit degranulation of mast cells – prevent
release of mediators, inhibit other inflammatory
cells, local axon reflexes
 Given by inhalation
 Prevent bronchospasm induced by allergens,
irritants, cold air, exercise
 Other Uses – allergic rhinitis, conjunctivitis
 ADR- mild, like cough, throat irritation
 Usage has declined

95. KETOTIFEN
 H1Antihistamine
 Like cromoglycate
 Orally given
 ADR – Sedation, dry mouth, weight gain
 1-2 mg BD
 Also used in other allergic disorders

100. LEUKOTRIENE RECEPTOR
ANTAGONISTS  Montelucast (OD) , zafirlucast (BD)
 Prevents the bronchoconstrictor effects of LTC4,
D4, E4
 overall efficacy lower than inhaled steroids
 Used in prophylaxis alternate to steroids
 Reduces the dose of steroids
 More acceptable in children
 Effective in aspirin induced asthma
 No role in COPD
 Very safe, few side effects- headache, rash
 rarely cause churg- strauss syndrome
 2nd – 3rd line role

101. Cysteinyl-
LT receptor
antagonists
-
zafirlukast
-
montelukast
5-LO
inhibitors
- zileuton

106. ZILUTON
 5 Lipoxygenase inhibitor
 Prevent all LT induced responses
 Efficacy similar to LT antagonists
 Limitations – short duration, hepatotoxicity

108. FUTURE DEVELOPMENTS
 Tablet form  increased compliance
 Od dose
 Children
 Less use in future
 Role in some patients

109. IMMUNOMODULATORY
THERAPIES
 Immunosuppression – less effective, more
side effects
 ANTI – IgE therapy

110. OMALIZUMAB
 A monoclonal antibody against IgE
 Binds to IgE  form a complex make IgE not
bind to IgE receptors on mast cells and basophils
 inhibition of allergic response
 Given S.C once in 2-4 weeks
 Reduces requirement of steroids
 ADR – Well tolerated, pain at the site of inj., allergy
 Caution – a very small% developed cancers
 Uses – resistant asthma with raised IgE levels who
require frequent hospitalisation
 EXPENSIVE

112. STATUS ASTHMATICUS
 Also known as refractory asthma , acute
severe asthma
 May be life threatening
 A medical emergency
 URI is mostly the precipitant
 Other triggers – drugs, stress, allergens,
abrupt withdrawal of steroids after prolonged
use

114. STATUS ASTHMATICUS
 Nebulized salbutamol (2.5-5 mg ) over 3 min, rpt in
15 min + ipratropium (0.5 mg ) intermittent inhalation
 Intermittent high flow humidified Oxygen inhalation by
mask
 Hydrocortisone hemisuccinate 100 mg i.v stat
followed by 100 – 200 mg 4-8 hourly infusion
 Salbutamol/Terbutaline 0.4 mg i.m/s.c may be added
 Antibiotics
 i.v fluids + sodium bicarbonate infusion
 Intubation and mechanical ventilation, if needed
 Aminophylline i.v use is restricted to resistant cases
 NO SEDATION

120. DRUG TREATMENT OF
ASTHMA
 Varies with the severity and the type
 Monitored by measuring PEFR, FEV1
 Severe attacks  measure ABG

121. SEASONAL ASTHMA
 inhaled cromoglycate or low dose
inhal.steroids
 Regularly 3-4 weeks before, continue till 3-4
weeks after season is over
 Individual episodes – short acting inhal. Beta2
agonist

124. CHOICE OF TREATMENT – MILD
EPISODIC ASTHMA
 Symptoms < once daily, normal between
attacks
 Inhaled beta2 agonist at onset of episode –
(Step1)
 Regular Prophylaxis not required

125. MILD CHRONIC ASTHMA
WITH OCCASIONAL
EXACERBATIONS
 Symptoms once daily
 Regular Low dose inhal. Steroids or
cromoglicate – (step2)
 Episode treatment with short acting inhal.
Beta2 agonist

127. MODERATE ASTHMA with
frequent exacerbations
 Attacks affect activity
 Occur > 1/day
 Increasing doses of Inhal. Steroids upto 800
micrograms/day + inhal. Long acting beta2
agonist – (Step3)
 Or LT antagonist for steroids
 Theophylline may be used as an alternative

128. SEVERE ASTHMA
 Continuous symptoms, activity limitation, frequent
attacks requiring hospitalisation
 Regular high dose inhaled steroids ( 800 – 2000
micrograms/ day ) with spacer + Inhaled salmeterol
BD
 Additional tt with one or more of a Leukotriene
antagonist/ Oral theophylline S.R/ oral beta2
agonist/ inhaled ipratropium –( Step4)
 Not controlled or needing frequent hospitalisation
 oral steroids – (Step5 )(periodically withdraw )

133. Asthma Treatment
Summary
Mild Intermittent
Use: Albuterol, Asthma Action Plan
Mild Persistent
Use: Albuterol and Controller medications (low dose
steroids, nedocromil, cromolyn, montelukast)
Moderate Persistent
Use: Combination of medications (low to medium dose
steroid plus long acting beta agonist, and/or Leukotriene
modifiers)
Severe Persistent
Use: High dose inhaled steroids, long acting beta
agonist, and leukotriene modifier. May need oral
steroids

135. WARNINGS
 BETA BLOCKERS even topical or selective
may precipitate asthma
 Can be fatal  so contraindicated
 Overuse of beta2 agonists  can cause
asthma related deaths

138. COPD
 INCOMPLETELY reversible airway obstruction
and mucus hypersecretion
 Disease of smaller airways
 Same drugs used
 Antimuscarinics are more effective
 Moderate to severe disease – use inhaled
steroids + long-acting beta2 agonists
 Thophylline for severe cases ( careful in elderly
)
 Mucolytics for recurrent, prolonged, severe
cases

141. INFECTION in COPD
 No prophylaxis
 If URI comes  Amoxicillin or Co-amoxiclav or
cotrimoxazole
 Influenza vaccine in winter
 Bronchospasm  Ipratropium
 Hypoxia  24% O2, increasing slowly
 Dehydration  fluids
 Cardiac failure  O2, diuretics
 Respiratory stimulants  doxapram 1- 4
mg/mind IV

142. ROUTES OF DRUG DELIVERY

143. INHALED ROUTE
 Preferred mode of delivery
 Has direct effect on airways
 Lower risk of systemic side effects
( particularly with steroids )
 Rapid onset of action ( bronchodilators)

144. DELIVERY DEVICES
 PRESSURIZED METERED-DOSE INHALERS
(pMDI)-
 Convenient, portable, delivers 100-400 doses,
patients should be taught how to use
 SPACE CHAMBERS – reduces local,
systemic side effects, useful in children
 DRY POWDER INHALERS –( insulin
delivery), co-ordination not necessary
 NEBULIZERS –JET, ULTRASONIC- Delivers
higher doses of drugs, useful in extreme
obstruction, in children

152. PHARMACOTHERAPY
OF COUGH

153. the velocity of cough!
 It’s at 60 miles per hour

154. When a human coughs, the droplets that comes out can
travel a distance of up to three feet.

156. COUGH
 It is a protective reflex
causing expulsion of
respiratory secretions
or foreign particles
from air passages.

157. COUGH
Useful cough should
be allowed
Useless cough
should be stopped

161. TREATMENT APPROACH
REMOVAL OF THE CAUSE -
tt of asthma, postnasal drip
 Expectorants
 Antitussives

164. NON SPECIFIC THERAPY
 Pharyngeal demulcents: Lozenges, cough
drops, syrup containing glycerin, liquorice
 sooth the throat
 Promote salivation
 Decrease afferent impulses
 provide symptomatic relief in dry cough arising
from throat.

168. EXPECTORANTS
(MUCOKINETICS)
 increase bronchial secretion
 reduce it’s viscosity
 Loosen cough
 Bring sputum out

171. GUIACOL
 Derivative  Guaiphenesin
 increase bronchial secretion and mucosal ciliary
action.

172. MUCOLYTICS
BROMHEXINE
 obtained from adhatoda vasica.
 Potent mucolytic
 Mucokinetic
 Induce thin copious bronchial secretion
 It depolymerises mucopolysaccharides and
liberate lysosomal enzymes  thereby breaks
fibres in thick sputum.
 Useful when mucus plugs are present.

175. BROMHEXINE
 Side effects- Rhinorrhoea, lacrymation,
gastric irritation
 patients with bronchiectasis  sputum thick
 difficulty in clearing  bromhexine helpful

178. AMBROXOL
 Metabolite of bromhexine
 similar

180. ACETYLCYSTEINE
 Opens disulfide bonds in mucoproteins
present in sputum  makes it less viscid
 not popular
 administered directly into respiratory tract
 more side effects

181. CARBOCISTEINE
 action like acetyl cysteine
 orally or inhalation
 useful when viscous secretion is a problem
( cystic fibrosis, tracheostamies )
 Side effects - GI irritation, rashes
 available in combination with amoxicillin for
bronchitis, sinusitis, bronchiectasis (carbomox)

185. Water inhalation
 Via an aerosol (breathing over a hot basin)
 Cheap and effective in bronchiectasis
 promote secretion of dilute mucus  Gives
protective coating to the inflamed mucous
membrane.
 Menthol and eucalyptus - gives therapeutic
smell
 Simple hydration of a dehydrated patient have a
beneficial effect

189. OTHER EXPECTORANTS
 Sodium and potassium citrate
Potassium iodide
 Iodine hypersensitivity  dangerous
 interferes with thyroid function tests.
 Iodism
 Goiter
 less popular
 Ammonium salts cause nausea

194. ANTITUSSIVES
 Raise the threshold of cough centre in CNS
 Or decrease cough impulses peripherally
 Used only for dry unproductive cough
 If cough is tiring
 or disturbs sleep
 or hazardous (hernia, piles, cardiac disease,
ocular surgery)

198. OPIOIDS- CODEINE
 Opium alkaloid
 More selective for cough centre
 Standard antitussive
 Suppress Cough for 6 hrs
 Low addictive liability
 Analgesic for moderate pain
 Side effects: Constipation, drowsiness.
 higher doses  respiratory depression
 C/I: Bronchial asthma, in diminished respiratory
reserve
 Preparation: Syrup codeine phos 4-8ml linctus

204. PHOLCODEINE
 Not an analgesic
 no sedation
 no addiction
 efficacy similar to codeine
 longer acting (12hrs or more )
 Morphine  high abuse liability
 Methadone or diamorphine linctus preferred in
advanced bronchial carcinoma

208. NON OPIOIDS - NOSCAPINE
 No analgesic and dependence inducing
properties.
 Equipotent as codeine.
 Specially useful in spasmodic cough.
 Side effects: release histamine  broncho
constriction.

210. DEXTROMETHORPHAN
 Synthetic compound
 increase threshold of cough centre
 effective as codeine
 Does not depress mucociliary function of
airways.
 No constipation.
 No addiction.
 S/E: drowsiness, ataxia.

214. ANTIHISTAMINES
 conventionally added to antitussive/ expectorant
formulation.
 Lack selectivity for cough centre.
 No expectorant action
 for cough in respiratory allergic states.
 Chlorpheniramine, Diphenhydramine
Promethazine
 IInd generation ineffective.

217. CETIRIZINE
 Penetrate brain poorly
 Not metabolized
 Also inhibits release of histamine – extrabenefit
in allergic disorders
 Higher and longer lasting concentration in skin
 Once daily dose
 Does not produce arrhythmias
 Levocetirizine effective at half the dose

221. AZELASTINE
 has good topical activity
 inhibits histamine release and inflammatory
reaction triggered by LTs, PAF
 bronchodilator
 Downregulate ICAM – 1 expression
 Long acting
 Given by nasal spray for allergic rhinitis
 Side effects – stinging , altered taste

225. BRONCHODILATORS
 Should be used only  when
bronchoconstriction is present.
 combinations with antitussive  not
satisfactory.

228. AEROMATIC CHEST RUB
 Widely advertised
 No evidence of benefit in pathological cough.
 Reduce experimentally induced cough

229. LOCAL ANAESTHETICS
 benzonatate
 Nebulized lignocaine  reduce coughing
during fiberoptic bronchoscopy
 Intractable cough in bronchial carcinoma.

232. SPECIFIC TREATMENT
APPROACHES TO COUGH
Etiology of cough
 Upper/ lower respiratory tract
infection
 Smoking/ chronic bronchitis
 Pulmonary tuberculosis
 Asthmatic cough
 Postnasal drip due to sinusitis
 Postnasal drip due to allergic/
perennial rhinitis
 Gastro esophageal reflux
 ACE inhibitor associated cough
Treatment approach
 Appropriate antibiotics
 Cessation of smoking/ avoidance of
pollutants
 Antitubercular drugs
 Inhaled Beta2 agonists/ipratropium/
corticosteroids
 Antibiotic, nasal decongestant,
H1 antihistaminic
 Avoidance of precipitating factor (s),
corticosteroid nasal spray
 Bed head elevation, light dinner, diet
modification, H2 blocker, omeprazole,
Metoclopramide
 Substitute ACE inhibitor by losartan

235. RESPIRATORY STIMULANTS
( DOXAPRAM, AMINOPHYLLNE )
 Doxapram – increases rate and depth of
respiration
 Almitrine
 Useful In acute exacerbations of chronic lung
disease with hypercapnia
 In conjunction with assisted ventilation
 Overdose with sedatives, post-anaesthetic
respiratory depression
 apnoea in premature infants( aminophylline,
caffeine)

236. CONTRAINDICATIONS
 Epilepsy
 IHD
 Hypertension
 Thyrotoxicosis
 Status asthmaticus

237. PULMONARY SURFACTANT
 RDS  failure to produce natural surfactant
 Colfosceril palmitate, poractant alpha,
beractant
 Given by intratracheal instillation
 Useful in neonates with RDS

238. OXYGEN THERAPY
INDICATIONS
 Inadequate oxygenation due to MI ,
Pulmonary Disorders , drug overdose ,
trauma, in acutely ill patient
 High conc. of O2  TYPE I respiratory failure
( low PaO2 with normal or low PaCO2)
 Low conc. Of O2  TYPE II respiratory failure
(low PaO2 with raised PaCO2)( patients with
COPD )

239. OXYGEN THERAPY
 Continuous long-term domiciliary O2 therapy –
(LTOT)
 For patients with severe hypoxaemias
 Cor pulmonale
 Improve survival

240. REC0MMENDED CRITERIA
 PAO2 less than 7.3 kPa
 PACO2 more than 6.0 kPa
 FEV1 less than 1.5L
 FVC less than 2.0 L

241. COMPLICATIONS OXYGEN
THERAPY
 Promote absorption atelectasis
 Depress ventilation
 Irritation of mucosal surfaces
 Fire hazard

242. PNUMONIAS
 Community-acquired
 Hospital- acquired – I.V BSA ( eg cefuroxime )
 ANTIBIOTICS – depending on the organism 
Amoxicillin, azithromycin , doxycycline,
flucloxacillin , cephalexin, gentamicin +
cephalosporin
 ROUTES  oral , parenteral ( SEVERE )
 DURATION  7-10 days usually , 2-3 weeks in
some
 OXYGEN – in severe hypoxia
 FLUIDS – if dehydration

243. DRUGS FOR PULMONARY
ARTERIAL HYPERTENSION
 Mostly secondary
 O2 to correct hypoxia
 Diuretics initially for right heart failure
 Continuous I.V infusion of Prostacyclin (PG
I2; epoprostenol )
 Endothelin receptor antagonists – Bosentan,
ambrisentan – (requires LFTs monitoring )
 Phosphodiesterase 5 inhibitors – sildenafil ( 20
mg tid orally), tadalafil ( od )

244. SUMMARY
 Most antiasthma treatment is with glucocorticoids
and beta2 agonists
 Aggressive use of glucocorticoids, especially by
inhaled route is the keystone of stepped approach
 Smoking cessation and long-term treatment with
oxygen are the only measures known to improve
survival in COPD
 Antihistamines have a wide role in allergic
disorders
 2nd generation antihistamines do not cause
sedation unlike 1st generation

246. SUMMARY
 If cough is irritating and unproductive -
suppress it
 productive and difficulty in expectoration –
use expectorants
 Treat the underlying condition
 Use codeine, pholcodine when dry cough is
disturbing sleep.

247. SUMMARY
 Morphine, diamorphine  useful in patients
with terminal illness.
 Steam inhalation with or without menthol is
soothing and harmless to aid expectoration.
 Mucolytic expectorants are no better than
steam inhalations.
 Other expectorants are toxic and of no value.

249. THANK U…