ANTI INFLAMMATORY AGENTS USED IN ASTHMA AND COUGH

ANTI INFLAMMATORY AGENTS USED IN ASTHMA AND COUGH SUPPRESANTS: 

ANTI INFLAMMATORY AGENTS USED IN ASTHMA AND COUGH SUPPRESANTS PRESENTED BY RAVINDER NAIK . D NIPERA1113PC01

FLOW OF SEMINAR : 

FLOW OF SEMINAR Introduction -Asthma and causes -Classification - Pathophysiology -Diagnosis Treatment Inflammatory agents in asthma -Non steroidal -Steroidal Cough suppressants

Introduction : 

Introduction Asthma is an inflammatory disorder that causes the airways of the lungs to swell and narrow, leading to wheezing, shortness of breath, chest tightness, and coughing. According WHO statistics Some 235 million people currently suffer from asthma worldwide . It is the most common chronic disease among children. More prone in developing and under developed countries

Causes : 

Causes Animals (pet hair or dander) Dust Changes in weather (most often cold weather) Chemicals in the air or in food Exercise Mold Pollen Respiratory infections, such as the common cold Strong emotions (stress) Tobacco smoke

Symptoms : 

Symptoms Cough Shortness of breath Rapid pulse Chest pain Anxiety

Types Of Asthma: 

Types Of Asthma Intermittent : Asymptomatic (symptoms occur < 1 time a week) Mild persistent : symptoms occur < 1 time a day, Attacks may affect activity Moderate persistent : symptoms occur Daily, Attacks affect activity Sever persistent : symptoms are Continuous, Limited physical activity

Pathophysiology : 

Pathophysiology

Diagnosis : 

Diagnosis Peak flow Spyrometry Complete pulmonary function testing Chest X-ray Allergy testing

Drugs Used In Asthma : 

Drugs Used In Asthma Bronchodilators : a. Xanthines : Aminophylline , Deriphylline b. Beta- adrenergics : Salbutamol , Salmeterol , Terbutaline , Bambuterol , Formoterol . Anticholinergics : Ipratropium,Tiotropium

Anti Inflammatory Agents: 

Anti Inflammatory Agents Corticosteroide : a. Inhaled : Beclamethasone , Budesonide , Fluticasone,Cyclesonide b. Oral : Prednisoline , Betamethasone , Dexamethasone Mast Cell Stabalizers : Ketotifen , Sod.cromoglycate Leukotreine antagonists : Montelenkast , zefirlukast Anti IgE antibody : Omalizumab

Corticosteroids : 

Corticosteroids MOA : negative regulation of COX-2 and of genes for cytokines in macrophages, endothelial cells & lymphocytes hence reduces the release of PG, IL-1, IL-2, IL-3, IL-6,TNF α , γ - Interferons which causes inflammation ADR :

PowerPoint Presentation: 

Beclamethasone : available as intra nasal spray Budesonide : -Non halogenated glucocorticoid -Highly active topically and systemically -Claimed to be better than Beclamethasone -Rapidly metabolized Fluticasone : -for inhalation purpose because less oral bio availability -highly potent

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Prednisolone : -Highly potent & has a good oral BA -Intermediate duration of action -fluid retention does occur with high doses Dexamethasone : - Very potent & long acting -Causes marked Pituitary- Adrenal suppression but fluid retention and hypertension are not a problem -can be given orally/ IV infusion/ IM and also used topically

Mast Cell Stabilizers: 

Mast Cell Stabilizers Sod.Cromoglycate : -inhibits degranulation of mast cells -also inhibits the release of inflammatory mediators of asthma like ILs,LTs -has low oral bio availability hence it is given as aerosol -Rapidly excreted unchanged in urine and bile

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Ketotifen : -same action as Sod.Cromoglycate -not a bronchodilator but produces sedation -absorbed orally but bio availability is 50% due to first pass metabolism -t 1/2 is 22 hours ADR: -Sedation -Dry mouth -Weight gain

LT Antagonists: 

LT Antagonists Montelukast and Zefirlukast both have similar actions & clinical utility MOA: they competitively antagonise LT1 receptor mediated broncho constriction , increased vascular permeability and recruitment of eosinophils These are indicated for prophylactic therapy of mild-moderate Asthma Very safe drugs with fewer side effects Well orally absorbed and high plasma protein bound

Anti IgE antibody: 

Anti IgE antibody Omalizumab : -A humanized monoclonal antibody against IgE -it neutralises free IgE in circulation without activating mast cells and other inflammatory mediators -Can be given I.V. or S.C. - it is very expensive and mostly used in sever asthma

Cough : 

Cough Cough is protective refkux , its purpose being expulsion of respiratory secretions or foreign from air paasages It occurs due to stimulation of mechano-chemoreceptors In throat and respiratory passages or stretch receptors in lungs It is may be usefull or useless It is mainly two types -Non productive -productive

Causes : 

Causes Microbes (Bacteria, viruses,fungi ) Pollens Dust Smoking Chemicals Asthma Gastro esophageal refluxes

Cough suppressants: 

Cough suppressants Mucolytics : Bromhexine , Ambroxol , Acetyl cysteine , Carbocysteine Antitussives : a) Opioids : codeine,pholcodeine b)Non opioids : Noscapine , Dextromethorphan Anti histamines: Chlorpheniramine,Diphenhydramine,Promethazine

Mucolytics : 

Mucolytics Bromhexine : -Capable of inducing thin cupios bronchial secretion -It depolymerises mucopolysaccharides ADR: - Rhinorrhoea - lacrimation -Gastric irritation -Hypersensitivity

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Ambroxol : -it is a metabolite of bromhexine -having same action uses and sied effects Acetyl cysteine : -It breaks the disulfide bonds in muco proteins present in sputum- makes it less viscid -it has to be administered directly in to respiratory tract Carbocysteine : It liquefies viscid sputum in Same way as acetyl cysteine

Antitussives : 

Antitussives Opioids Codeine : -An alkaloid -More selective for cough centre & treated as the standard antitussive -Abuse liability is low -constipation is the main side effect -At higher doses respiratory depression may occur

Non Opioids: 

Non Opioids Dextromethorphan : -As potent as codeine -Does not depress mucociliary function of the airway mucosa -common side effects like dizziness,nausea , vertigo,irritability -anti tussive activity losts upto 6 hours

Anti Histamines: 

Anti Histamines Many H1 anti histamines have been used as anti tussives because of their sedative and anti cholinergic actions Only few of anti histamines are used to treat cough . The main side effect of this class of drugs is sedation

References : 

References Rang & Dale’s pharmacology 6 th edition Essentials of medical pharmacology by K.D.Tripati

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Thank you…..