Pharmaceutical guidelines of patients with pathology of breathing organs. Symptomatic treatment of COUGH

1. Pharmaceutical guidelines of patients with pathology of breathing organs. Symptomatic treatment of COUGH

2. Coughis a forceful expulsion of air from the lungs It isnormally a protective reflex for removing foreign bodies,environmental irritants, or accumulated secretions fromthe respiratory tract. The cough reflex involves centraland peripheral mechanisms. Centrally, the cough centerin the medulla oblongata receives stimuli and initiates thereflex response (deep inspiration, closed glottis, buildupof pressure within the lungs, and forceful exhalation). Peripherally,cough receptors in the pharynx, larynx, trachea,or lungs may be stimulated by air, dryness ofmucous membranes, or excessive secretions.

3. Cough A cough isproductive when secretions are expectorated; it is nonproductivewhen it is dry and no sputum is expectorated. Cough is a prominent symptom of • respiratory tractinfections (the common cold, influenza, bronchitis,pharyngitis,pneumonia) • chronic obstructive pulmonary diseases(emphysema, chronic bronchitis). • asthma, acid reflux into the esophagus (gastroesophageal reflux disease), sinusitis, postnasal drip, bronchitis, cigarette smoking, tuberculosis, hypersensitivity pneumonia (inflammation of the lung from exposure to certain environmental chemicals), and even lung cancer. Therefore, a persistent cough or a cough that is associated with chest pain, fever, weight loss, or blood-tinged or discolored sputum should be evaluated by a doctor.

4. Dry Laryngitis Dry pleurisy Smoking cough In the beginning of diseases: Acute bronchitis Pneumonia Lung abscess Tuberculosis Lung cancer Wet Acute viral diseases Bronchitis Pneumonia Tuberculosis Bronchiectatic disease Cough

5. Threatningsymptoms • Cough with increasing intensity that lasting above week • Cough accompanied by long steading (weeks) hyperthermia 38 °C • Cough accompanied by hyperthermia above 38 °C during 3 days or more • Cough accompanied by dyspnea and thorasic pain on breathing • Cough of pus • Blood spitting • Cough with pronounced dyspnea • Cough and weakness and weight loss • Excessive sweating,shivering • Sudden attack of severe cough • Severe cough during an hour without any interval • Abundant expectoration of sputum

6. Antitussives • Antitussive agents suppress cough by depressing the cough center in the medulla oblongata or the cough receptors in the throat, trachea, or lungs. • Centrally acting antitussives: narcotics (eg, codeine, hydrocodone) and non-narcotics (eg, dextromethorphan). • Locally acting agents (eg, throat lozenges, cough drops) may suppress cough by increasing the flow of saliva and by containing demulcents or local anesthetics to decrease irritation of pharyngeal mucosa. • Flavored syrups are often used as vehicles for other drugs.

7. Indication for use of antitussives a dry, hacking, nonproductive cough that interferes with rest and sleep. It is not desirable to suppress a productive cough because the secretions need to be removed. Although antitussives continue to be used and some people report beneficial effects, some research studies indicate that cough medicines are no more effective than placebos in children or adults.

8. Expectorants • Expectorants are agents given orally to liquefy respiratory secretions and allow for their easier removal. • Guaifenesin is the most commonly used expectorant. It is available alone and as an ingredient in many combination cough and cold remedies, although research studies do not support its effectiveness and many authorities do not recommend its use.

9. Expectorants Other expectorants (hot beverages, potassium iodide, andipecac) stimulate production of waterymucus.

10. Mucolytics • Mucolytics are administered by inhalation to liquefy mucus in the respiratory tract. Solutions of mucolytic drugs may be nebulized into a face mask or mouthpiece or instilled directly into the respiratory tract through a tracheostomy. • Sodium chloride solution and acetylcysteine (Mucomyst) are the only agents recommended for use as mucolytics.

11. Acetylcysteine is effective within 1 minute after inhalation, and maximal effects occur within 5 to 10 minutes. It is effective immediately after direct instillation. Oral acetylcysteine is widely used in the treatment of acetaminophen overdosage Mucolytics

12. Mucolytics • expectorants like bromhexine or ambroxole may effectively decrease viscosity ofbronchial secretions

13. Ambroxol • Ambroxol is a clinically proven systemically active mucolytic agent. When administered orally onset of action occurs after about 30 minutes. The breakdown of acid mucopolysaccharide fibers makes the sputum thinner and less viscous and therefore more easily removed by coughing. Although sputum volume eventually decreases, its viscosity remains low for as long as treatment is maintained.

14. Ambroxol (cont’d) Indications • All forms of tracheobronchitis, emphysema with bronchitis pneumoconiosis, chronic inflammatory pulmonary conditions, bronchiectasis, bronchitis with bronchospasm asthma. During acute exacerbations of bronchitis it should be given with the appropriate antibiotic. Contraindications • There are no absolute contraindications but in patients with gastric ulceration relative caution should be observed.

15. Types of cough medications available OTC for the temporary relief of cough due to a cold • oral cough suppressants, • oral expectorants, • topical (externally applied) medicines

16. Oral cough suppressants • Codeine and hydrocodone are narcotic oral cough suppressants that require a doctor's prescription. Dextromethorphan is an oral cough suppressant that is available OTC. Dextromethorphan is chemically related to codeine and acts on the brain to suppress cough, but does not have the pain-relieving and addictive properties of codeine. Diphenhydramine is another non-narcotic medication that acts on the brain to suppress cough. It is also an antihistamine.

17. Oral cough suppressants • Dextromethorphan and diphenhydramine can be used to relieve a dry, hacking cough. They are not generally used to suppress a productive cough • Cough suppressants are sometimes used to suppress even productive coughs if they are especially bothersome and prevent restful sleep.

18. Oral expectorants • Guaifenesin is an oral expectorant that is believed to increase the leaking of fluid out of the lung tissue and into the airways. This action thins (liquefies) the thick mucous in the airways and facilitates the clearing of the mucous by coughing. Clearing of mucous from the airways decreases cough.

19. Topical medications • Camphor and menthol are topical cough medications. Camphor and menthol ointments are rubbed on the throat and the chest as a thick layer. The anesthetic action of their vapors is believed to relieve cough. They are also available as products for steam inhalation. Menthol is also available as lozenges and compressed tablets.

20. ANTICOUGH MEDICATIONS. GUIDELINES • These drugs may relieve symptoms but do not cure thedisorder causing the symptoms. • An adequate fluid intake, humidification of the environment,and sucking on hard candy or throat lozenges canhelp to relieve mouth dryness and cough.

21. ANTICOUGH MEDICATIONS. GUIDELINES • The patient should take medications as prescribed or as directed on the labelsof OTC preparations. Taking excessive amounts ortaking recommended amounts too often can lead to seriousadverse effects. • The patient should take cough syrups undiluted and avoid eating anddrinking for approximately 30 minutes. Part of the beneficialeffect of cough syrups stems from soothing effectson pharyngeal mucosa. Food or fluid removes the medicationfrom the throat.

22. Use in Children • Most infections are viral in origin and antibiotics are notgenerally recommended. • For bronchitis, which is almost always viral, antibioticsare not usually indicated unless pneumonia is suspectedor the cough lasts 10 to 14 days without improvement.

23. ANTICOUGH MEDICATIONS. GUIDELINES (cont’d) • Adverse effects Excessive suppression of the cough reflex with antitussives(inability tocough effectively when secretions are present): This is a potentially serious adverse effect because retained secretionsmay lead to atelectasis, pneumonia, hypoxia,and respiratory failure.

24. ANTICOUGH MEDICATIONS. GUIDELINES (cont’d) Adverse effects: • Nausea, vomiting, constipation, dizziness, drowsiness,pruritus, and drug dependence: associated with narcotic agents. When narcotics are given for antitussive effects, however,they are given in relatively small doses and are unlikely tocause adverse reactions.

25. ANTICOUGH MEDICATIONS. GUIDELINES (cont’d) • Drug interactions Drugs that increase antitussive effects of codeine:CNS depressants (alcohol, antianxiety agents, barbiturates,and other sedative-hypnotics) - Additive CNS depression. Codeine is given in small doses for antitussiveeffects, and risks of significant interactions are minimal.

26. ANTICOUGH MEDICATIONS. GUIDELINES (cont’d) • drug interactions Drugs that alter effects of dextromethorphan: • MAO inhibitors - This combination is contraindicated. Apnea, muscular rigidity, hyperpyrexia, laryngospasm, and death may occur.

27. ANTICOUGH MEDICATIONS. GUIDELINES (cont’d) • Anticough agents that include codeine, Dextromethorphan, butamirat are not recommended for using in kids (to 2 years of age), during pregnancy and lactation • Agents that include glaucini hydrochloridum may provoke decreasing of arterial blood pressure in kids • Anticough agents that include Dextromethorphanmay cause CNS and breathing depressionif using in hight doses or for a long period • Anticough agents that include butamirat, dextromethorphanmay cause weakness, sleepiness, dizziness

28. Mucolytics& expectorantsGUIDELINES • Ambroxol is contraindicated in first term of pregnancy • Acetylcysteine may cause pulmonary hemorrage, liver and kidney function disturbances, may provoke attack of asthma in patients with BA • Acetylcysteine solution don’t use in one syringe with antibiotics • Bromhexineandambroxole may increase liver transaminase activity

29. Mucolytics& expectorantsGUIDELINES (cont’d) • Bromhexineandambroxoleare not combined with codeine including drugs • Bromhexineandambroxolestimuly surfactant synthesis, making better alveolar cells function, and help clearing of mucous from the airways

30. Mucolytics& expectorantsGUIDELINES (cont’d) • Bromhexinedon’t use in kids to 3 years age • Expectorantsdon’t combine with drugs that supress cough reflex • Expectorantsdon’t combine with drugs that dehydrateorganism (diuretics, laxatives) • Expectorantswith reflective mechanism of action (thermopsis) may provoke vomiting and are contraindicated in patients with ulcer disease

31. Mucolytics& expectorantsGUIDELINES (cont’d) • Expectorantsshow their clinical efficiency on 6-7 days of treatment • In the first 2-3 days of reception of expectorantsa cough and separation of sputum can increase: these phenomena testify to efficiency of preparation • At presence of acute inflammatory process herbal expectorants are preferable • At an overdose or prolonged reception of preparations, containing iodides, the origin of iodism is possible: rrhinitis, somnolence, swelling;hyperthyroidism - tachicardia, tremor, insomnia, diarrhea are possible (more frequent at persons after 40 years) • Plant decoctions and extracts render not only coughing up action, but also the regenerations of the damaged mucous membrane of bronchial tubes promote due to the contained microelements, vitamins and biogenic stimulators