Respiratory Diseases

Presented by;
Ms.Dhanashree Bhosale
Lecturer
AIMS College of pharmacy
ASTHMA
Introduction to Asthma
● Asthma is a condition in which your airways
narrow and swell and may produce extra
mucus.
● This can make breathing difficult and trigger
coughing, a whistling sound (wheezing) when
you breathe out and shortness of breath.
● Asthma can't be cured, but its symptoms can
be controlled.
Types of asthma
On the basis of source of stimulus:

1. Extrinsic Asthma: It is also called allergic asthma. It is most common in childhood

and caused by exposure to definite allergens.
2. Intrinsic Asthma: It is also called non-allergic asthma. It usually develops beyond
age of 40 and have many causes other than exposure to allergens. This type of asthma
is triggered by the presence of irritants in the air that are not related to allergies.
3. Mixed Asthma: Mixed asthma is the combination of both allergic and non-allergic
asthma. Many patients do not clearly fit in to either of the above two categories and
have mixed features of both. This is the most common form of asthma.
Types of asthma
On the basis of duration:

● Acute Asthma: Acute asthma is sudden in onset. Acute asthma exacerbation happens
when there is a sudden episode of progressive worsening of symptoms of asthma, like
wheezing, chest tightness, cough, and shortness of breath.
● Chronic Asthma: Chronic asthma is a long-term condition. Chronic asthma
exacerbation happens when the asthma symptoms are intense and there is chronic
inflammation and narrowing of the airways in the lungs. In chronic asthma, an asthma
attack, is called a flare up or exacerbation.
Types of asthma
On the basis of severity:

● Mild Intermittent Asthma: A person with intermittent asthma has mild symptoms. He will have symptoms up to two
days per week or two nights per month and requires treatment with short-acting inhalers on 2 days per week or fewer. This
type of asthma doesn't hinder any activities and can include exercise-induced asthma.
● Mild Persistent Asthma: A person with mild persistent asthma still has mild symptoms but they occur more than twice
per week but do not occur every day. This type of asthma interferes with daily activities. Nighttime symptoms occur 3 to 4
times a month.
● Moderate Persistent Asthma: A person with moderate persistent asthma has asthmatic symptoms every day. They use
their asthma medicine every day. Symptoms interfere with daily activities. Nighttime symptoms occur more than 1 time a
week, but do not happen every day.

● Severe Persistent Asthma: A person with severe persistent asthma has symptoms multiple times during the day. These
symptoms will occur almost every day. They have a decrease in their physical activity. Nighttime symptoms occur often,
sometimes every night.Severe persistent asthma doesn't respond well to medications even when taken regularly.
Types of asthma
● Exercise-induced asthma, which may be worse when the air is cold and dry
● Occupational asthma, triggered by workplace irritants such as chemical fumes,
gases or dust
● Allergy-induced asthma, triggered by airborne substances, such as pollen, mold
spores, cockroach waste, or particles of skin and dried saliva shed by pets (pet
dander)
Symptoms of asthma
Asthma signs and symptoms include:

● Shortness of breath
● Chest tightness or pain
● Wheezing when exhaling, which is a common sign of asthma in children
● Trouble sleeping caused by shortness of breath, coughing or wheezing
● Coughing or wheezing attacks that are worsened by a respiratory virus, such as a cold
or the flu
Causes of asthma
● Airborne allergens, such as pollen, dust mites, mold spores, pet dander or particles of cockroach waste.
● Respiratory infections, such as the common cold.
● Physical activity.
● Cold air.
● Air pollutants and irritants, such as smoke.
● Certain medications, including beta blockers, aspirin, and nonsteroidal anti-inflammatory drugs, such as ibuprofen (Advil,
Motrin IB, others) and naproxen sodium (Aleve).
● Strong emotions and stress.
● Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes,
beer and wine.
● Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat.
Risk factors
● Having a blood relative with asthma, such as a parent or sibling
● Having another allergic condition, such as atopic dermatitis — which causes red, itchy skin
— or hay fever — which causes a runny nose, congestion and itchy eyes
● Being overweight
● Being a smoker
● Exposure to secondhand smoke
● Exposure to exhaust fumes or other types of pollution
● Exposure to occupational triggers, such as chemicals used in farming, hairdressing and
manufacturing
Etiopathogenesis of Asthma Allergens, Viral
infections,
Drugs-NSAID,
beta Blockers,
dust, smoking,
secondhand
smoke, Air
pollution, stress.
Etiopathogenesis of asthma
● Pathophysiology of asthma consists of three key abnormalities: bronchoconstriction, airway inflammation, and
mucoid impaction.
● Asthma is usually caused by an allergic reaction to an allergen and is mediated by immunoglobulin E (IgE). IgE is
formed in response to exposure to allergens such as pollen or animal dander.
● Sensitization occurs at first exposure, which produces allergen-specific IgE antibodies that attach to the surface of mast
cells.
● Upon subsequent exposure, the allergen binds to the allergen-specific IgE antibodies present on the surface of mast
cells, causing the release of inflammatory mediators such as leukotrienes, histamine and prostaglandins.
● These inflammatory mediators cause bronchospasm, triggering an asthma attack. If an attack is left untreated,
eosinophils, T helper cells and mast cells migrate into the airways. Excess mucus production caused by goblet cells plug
the airway and, together with increased airway tone and airway hyperresponsiveness, this causes the airway to narrow
and further exacerbates symptoms.
Non-Pharmacological Management of Asthma
● Triggers avoidance is a key component of improving control and preventing attacks
● Infants who are exclusively breastfed for 3-4 months have lower risk for childhood
asthma.
● Avoid use of broad-spectrum antibiotic during the first year of life.
● Obesity: Weight reduction improves lung function, symptoms, disease occurrence and
health status of obese asthmatics
● Physical Activity Light to moderate tolerable exercise should be encouraged
especially for patients with comorbidities caused by weight problems.
Pharmacological Management of Asthma
Drugs for treating asthma are divided into two categories:

(i) Quick-relief medications (which are used to relieve acute asthma).

(ii) Long-term asthma control medications (which are used as prophylactic measures).
Pharmacological Management of Asthma
Quick-relief medications: They are used as needed for rapid, short-term symptom relief during an asthma attack. Types of
quick-relief medications are:

1. Short-acting B2 agonists (bronchodilators): These are quick-relief bronchodilators act within minutes to rapidly ease
symptoms during an asthma attack. Short-acting B2 agonists can be taken using a portable, hand-held inhaler or a
nebulizer. Examples are salbutamol (Asthalin SA, Cipla ) and terbutaline.
2. Antimuscarinics: These inhaled antimuscarinics act quickly to relax the airways, making it easier to breathe. Examples are
ipratropium (Ipravent. Cipla Ltd.) and tiotropium.
3. Systemic corticosteroids: These corticosteroids are administered orally and intravenously, relieve airway inflammation
caused by severe asthma. However, due to serious side effects, they are used only on a short-term basis to treat severe
asthma symptoms. Examples are prednisone (Mornipred, Zydus Cadila) and methyl prednisolone.
4. Intravenous xanthines: Xanthines relax smooth muscle, relieve bronchial spasm and are indicated for severe asthma
attack. Example is aminophylline (Aminophylin, Zydus Cadila).
Pharmacological Management of Asthma
Long-term asthma control medications: These drugs work to reduce the amount of inflammation in the airways and prevent asthma attacks
occurring.

1. Inhaled corticosteroids: These are the most effective preventers; however, they take several days to weeks before they reach their
maximum benefit. Examples are fluticasone and budesonide (Budecort 400 Rotacap, Cipla Ltd).
2. Long-acting B2 agonists: Inhalation of these drugs opens the airways. Some research shows that they may increase the risk of a severe
asthma attack, unless they are used in combination with an inhaled corticosteroid. Examples are salmeterol ( Seroflo 250 Rotacap,
Cipla Ltd) and formoterol
3. Leukotriene inhibitors: They provide protection against bronchoconstriction when taken before exercise or exposure to allergen or
aspirin or to cold air. Examples of leukotriene inhibitors include montelukast and zafirlukast.

4. Xanthines: These drugs relax bronchial muscle and provide relief from bronchial spasm. Also, they have anti-inflammatory effects and

stimulant effects on respiration. Example is theophylline.

Pharmacologica
l Management
of Asthma
Pharmacological Management of Asthma
 Chronic Obstructive
Pulmonary Disease (COPD)
What is COPD?
● Chronic obstructive pulmonary disease, commonly referred to as COPD, is a group of progressive
lung diseases.
● The most common of these diseases are emphysema and chronic bronchitis. Many people with
COPD have both of these conditions.
● Emphysema slowly destroys air sacs in your lungs, which interferes with outward air flow. Bronchitis
causes inflammation and narrowing of the bronchial tubes, which allows mucus to build up.
● It’s estimated that about 30 million people in the India have COPD. As many as half are unaware that
they have it.
● Untreated, COPD can lead to a faster progression of disease, heart problems, and worsening
respiratory infections.
What Are COPD Symptoms?
● Shortness of breath, after even mild forms of exercise like walking up a flight of stairs
● Wheezing, which is a type of higher-pitched noisy breathing, especially during exhalations
● Chest tightness
● Chronic cough, with or without mucus
● Need to clear mucus from your lungs every day
● Frequent colds, flu, or other respiratory infections
● lack of energy.
● Breathlessness.
● Sore throat.
Etiopathogenes
is
of COPD
Emphysema
● Emphysema is a lung condition that causes shortness of breath.
● People with emphysema, the air sacs in the lungs (alveoli) are damaged.
● Over time, the inner walls of the air sacs weaken and rupture — creating larger air
spaces instead of many small ones.
Diagnosis of COPD
1. Physical examination.
2. Chest X-ray
3. Pulmonary lung function test.
4. Blood test.
5. Sputum culture.
6. Spirometer exercise.
7. bronchoscopy.
Non-Pharmacological Management of COPD
1. Quit smoking.
2. Avoid people who are sick with cold or the flu.
3. Exercise.
4. Pneumonia vaccination.
5. Wear mask.
6. Pulmonary rehabilitation program; it work with a respiratory therapist to help
breathing.
7. Nutrition.
8. Education.
Pharmacological Management of COPD
1. Oxygen therapy.
2. Antibiotics such as; azithromycin, benzylpenicillin, ampicillin are required as infection often
precipitates acute attacks.
3. Bronchodilators:
a. Inhaled bronchodilators:
■ Inhaled bronchodilators are preferred to oral formulations due to their better efficacy
and lesser side effects.
■ Short acting beta agonists - Salbutamol, 1-2 puffs three times a day, Terbutaline 1.5
mg three times a day.
■ Long acting beta agonist (Salmeterol, Formoterol), 1-2 puffs twice a day.
■ Short acting anticholinergics (Ipratropium) 1-2 puffs, 2-3 times a day.
■ Long acting anticholinergic (Tiotropium) 1-2 puffs once a day.
Pharmacological Management of COPD
3. Bronchodilators:
a. Methylxanthines:
● Inj. Aminophylline 250 mg in 500 ml of 5 % Dextrose slowly over 8-10 hours in acute
attacks.
● Tab. Theophylline 100-300 mg three times a day. Side effects of theophylline: Tachycardia,
nausea, arrhythmias and convulsions.
3. Glucocorticoid:
b. Inhaled corticosteroids: These should be given in severe COPD or in those with repeated exacerbation.
■ Fluticasone 1-2 puffs twice a day
■ Budesonide 1-2 puffs twice a day
c. Systemic corticosteroids: These should be given only in patients with acute exacerbation of COPD.
■ Tab Prednisolone 30-40 mg/day for 8-10 days in tapering doses.
Question Bank
1. What is asthma, explain the various types of asthma. (3/5)
2. Explain the etiopathogenesis of asthma with clinical manifestation. (5)
3. Explain the non-pharmacological and pharmacological management of asthma. (5)
4. List the symptoms, causes and risk factors of asthma.
5. What is COPD, explain the various types of COPD. (3)
6. Explain the etiopathogenesis of COPD. (5)
7. Explain the non-pharmacological and pharmacological management of COPD. (5)
8. List the symptoms of COPD.(3)