Respiratory Disease&

Management

Nitesh Gunjan1St year

M.Pharma(Pharmaceutical management)

DPSRU, New Delhi

Introduction

Pathological condition that affects the organs and tissue that helps in gas exchange.

Affected organs like Trachea, Bronchi, Bronchioles, Alveoli, Lungs & muscles of breathing.

Study of respiratory disease is also known as Pulmonology.

Classification of disease Infectious Diseases

o Upper respiratory tract infections• Common cold• Sinusitis

o Lower respiratory tract infections• RSV(Respiratory Syncytial Virus)• Tuberculosis(TB)• Pneumonia• Cough

Obstructive Lung Diseaseso Lung Cancero Asthma

Chronic Obstructive Pulmonary Disease (COPD)o Emphysemao Bronchitis

Prevalence of different diseaseDisease Number of patients

(n=2012)% of all cases

Asthma 534 26.54

COPD 245 12.18

Infective problems 144 7.16

Soft tissue mass (proved bronchogenic carcinoma)

78(59) 3.88

TB (typical and atypical) 146 7.26

Pleural pathology 56 2.78

Obstructive Sleep Apnea 39 1.94

Interstitial Lung Disease 87 4.32Sarcoidosis 24 1.19

Cough of undiagnosed etiology 101 5.02

SOB of undiagnosed etiology 80 3.97

Hemoptysis of undiagnosed etiology

88 4.37

Systemic diseases with lung involvement

9 0.45

Pain chest of undiagnosed etiology 17 0.84Lymphadenopathy of undiagnosed 14 0.69

etiology

Others 41 2.04Other not enlisted problems and 297 14.76

non responsible problems

Etiology Microorganisms

• Streptococcus• mycobacterium

Smoking Virus

• Rhino virus• RSV

Allergens• Mites • pollen

Life style Genetic factors.

Diagnostic Tools

Blood Test Chest X-ray CT Scan Culture of M.O. Bronchoscopy Biopsy Radiography

Manifestation• Rapid heart

rate(tachycardia)• High fever• Bluish lips, nails, or

skin.

• Sneezing• Coughing

o Irritationo Constant, dry unproductive

vs. productive cough• Sputum

o Mucus dischargeo Yellowish-greeno Hemoptysis

• Changes in ABG (arterial blood gases)o Hypoxemia inadequate

oxygen in bloodo Hypoxia inadequate oxygen

supply to cells

Common Cold Virus (Rhinovirus) Spread through respiratory droplets Highly contagious Initially mucous membranes of nose, pharynx

swollen Symptoms:

o Nasal congestion o watery dischargeo Mouth breathingo Change in tone of voiceo Sore throat, headacheo slight fevero Cough

TreatmentClass Antihistamine NSAIDs Decongestant

s(vasoconstrictor)

Anticholinergic

M.O.A. Preventing histamine from attacking to a cellular receptor(H₁).

Block the production of inflammatory mediators called prostaglandins(cox2).

Acts by stimulating the ᾳ-adrenergic receptor causes vasoconstriction.

Block the action of parasympathetic(Ach) action on mucus gland secretion.

Drugs Diphenhydramine(Benadryl),Levocetrizine(Xyzal),Promethazine(Antinaus50), fexofenadine(Allegra ODT)

Diclofenac(Zorvolex),ibuprofen(Advil), Ketrolac(Toradol)

Pseudoephedrine(Nexafed),Phenylepherine (Contac-D)

Ipratropium(Atrovent),Tiotropium(Spirivia)

Side-effects

Sedative, tranquillizers, drowsiness

GIT irritation,Reduce kidney function

Hypertension,↑ heart rate,

Glaucoma,Urination problem

Classification of drugs :

• Combination drug therapy:

(NSAIDs + Antihistamine + Decongestants)Sinarest(acetaminophen+chlorpheniramine+pseudoephedrie)Vituz(chlorpheniramine+acyclovir)

Cough Protective reflex Caused by common cold, allergies, and

infection. Types(duration):

o Acute cough – 3 weekso Sub acute cough – 3 to 8 weeks o Chronic cough - >8 weeks

Symptoms:o Running noseo Sneezingo Mild fevero Tiredness

TreatmentClassification of drugs:Class Demulcents Expectorants Antitussives

M.O.A. Sooth the throat and reduce afferent impulse from the inflamed mucosa.

Increase bronchial secretion or reduce viscosity , facilitate removal by coughing.

Act on CNS to reduce tussles impulse , suppress coughing.

Drugs Lozenges(Vicks),GlycerinLiquorice(licorice)

Guaifensin(mucinex),Potassium iodide(pima)

Dextromethorphan(Vicks formula44)Carbapentane(Solutuss)Benzontate(Tessalon)Combination Drug:

Mucinex DM(dextrometorphan+guaifensin)Tylenol+Codeine(acetaminophen+codeine)

Asthma• Periodic episodes of severe but reversible bronchial

obstruction• Frequency may lead to irreversible damage and COPD

Treatment Class bronchodilato

rLeukotrieneAntagonists

Mast cell stabilizer

Corticosteroid

M.O.A. A. AdrenergicE.g.: epinephrine(Epipen) , terbutaline(Bericanyl), metaproterenol(Metaprel)B. AnticholinergicE.g.: Ipratropium(atrovent)C.Methyl xanthineE.g.:theophylline(Theo24)Dyphylline(Dilor)

Blocking the enzyme 5-lipoxygenase

Block Calcium channel and inhibits release of histamine.

Reducing bronchial hyperactivity and suppressing inflammatory response.

Oral: prednisolone(prelone)

Drugs Zafirlukast(Accolate), Montelukast(singulair)

nedocromil(Tildae)Cromolyn(Intal)

Beclomethasone(Qvar)Fluticasone(Flovent)

Combination Therapy

E.g. :Advair HFA (fluticasone+salmeterol)

Tuberculosis • Infectious disease occurs in Lungs• Caused by Mycobacterium tuberculi.

Treatment Classification :Class First line Second line Combination

therapyM.O.A. Inhibition of

synthesis of mycolic acid(cell wall)

Inhibition of DNAgyrase and topoisomerase

Drugs IsoniazidRifampin(rifadin)Ethambutol(myambutol)Refapentine(priftin)

Ciprofloxacin(cipro i.v.)Ofloxacin(floxin)Cycloserine(seromycin)

Rifampin+isoniazid(rifamate)Isoniazid+pyrazinamide+rifampin(rifater)

Algorithms of treatment

T.B.

1Untreated ,

Smear positive

HRZ+E/SDaily or

thrice weekly for 2 months

2Relapses

HRZEFor 4 months

3Smear negativePulmonary TB

HREFor 2 months

4Chronic case

H resistance=R

ZE for 12 months

H+R resistance=ZE+S/Kmc/Am

/Cpr

H=isoniazidR=rifampin

Z=pyrazinamideE=

ethambutolS=streptomyc

in

Lung Cancer

Treatment Techniques

Surgery RadiationTherapy

Chemotherapy

TargetedDrug therapy

Combination

Pneumonectomy ,Segmental resection,lobectomy,

X-ray Paclitaxel(taxol)Gemcitabine(gemzar)Irinotecan(camptosar)

Bevacizumab(avastin)Nivolumab(opdivo)

Cisplatin+gemcitabineCarpoplatin+paclitaxel

Swine Flu

Diagnostic tools:• Nasopharyngeal swab for viral culture • The gold standard test • Rapid immune fluorescence test• Viral culture

Treatment:• Neuraminidase inhibitor antiviral medications

E.g. : Oseltamivir(Tamiflu), Zanamivir(Relenza), Peramivis(Rafivab)inj.M.O.A. : blocking the enzyme NEURAMINIDASE, enables the virus to spread

• Immunization by vaccinesFlumist(live influenza virus)M.O.A. : producing antibody to fight against virus.

• Possible herbal therapy E.g. : Elderberry, Japanese wasabi leaves, Tulsi etc.