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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.