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Anatomy of Respiratory SystemAnatomy of Respiratory System
• NoseNose• Pharynx (throat)Pharynx (throat)• Larynx (Voice box)Larynx (Voice box)• Trachea (Wind pipe)Trachea (Wind pipe)• BronchiBronchi• LungsLungs
• Muscles of Respiration Muscles of Respiration : : Intercostal musclesIntercostal musclesDiaphragm Diaphragm
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Upper Resp. Upper Resp. TtractTtract
Nose Pharynx
Lower Resp. Lower Resp. TractTract
LarynxTracheaBronchiLungs
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5
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RespiratoryBronchiole
AlveolarSac
Acinus
AlveolarDuct
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Lower Respiratory TractLower Respiratory Tract
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Respiratory Function:
Air is warmed, moistened & filtered
Olfactory function
• Citated columar epithelium
• Mucus secreting goblet cells
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• Nasal partNasal part• Oral PartOral Part• Laryngeal PartLaryngeal Part
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Functions of Pharynx:Functions of Pharynx:
Respiratory: Respiratory: Air passes thru the nasal & Air passes thru the nasal & oral parts.oral parts.
Air is further warned & moistenedAir is further warned & moistened
Digestive: Digestive: Food passes thru, oral & Food passes thru, oral & laryngeal partslaryngeal parts
Principles of Anatomy & Physiology, Tortora, 1996, pg 708
Lies in front of pharynx. Lies in front of pharynx. After puberty, grows larger in the male which After puberty, grows larger in the male which explains the prominence of the ‘explains the prominence of the ‘Adam’s appleAdam’s apple’ ’ and deeper voice. and deeper voice.
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Speech consists of manipulation of sound produced by vocal cords, tongue, cheeks.
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• Passage way for air between pharynx & trachea (air further moistened, filtered, warmed)
• Vocal cords produce sounds of various loudness & pitch
• During swallowing larynx moves upwards occluding the opening into it from the pharynx
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Trachea : Trachea : 12 cm long 12 cm long Diameter 2 .5 cmDiameter 2 .5 cm
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Cartilages keep the air passages open, Cartilages keep the air passages open, allowing for unobstructed passage of air allowing for unobstructed passage of air
Sticky mucus lining the membranes Sticky mucus lining the membranes filters airfilters air
Wave motion of cilia & lining membrane Wave motion of cilia & lining membrane waft mucus and adherent particles waft mucus and adherent particles towards the throat.towards the throat.
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Contraction & relaxation of muscles in the wall Contraction & relaxation of muscles in the wall regulate the volume of air entering the lungsregulate the volume of air entering the lungs
Cells (lymphocytes, plasma cells, PMNs, macrophages) Cells (lymphocytes, plasma cells, PMNs, macrophages) protect against infection and inhaled foreign particles.protect against infection and inhaled foreign particles.
Air warmed (or cooled) and moistenedAir warmed (or cooled) and moistened
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• 15 times/ min
• Inspiration
• Expiration
• Pause
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Diaphragam Intercostals
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Coughing Sneezing Sighing Yawning
Sobbing Crying Laughing Hiccuping
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The process of respiration is carried out by the help of a large number of muscles:
1) Diaphragm
2) Intercostal muscles
3) Accessory muscles of respiration
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Structure of a BronchioleStructure of a Bronchiole
SmoothSmoothMuscleMuscle
CiliaCilia
MucousLayerMucousLayer
MucusGlandMucusGland
GobletCellGobletCell
Mast Mast CellsCells
Epithelium Sub-Mucosa 28
Respiration: External Internal Tissue
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Pharyngitis: Inflammation of pharynxInflammation of pharynx
Laryngitis: Inflammation of larynxInflammation of larynx
Tracheitis: Inflammation of tracheaInflammation of trachea
Bronchitis Inflammation of bronchiInflammation of bronchi
Bronchiolitis: Inflammation of bronchioleInflammation of bronchiole
Otitis Medium: Inflammation of middle Inflammation of middle earear
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Common cold: Is associated with running nose Is associated with running nose
i.e. i.e. rhinorrhoea, congestion, rhinorrhoea, congestion,
sneezing sneezing etc. etc.
It is the inflammation of the It is the inflammation of the
nasal nasal mucus membranemucus membrane
Cough: It is a protective and It is a protective and
physiological physiological reflex reflex which is which is
responsible for responsible for expelling any expelling any
foreign matter foreign matter entering the entering the
respiratory tract.respiratory tract.
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Bronchiectasis: Localised, chronic and Localised, chronic and
irreversible irreversible dilatation of the dilatation of the
bronchi.bronchi.
Pneumonia: Inflammation and consolidation of Inflammation and consolidation of
the lung tissue (parenchyma).the lung tissue (parenchyma).
Empyema: Accumulation of pus in pleural Accumulation of pus in pleural
cavity.cavity.
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Sinusitis: Inflammation of the mucus Inflammation of the mucus
membrane membrane lining the lining the
various sinus cavities in the various sinus cavities in the
skull.skull.
Tonsillitis: Inflammation of the tonsils.Inflammation of the tonsils.
Lung abscess: Collection of pus in the lungs.Collection of pus in the lungs.
Adenitis: Inflammation of the adenoids.Inflammation of the adenoids.
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•Sinuses: Sinuses:
hollow cavities within hollow cavities within the facial bones. the facial bones.
•Sinus infections: Sinus infections:
most frequently most frequently maxillary and frontal maxillary and frontal sinuses.sinuses.
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SinisitisSinisitis
Nasal congestion, Nasal congestion, Greenish nasal phlegm (discharge), Greenish nasal phlegm (discharge),
Night-time cough. Night-time cough. Fever, malaise (feeling ill), bad breathFever, malaise (feeling ill), bad breath
Sore throat,Sore throat, Facial and/or dental pain, eye pain, Facial and/or dental pain, eye pain,
headache.headache.
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Classic Symptoms of Acute Classic Symptoms of Acute SinusitisSinusitis
Runny nose , Nasal congestion Runny nose , Nasal congestion Sneezing Sneezing
Sore throat , Cough Sore throat , Cough
Muscle aches , Headache Muscle aches , Headache FeverFever
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Common Cold - SymptomsCommon Cold - Symptoms
Cough: with or Cough: with or without mucus ,without mucus ,
Nasal discharge Nasal discharge
Headache , muscle Headache , muscle aches and stiffness aches and stiffness
Shortness of Shortness of breath breath
Stuffy, congested Stuffy, congested nose , nose - bleed nose , nose - bleed
Sore throat Sore throat
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Flu (influenza) - SymptomsFlu (influenza) - Symptoms
Cough: mucus (sputum), Cough: mucus (sputum), blood streakedblood streaked
Shortness of breath Shortness of breath Frequent RTI(colds) Frequent RTI(colds)
Wheezing Wheezing Fatigue, Headaches Fatigue, Headaches Reddish mucous membranes Reddish mucous membranes
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Bronchitis- SymptomsBronchitis- Symptoms
The presence of chronic The presence of chronic
productive cough for 3 productive cough for 3 months,months,
In each of 2 successive In each of 2 successive years.years.
In a patient in whom other In a patient in whom other causes of chronic cough causes of chronic cough have been excluded.have been excluded.
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Chronic BronchitisChronic Bronchitis
Cough: mucus-like, Cough: mucus-like, greenish, or pus-like greenish, or pus-like sputum sputum
Fever: chills with shaking Fever: chills with shaking
Chest pain: sharp or Chest pain: sharp or stabbing, increased by stabbing, increased by deep breathing, increased deep breathing, increased by coughingby coughing
Headache Headache
General discomfort: General discomfort: uneasiness / ill feeling uneasiness / ill feeling (malaise) (malaise) 43
Pneumonia - SymptomsPneumonia - Symptoms
Chronic cough: Chronic cough: large amounts of large amounts of foul-smelling foul-smelling sputum production sputum production
Coughing up blood Coughing up blood Cough worsened by Cough worsened by
lying on one side lying on one side
Shortness of breath Shortness of breath worsened by worsened by exercise exercise
Wheezing Wheezing Weight loss ,Fatigue Weight loss ,Fatigue
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Brochiectasis - SymptomsBrochiectasis - Symptoms
Sore throat: accompanied accompanied by fever, headache, by fever, headache, swollen lymph nodes in the swollen lymph nodes in the neck. neck.
Viral Pharyngitis: associated with runny nose associated with runny nose (rhinorrhea) and postnasal (rhinorrhea) and postnasal discharge discharge
Severe Pharyngitis: accompanied by difficulty accompanied by difficulty swallowing and difficulty swallowing and difficulty breathing.breathing.
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Pharyngitis - SymptomsPharyngitis - Symptoms
Cough, Cough, Wheezing, shortness of breath, or Wheezing, shortness of breath, or
difficulty breathing, difficulty breathing,
Bluish skin due to lack of oxygen Bluish skin due to lack of oxygen (cyanosis),(cyanosis),
Rapid breathing (tachypnea),Rapid breathing (tachypnea),
Nasal flaring(swelling) in infants, Nasal flaring(swelling) in infants, Fever.Fever.
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Bronchiolitis - SymptomsBronchiolitis - Symptoms
Normal LungNormal Lung BronchiolitisBronchiolitis
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BronchiolitisBronchiolitis
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What is cough?What is cough?
CoughCough is a protective protective and physiologicalphysiological reflex aimed at maintaining an open airway.
Cough involves rapid expulsion of air at high velocity from the respiratory airway which expel irritants and excessive secretions from respiratory tract.
CoughCough
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Coughing is under voluntaryvoluntary and involuntaryinvoluntary control and consists of 3 3 phases.
InspiratoryInspiratory : initiated by taking a deep breathe PhasePhase and results in maximal dilation of
the lungs.
CompressiveCompressive : closure of the glottis followed byphasephase contraction of thoracic and abdominal muscles against a fixed diaphragm.
Expiratory : sudden glottis opening results in phase the explosive release
air.
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Cough - PhysiologyCough - Physiology
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Act of CoughingAct of Coughing
Cough
Cancer
Smoking
Acute LVF
Psychogenic
Infections
URTI, LRTI, TB
Chemicals
Drugs (ACEI)
Dust Pollens
Bronchial Asthma
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Cough - Aetiology (Causes)Cough - Aetiology (Causes)
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Classification of Cough: A cough can be classified by its -
Duration, Character, Quality, and Timing.
Classification as per the Duration of Cough:
Acute (of sudden onset): Present < 3 weeks, Subacute:
Present between 3 and 8 wks, Chronic:Lasting > 8 weeks.
Types of CoughTypes of Cough
1. Acute Cough1. Acute Cough
Cough which comes all of a sudden,Cough which comes all of a sudden,
1. Dry cough
2. Productive cough
3. Bronchospastic / Asthmatic cough
Most commonly relates to -Most commonly relates to -
1. Viral – induced lower respiratory tract infections.2. Post-nasal drip resulting from rhinitis or sinusitis. 3. Throat - clearing secondary to laryngitis or pharyngitis.
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Types of CoughTypes of Cough
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Cough is present between 3 and 8 weeks.
The most common causes:
Post infectious Cough. Acute Sinusitis.Asthma.
2. Sub-acute Cough:2. Sub-acute Cough:
Cough lasting for more than 3 weeks. Cough lasting for more than 3 weeks.
Most Important Causes :Most Important Causes :
•SmokingSmoking•Post-nasal DripPost-nasal Drip•AsthmaAsthma•GERDGERD•Chronic bronchitisChronic bronchitis•BronchiectasisBronchiectasis•Occupation environmentOccupation environment•Psychogenic coughPsychogenic cough
•LVF LVF (left (left ventricular failure)ventricular failure)
•TuberculosisTuberculosis
•Lung CancerLung Cancer
•Intestinal lung Intestinal lung diseasedisease 5656
3. Chronic Cough … cont.3. Chronic Cough … cont.
FindingsFindings
Patient is a smoker Purulent sputum TB exposure Wheezing Cough worse at work Cough after URTI Facial / tooth pain Wt loss
Possible DiagnosisPossible Diagnosis
Tobacco induced bronchitis Pneumonia, Bronchitis Pulmonary TB Asthma Occupational cause Postnasal drip Sinusitis Cancer, TB
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Chronic Cough: DiagnosisChronic Cough: Diagnosis
Step 1Step 1:: Initial evaluation + Diagnosis + Rx.Cough = Symptomatic treatment
Step 2Step 2: : Treatment for postnasal drip. Rx = Antihistamine + decongestant
Step 3Step 3:: Add treatment for Asthma. Cough= Symptomatic Rx + Bronchodilator
Step 4Step 4:: Lab. Investigations (x-ray, CT scan) Rx = Cough formula till cough subsides.
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Chronic Cough: TreatmentChronic Cough: Treatment
Troublesome type of cough,Troublesome type of cough,
Tends to aggravate because of rapid Tends to aggravate because of rapid flow of air, further irritating the flow of air, further irritating the trachea and pharyngeal mucosa. trachea and pharyngeal mucosa.
There is no sputum or secretions are There is no sputum or secretions are too thick and viscid.too thick and viscid.
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4. Dry cough4. Dry cough
Patient spits out a lot of sputum. Patient spits out a lot of sputum. Secretions may be thick or watery.Secretions may be thick or watery. It is usually the result of an allergic It is usually the result of an allergic response or RTI.response or RTI.
•Productive cough are coughs that produce phlegm, in contrast to dry coughs.
•Productive cough is associated with tuberculosis, bacterial pneumonia, and bronchitis .
•The loose productive cough is a sign of chest congestion or infection due to colds or flu.
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5. Productive Cough5. Productive Cough
Associated with Associated with bronchospasm, bronchospasm,
Common in asthma Common in asthma patients & chronic patients & chronic bronchitis. bronchitis.
It frequently wakes It frequently wakes up the patient up the patient during the night or during the night or the early hours of the early hours of the morning.the morning.
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6. Bronchospastic (Asthmatic) 6. Bronchospastic (Asthmatic) CoughCough
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Characteristics of Cough Originating at Various Levels of Respiratory Tract:
Origin Causes CharacteristicsPharynx Pharynx Post nasal dripPost nasal drip Usually Persistent.Usually Persistent.
LarynxLarynx Laryngitis, tumor, Laryngitis, tumor,
whooping cough, croupwhooping cough, croupHarsh, barking, painful, persistent, Harsh, barking, painful, persistent,
often associated with strider.often associated with strider.
TracheaTrachea TracheitisTracheitis PainfulPainful
BronchiBronchi Acute Bronchitis and Acute Bronchitis and
COPDCOPD
Asthma. Asthma.
Bronchial Carcinoma Bronchial Carcinoma
Dry or Productive, , worse in mornings.Dry or Productive, , worse in mornings.
Dry or productive, worse at night.Dry or productive, worse at night.
Persistent often with haemoptysis.Persistent often with haemoptysis.
Lung Lung
ParenchymaParenchymaTuberculosisTuberculosis
PneumoniaPneumonia
BronchiectasisBronchiectasis
Pulmonary edemaPulmonary edema
Interstitial FibrosisInterstitial Fibrosis
Productive, often with haemoptysis.Productive, often with haemoptysis.
Initially Dry, Productive later.Initially Dry, Productive later.
ProductiveProductive
Often at night ( may be productive)Often at night ( may be productive)
Dry, irritant and distressing.Dry, irritant and distressing.
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CoughRunning Nose,
Nasal & Chest CongestionBreathlessness
Sore Throat
Sinusitis, Common ColdInfluenza (Flu), Pharyngitis, Bronchitis
Pneumonia, BronchiolitisBronchiectasis
Most Common Symptoms in ….
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Resp. Mucous Membrane:
Lined by respiratory epithelium
Ciliated columnar cells
Goblet cells
Cilia - propel foreign particles upwards
Respiratory Tract FluidsRespiratory Tract Fluids
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Water 95% - secreted by Water 95% - secreted by bronchial glandsbronchial glands
Glycoproteins - thick Glycoproteins - thick mucopolysaccharides mucopolysaccharides secreted by Goblet cellssecreted by Goblet cells
FatsFats
Proteinaceous material is Proteinaceous material is called mucuscalled mucus
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Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.
Together - Muco-ciliary blanket
It has two layers:It has two layers:
Sol layer :Sol layer : watery layer in which cilia bathe watery layer in which cilia bathe freelyfreely
Gel layer :Gel layer : above the sol layer contains above the sol layer contains mucus mucus
relatively thicker and stickier relatively thicker and stickier
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Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.
The respiratory tract fluid and The respiratory tract fluid and muco-ciliary equilibrium:muco-ciliary equilibrium:
Resp. Fluid gradually propelled upwards Resp. Fluid gradually propelled upwards into the pharynx where it is swallowed into the pharynx where it is swallowed without awareness. without awareness.
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Respiratory Tract Fluids …cont.Respiratory Tract Fluids …cont.
Respiratory tract fluid - increases Respiratory tract fluid - increases
during infectionsduring infections
During RTIs or when lungs are exposed to During RTIs or when lungs are exposed to
foreign particles secretion increase in order foreign particles secretion increase in order
to:to:
Dilute irritants, if any,Dilute irritants, if any,
Drive away foreign bodies and unwanted Drive away foreign bodies and unwanted
particles, particles,
Trap micro-organisms.Trap micro-organisms. 69
Respiratory Tract FluidsRespiratory Tract Fluids
When respiratory tract is When respiratory tract is
contaminated by –contaminated by –
Oropharyngeal cells, bacteria, food Oropharyngeal cells, bacteria, food
particles and particles and
saliva, … it is called sputum.saliva, … it is called sputum.
What is Sputum?What is Sputum?
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⁺Phlegm is a sticky material from patient’s mucous membranes in the respiratory system.
During Cold it might be yellowish brown. During an infection, it might be greenish brown. Normal phlegm is usually clear.
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Drugs Used In CoughDrugs Used In Cough
Centrally Acting:Centrally Acting:
Excessive Cough Bouts - Excessive Cough Bouts - Central Central
Antitussive Antitussive
Peripherally Action:Peripherally Action:
Increased Respiratory Tract Fluid - Increased Respiratory Tract Fluid - ExpectorantExpectorantBreakdown Thick Mucus - Breakdown Thick Mucus - MucolyticMucolyticDecreased Bronchoconstriction - Decreased Bronchoconstriction - BronchodilatorBronchodilatorDecreased Congestion - Decreased Congestion - DecongestantDecongestantDecreased Allergy - Decreased Allergy - AntihistamineAntihistamine
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Anti-Cough Drugs - Mechanism of Action Anti-Cough Drugs - Mechanism of Action
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Actions of Anti-Cough PreparationsActions of Anti-Cough Preparations
Mucolysis Mucokinesis Expectoration
Breaking down of the long, complex, muco polysaccharide fibers to facilitate better expectoration.
Upwards movement of the mucous (mainly, gel layer of the Respiratory Tract Fluid).
Driving away of respiratory tract fluid, done by liquefying the secretions so that extraneous (foreign particles, bacteria and the line) material can easily be thrown out
Mucokinesis is responsible for removal of Mucokinesis is responsible for removal of secretions from respiratory tract.secretions from respiratory tract.
If defectiveIf defective: : Mucus retention occurs resulting in …Mucus retention occurs resulting in … Impairment in the distribution of inspired Impairment in the distribution of inspired
air,air, Worsening of gas exchange at alveoli,Worsening of gas exchange at alveoli, Development of bronhcietasis and Development of bronhcietasis and
atelectasis,atelectasis, Reduction in the ability of the lung to Reduction in the ability of the lung to
resist infection.resist infection.
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How Important is Mucokinesis?How Important is Mucokinesis?
Drugs which suppress cough centre situated Drugs which suppress cough centre situated
in the medulla.in the medulla.
(Latin (Latin tussistussis = Cough). = Cough).
There are two types of these drugs :There are two types of these drugs :
NarcoticsNarcotics
Non-NarcoticsNon-Narcotics
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Anti-tussivesAnti-tussives
In addition to cough suppressing action, they have properties like -
Powerful analgesia ,
Sedation, and
Psychic effects,.
Codeine, Codeine, HydrocodeinHydrocodein
e, e, EthylmorphinEthylmorphin
e, e, DihydrocodeiDihydrocodei
ne, ne, OxycodeineOxycodeine
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Anti-tussives (Narcotics)Anti-tussives (Narcotics)
NOT the drugs of first choice because of addiction NOT the drugs of first choice because of addiction
properties.properties.
Nausea, vomiting, constipation, skin rashes, Nausea, vomiting, constipation, skin rashes, drowsiness, addiction, confusion, headache, drowsiness, addiction, confusion, headache, palpitation, convulsions, sweating, vertigo, palpitation, convulsions, sweating, vertigo, shock shock
RarelyRarely : Respiratory failure and coma, : Respiratory failure and coma, leading to deathleading to death
Reduce ciliary motility of respiratory tract.Reduce ciliary motility of respiratory tract.
Interact with Interact with alcohol, antipsychotics, anti-alcohol, antipsychotics, anti-depressants, anti-histaminics and anti-depressants, anti-histaminics and anti-cholinergics.cholinergics.
Contra-indicatedContra-indicated in respiratory, liver, in respiratory, liver, cerebral diseases and endocrine disorders.cerebral diseases and endocrine disorders.
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Anti-tussives (Narcotics) – Side Anti-tussives (Narcotics) – Side EffectsEffects
These are a group of These are a group of centrally actingcentrally acting anti-anti-
tussives tussives withoutwithout the the narcoticnarcotic properties properties
which include –which include –
Noscapine and Noscapine and
Dextromethorphan .Dextromethorphan .
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Non- Narcotic Anti- TussiveNon- Narcotic Anti- Tussive
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Class Drug Name Action
AntihistaminesAntihistamines Cetirizine, Levocetrizine, Diphenhydramine, Cetirizine, Levocetrizine, Diphenhydramine,
Chlorpheniramine maleate (CPM)Chlorpheniramine maleate (CPM)Block effects of histamine in Block effects of histamine in
allergic cough.allergic cough.
Anti-tussive Anti-tussive
(Cough (Cough
suppressants)suppressants)
Codeine, Pholcodeine, Codeine, Pholcodeine,
Noscapine, DextromethorphanNoscapine, DextromethorphanTo suppress the cough reflex.To suppress the cough reflex.
DemulcentsDemulcents
(Soothing Agents)(Soothing Agents)
Lozenges, cough drops, linctuses containing syrup. Lozenges, cough drops, linctuses containing syrup.
(glycerin, liquorice), and (glycerin, liquorice), and
mentholmenthol (local action)(local action)
To sooth the respiratory To sooth the respiratory
mucosa. mucosa.
ExpectorantsExpectorants Reflexly acting - Ammonium chloride (local action), Reflexly acting - Ammonium chloride (local action),
Potassium chloride.Potassium chloride.
Directly- Guaiphenesin (local action), Sodium and Directly- Guaiphenesin (local action), Sodium and
Potassium citrate, Potassium iodide.Potassium citrate, Potassium iodide.
To increase mucus clearance.To increase mucus clearance.
MucolyticsMucolytics Bromhexine (local action), CarbocisteineBromhexine (local action), Carbocisteine to liquefy the respiratory to liquefy the respiratory
secretions for easy secretions for easy
expectoration.expectoration.
DecongestantDecongestant Ephedrine, Ephedrine, phenylephrinephenylephrine, and topical drugs like , and topical drugs like
oxymetazoline, xylometazoline are widely used as oxymetazoline, xylometazoline are widely used as
decongestants. Phenylephrine HCL a synthetic decongestants. Phenylephrine HCL a synthetic
sympathomimetic agent, sympathomimetic agent,
Sympathomimetic agents are a Sympathomimetic agents are a
vasoconstrictor and pressor vasoconstrictor and pressor
drug chemically related to drug chemically related to
epinephrine and ephedrine.epinephrine and ephedrine.
Drug Therapy of CoughDrug Therapy of Cough
Blocks H1 histamine receptor and thus Blocks H1 histamine receptor and thus inhibits the actions of histamine.inhibits the actions of histamine.
Prevents allergic manifestations of Prevents allergic manifestations of
cough.cough.
Well absorbed from GIT and penetrates Well absorbed from GIT and penetrates
the CNS.the CNS.
Side EffectsSide Effects: drowsiness, nausea and : drowsiness, nausea and
vomiting.vomiting.81
AntihistaminesAntihistamines
Antihistamine, antagonises the actions of histamine at the receptor sites.
Reduces allergic reactions produced due to histamine in the respiratory tract.
Drowsiness and anticholinergic side effects are common.
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AntihistaminesAntihistamines
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DecongestantsDecongestants
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Anti-pyretic - AnalgesicsAnti-pyretic - Analgesics
Menthol:Menthol:
Soothening action, produces cooling Soothening action, produces cooling
sensation and has a mild anesthetic sensation and has a mild anesthetic actionaction
Side effects are mild hypersensitivity Side effects are mild hypersensitivity reactionsreactions
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Soothing AgentsSoothing Agents
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Composition: Each 5 ml containsComposition: Each 5 ml contains
Phenylephrine Phenylephrine 55 mgmg
Paracetamol Paracetamol 250250 mgmg
Chlorpheniramine Chlorpheniramine Maleate (CPM) Maleate (CPM) 11
mgmg
Menthol Menthol 1.25 1.25 mgmg
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Synthetic sympathomimetic agent,
Stimulate receptors, Very minimal effect on -receptor,
Vasoconstrictor, Vaso-presser drug.
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1.1. Phenylephrine (Decongestant)Phenylephrine (Decongestant)
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1.1. Phenylephrine … cont.Phenylephrine … cont.
Powerful Vasoconstrictor
Cardiac Safety
Blood Vessels: Cutaneous, limb, kidney, spleen
Coronary blood flow increased
Pulmonary Blood vessels constrictedIn nasal mucosa:
Very minimal effects on -receptors of heart
Stimulate -receptors in the Blood vessels, which constricts & stop secretions.
Complete lack of action on heart
Very potent decongestant, Very potent decongestant, Constricts (shrinks) blood vessels (veins and Constricts (shrinks) blood vessels (veins and
arteries), arteries), Constriction leads to drainage of supplied areas, Constriction leads to drainage of supplied areas, Decreases congestion & swelling of mucus Decreases congestion & swelling of mucus
membrane,membrane, Site of action: Nose & Sinuses.Site of action: Nose & Sinuses.
Phenylephrine in RTI : Phenylephrine in RTI :
•Opens airwaysOpens airways•Decreases amount of fluid Decreases amount of fluid in RTin RT•Make easier to breath Make easier to breath
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Phenylephrine- Place in TherapyPhenylephrine- Place in Therapy
Adults & adolescents > 12 yr.:Adults & adolescents > 12 yr.: 10-20 mg 4 10-20 mg 4 hrlyhrly
Children 6 to 12 yr. : Children 6 to 12 yr. : 10 mg 4 10 mg 4 hrlyhrly
Children < 6 yr. : Children < 6 yr. : 5 mg 4 hrly5 mg 4 hrly
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Phenylephrine- Dosage & Phenylephrine- Dosage & Administration Administration
2. Paracetamol2. Paracetamol(Anti-Pyretic)(Anti-Pyretic)
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Histamine in Nature Present in: Plants Venom and stings Synthesized by bacteria and certain
fungi
3. Chlorpheniramine Maleate 3. Chlorpheniramine Maleate (CPM)(CPM)
Human Tissue:1. Cells: Mast cells, Basophils, Neurons, Cells in the stomach.
2. Tissues: Skin, Lung, Gastrointestinal tract.
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CPM: Synthesis and Metabolism
Histidine HistamineL-histidine
carboxylase
Methylhistamine
N – methylimidazole acetic acid
histamine methyl transferase
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H-1: H-1: GI & bronchial SM GI & bronchial SM contraction.contraction.
H-2: H-2: Cardiac stimulation, Gastric Cardiac stimulation, Gastric secretion.secretion.
H-1 & H-2: H-1 & H-2: Dilation of arterioles and Dilation of arterioles and veins.veins.
H-3:H-3: Mainly in the CNS, Mainly in the CNS, Preterminal and autoreceptors, Preterminal and autoreceptors, Not considered further.Not considered further.
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Action Histamine Receptor
Bronchial Bronchial contractioncontraction
H-1H-1
GI contractionGI contraction H-1H-1
HeartHeart H-2, H-1 (AV node)H-2, H-1 (AV node)
large artery large artery contractioncontraction
H-1H-1
Microvessel dilationMicrovessel dilation H-1 & H-2H-1 & H-2
Venule permeabilityVenule permeability H-1 & H-2 (?)H-1 & H-2 (?)
Gastric acid Gastric acid secretionsecretion
H-2H-2
CNS arousalCNS arousal H-1H-1
Smooth muscle
antihistamines
Histamine,PG’s, 5-HT, PAF
Drug
Protein
IgE antibody
IgE-Sensitized Cell
Histamine Release from Mast CellsHistamine Release from Mast Cells
Mast Cell
Allergen
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H-1 blockers 1st generation or classical (older) 2nd generation or non-sedating
(newer)
H-2 blockers gastric acid blockers
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1. Block H-1 receptors competitively.
2. Reduce local response to intradermal histamine.
3. Antagonize the vasoconstrictor, and to a lesser extent, the vasodilator effects of histamine.
4. Antagonize histamine-induced bronchospasm.
5. Inhibit GI smooth muscle contractions.
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Developed in France pre-WWII More sedating Penetrate the CNS and generally have CNS
effects Significant anticholinergic effects Example:
CPM: Sedative action, available OTC.Diphenhydramine:highly sedating, available OTC.Hydroxyzine: used frequently for urticaria.Promethazine (Phenergan):anti-motion sickness
activity used by NASA for space motion sickness
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Less sedating - less CNS penetration. Almost no anticholinergic effects. Produce cardiac toxicity: Removed from
the market (Terfenadine , Astemizole).
Loratidine – no apparent cardiac toxicity Fexofenadine - active metabolite of
Terfenadine, safer than parent compound Cetirizine, Levocetrizine – Used for Non-
sedative properties.
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1.Common cold: Symptomatic relief.
2.Local allergic manifestations:Urticaria, rhinitis,
rhinorrhea. 3. Motion sickness: Nausea and
vomiting.
4. Sedative/hypnotic: In sleep remedies (1st generation).
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Soothing action, produces cooling Soothing action, produces cooling sensation and has a mild anesthetic sensation and has a mild anesthetic action.action.
Action: Stimulation of the mucous membranes cold receptors.
Produce a cooling effect when inhaled or come in contact with mucous membrane
Use: Relieve sore throat, or nasal congestion, headache, cold, or sore throat. Products that commonly contain menthol include toothpaste, cough syrups, lip balm, mouthwash, gum, and cigarettes.
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Menthol in Cough Syrups often soothe and cool sore throats by relieving inflammation.
It can also help clear stuffy sinus passages and break up chest congestion.
This usually helps a person to cough less and breathe easier.
The combination of menthol in cough syrup is often an easy treatment that can be given to a person of almost any age.
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ZEDEX - IndicationsZEDEX - Indications
105
ZEDEX - Dosage and AdministrationZEDEX - Dosage and Administration
106
DiagnosisDiagnosis
URTIFlu (Influenza) Rhinitis Common cold0
SinusitisPharyngitisCoryzaSore throat
BronchitisPneumoniaBronchitis
BronchiolitisBronchiectasisBronchopneumonia
LRTI
ZEDEX Rational
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Cough with sputum
Most Most Common Common
SymptomsSymptoms
Chronic coughin
gShortness of
breath
Difficult to cough out sputum
Sore throat
Nose & Throat congestion
Nasal Dischar
ge
Red & swollen mucus
membrane
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Sinuses & Throat Pain (Paracetamol)
Most Effective
Treatment
Fever(Paracetamol)
Difficult to cough out sputum
(Decongestant)Sore
throat (Menthol
)
Nose & Throat congestion
(Antihistamine +
DecongestantNasal Discharge
(Antihistamine +
Decongestant)
Red & swollen mucus membrane
(Antihistamine +
Decongestant)109
Cough Formula
Antihistamine (CPM)
Decongestant (Phenylephrin
e)
Anti-pyretic + Analgesic
(Paracetamol)
Soothing AgentSoothing Agent(Menthol)(Menthol)
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ZEDEX - Product DescriptionZEDEX - Product Description
PackagingPackagingBottle
Shipper pack
Stockiest Price
Retailer Price
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Product Positioning :Product Positioning :
Product Differential :Product Differential :
ZEDEX - Marketing AspectsZEDEX - Marketing Aspects
113
ZEDEX – Target Doctors and IndicationsZEDEX – Target Doctors and Indications
115
ZEDEX – Communication StrategyZEDEX – Communication Strategy
116
ZEDEX – Input PlansZEDEX – Input Plans
117
119
Cold Cough Syrup – Brand TrendsCold Cough Syrup – Brand Trends
120
Thank YouThank You
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