Respiratory system disorders

Lecture 4: Dr. Dina El-Kersh

 Respiratory Tract Disorders
The respiratory system is composed of:
✓ Nasal cavity
✓ Pharynx, Larynx & Trachea
✓ Lungs, bronchi & bronchioles
The major role of the respiratory system is:
1. To provide adequate oxygen for cellular metabolism.
2. Carbon dioxide is excreted through the lungs in the
exhaled air, thus creating proper PH of blood (7.4)
creating proper healthy cells habitat.
Gas exchange occurs across the lung alveoli
http://cbm.msoe.edu/images/contentImages/smartTeams/alumni/2008-09/WauwatosaWest.pdf
Carbonic anhydrase enzyme (CAE): balances the pH of the blood and enables the
breathing out of carbon dioxide.

In RBCs, carbonic anhydrase catalyzes the reaction to convert CO2 into H2CO3,
which further breaks down into bicarbonate ions and protons (H+). The
production of bicarbonate ions and protons regulates the pH of the blood,
creating an environment in which your cells can live.

In the lungs, the reaction is reversed as CAE will break down the H2CO3 to CO2
to be exhaled and H2O. This reaction will maintain the PH of blood by
controlling the H2CO3 and Protons.
The common respiratory tract disorders:
➢ upper respiratory tract disorders such as:
Rhinitis
Common cold & influenza (flu)
Sinusitis

➢ Lower respiratory tract disorders (Cough-associated

diseases) such as:
❖ Asthma
❖ Bronchitis
❖ Pneumonia
❖ Whooping cough
❖ Tuberculosis
 A-Upper Respiratory tract disorders
I-Rhinitis
Definition: Rhinitis is the chronic or acute inflammation, irritation & edema of
the mucous membrane of the nose due to vasodilation of the nose blood
vessels.
Types & Etiology:
1. Infectious (bacterial infection).
2. Non allergic (any unknown irritant=smoke, chemicals,
perfumes, etc..)
3. Seasonal allergic (Irritants are specific to pollen grains, spore molds
or dust hay fever).
Symptoms: Sneezing, itching, nasal congestion & discharge.
Some patients suffer mixed allergic & non allergic rhinitis
 Treatment of seasonal allergic rhinitis
• Treatment must be started 6 weeks before the season
starts and continued through the season.
• You must exclude any food that may cause allergy
• Avoid the source of pollution and dust.
• You can use nasal decongestant for decreasing symptoms

Butterbur herbs & roots Although F. Asteraceae !! (# dog fennel #)

(Petasites vulgaris, Asteraceae)

Antihistaminic : equivelent to cetirizine “zirtec®”

Anti-inflammatory (due to petasins “sesquiterpene lactones)
Page 12:

4.2 Prevention of PA Poisoning:

Prevention of exposure is the only
effective method of limiting toxicity due to
PAs. Even low doses over a period of time
may present a health risk and exposure
should be avoided or minimized as far as
possible. Measures are required at several
action points.
 Nasal Decongestants
Herbal drugs used to relieve nasal congestion by constricting the
blood vessels in the area of congestion resulting in a reduction in
swelling & easier breath.

Rhinitis medicamentosa: Conventional nasal

decongestants “xylometazoline HCl 0.05 %,
oxymetazoline HCl 0.05 %” weaken
immunity & cause a rebound congestion if
taken more than 3 days.
 II. Common cold & influenza
Common cold
Etiology: Viral infection by rhinovirus
of the upper respiratory
system, doesn’t involve the
lungs
Symptoms: ✓ Fever & headache
✓Sore throat & coughing
✓nasal congestion
✓ Runny nose
✓muscle pains & fatigue
✓Chills
✓irritated eyes
Influenza (Flu)
Viral infection by influenza A,
B or C that reaches the lungs
& it is more severe.
The same but more severe
symptoms and:
Can lead to
pneumonia
 Herbs of common cold and flu

Viral cold and flu infection are self-limiting (5-7 days) but may
become complicated by bacterial infections

Treatment of symptoms of Cold & Flu:

➢ Analgesic and anti-inflammatory drugs
➢ Antipyretic
➢ Demulcents & emollients
➢ Immuno-stimulant drugs (Respiratory system)-Nigella
 Herbs used for treatment of common cold & influenza
Drug Plant name Main active Action Photo
constituent(s)
Iceland moss Cetraria Mucilage Demulcent
Lichen (symbiotic islandica
association of a fungus (Parmeliaceae)
with a photosynthetic
partner ‘algae’)

Cinnamon barks Cinnamomum Volatile oil Demlucent &

zeylanicum & C. (cinnamaldehyde anti-inflammatory&
verum , eugenol & expectorant
(Lauraceae) cinnamic acid) &
mucilage
Coltsfoot leaves Tussilago Mucilage, Anti-inflammatory,
flowers & roots farfara flavonoids, demulcent &
(Asteraceae) tannins & toxic immuno-stimulant
pyrrolizidine
alkaloids
(PA-Free)
https://en.wikipedia.org/wiki/Pyrrolizidine_alkaloid
 IV-Sinusitis
Sinuses function are decreasing relatively the weight of
front of the skull, improve the resonance of the voice and
mainly produce thin mucus for moistening inside of the
nose.

Sinusitis is an acute or chronic inflammation of the paranasal sinuses (air-

filled spaces filled with fluids) congestion & mucosal edema resulting in
blocking of the drainage of sinuses & stasis of the accumulated fluids that
allows infection to progress. It is accompanied by nasal congestion, thick nasal
discharge & headache.

Etiology (factors and causes):

Infection (viral or bacterial), allergy-irritants (pollution, dust, smoke), cold &
damp weather, dental problems, trauma, deviated septum or autoimmune
issues.

Herbal treatment:
Nasal decongestant, anti-inflammatory & demlucents (ttt common cold).
 Coughing
Cough is a forceful release of air from the lungs that can be
heard in order to clear it of irritants and secretions.

Types of cough:
1) Dry cough: Free of secretions
2) Cough with thick mucus: Secretions, phlegm, sputum.

Drugs to suppress cough

Local irritation: mucilaginous herbs
Peripheral cough reflex: essential oils
The sensitivity of the "cough center“: opiates
 Phytotherapy of Cough
1-Mucilaginous drugs are demulcent remedies traditionally used
to relieve "dry" coughs. They act as Demulcents & emollients
e.g. Linden, Marshmallow & Coltsfoot.

Mechanism of action:
Form protective layer over the mucus membrane of the epithelium of
pharynx, larynx & trachea so preventing mechanical irritation.

2-Essential oils
Volatile aromatic mixtures of many different components.
Most of the essential oil-containing drugs used to treat cough
by peripheral suppression of cough reflex by decreasing the
sensitivity of cough receptors also have expectorant
properties. (discuss later)
3-Opiates
• They are constituents of opium poppy (Papaver
somniferum) as Morphine and codeine alkaloids.
• with anti-tussive activity.
MOA: Both compounds possess central anti-tussive actions
by their agonist actions on opiate receptors in the
cough center.
Codeine is usually used therapeutically in cough
mixtures.
Disadvantages:
Large doses may cause respiratory depression &
constipation and liable to abuse.
Mechanism of action of herbal products
 B- Cough associated diseases

Bronchial Asthma
It is characterized by difficulty in breathing caused by
broncho-spasm and dyspnea in addition to nasal
congestion & discharge.
The clinical features of asthma result from
Inflammatory response in the airways involving local
inflammatory cell accumulation For cytotoxic mediators
(pro-inflammatory) as leukotrienes & free radicals.
Herbs treating asthma
Ephedra: (alkaloids)
(Ephedrine, pseudoephedrine, norephedrine, norpseudoephedrine).
Uses: Ephedrine is a clinically effective anti-asthmatic drug.

Mode of action:
• Ephedrine directly stimulates α1- and ß2- adrenergic receptors.
• There is also an increase in ciliary activity and liquefaction of
tenacious mucus, resulting in a mild expectorant action.

• Ephedrine acts on α1- adrenergic receptors, produces

vasoconstriction in nasal blood vessels, thus relieving congestion
in the nasal passages.
• Ephedrine stimulates ß2-adrenergic receptors, so relaxes
bronchial smooth muscles.
Adverse events:
Common side effects include
• Irritability
• Headache
• Tremor and palpitation
• Nausea, vomiting
• Sleep disturbances
• Higher dosages of Ephedra may result in
blood pressure and cardiac rhythm disorders.

Contraindications:
The drug is contraindicated in patients suffering from:
• Heart conditions
• Hypertension
• Diabetes
• Thyroid disease
 Bronchitis
Bronchitis indicating inflammation of the bronchi of the lungs

Acute bronchitis:
Short-term inflammation of the bronchi of the lungs
where it occurs in winter months following the same
symptoms of upper respiratory infection as Coughing
with little mucus, chills, sore throat and slight fever.

Chronic bronchitis
Chronic inflammation causes alveolar hypoventilation,
hypercapnia ( CO2/blood) and hypoxia It follows
symptoms of lower respiratory infection as productive
cough with heavy sputum and air way obstruction.
Phytotherapy of Bronchitis
• Bronchodilators (reduce airway constriction)
• Expectorants and mucolytics (reduce mucus viscosity so
easily expelled in productive coughing)

• Bronchodilators:

Ephedra herb ( F. Ephedreacea): Presence of alkaloids

(ephedrine & pseudoephedrine) which cause relaxation of
constricted air ways through B2 adrenergic stimulation.

Lobelia herb ( F. Campanulaceae): Presence of alkaloids

(Lobelin & lobelanine) which cause relaxation of constricted
air ways through B2 adrenergic stimulation.
 • Expectorants and mucolytics
Reflex expectorants: includes
saponin-containing drugs and
drug containing emetic, acid
tasting or bitter compounds.
These expectorants evoke a reflex
stimulation of respiratory
secretion of thin serous mucus
(by activating a parasympathatic
pathway upon contact with the
gastric or duodenal mucosa)
S.E “These drugs can stimulate
the emetic center and will induce
vomiting unless administered in
small quantities”
Direct-acting expectorants:
includes
essential oil containing
drugs.
(In contrast to reflex
expectorants) the essential
oils are well
absorbed after oral
administration & are
partially excreted via the
lung where they stimulate
the serous mucus and ciliated
epithelium
 Thin serous mucus

Reflex
parasympathatic
Pathway stimulation

Mechanism of action of a reflex expectorant

 Thin serous mucus (surfactant
effect) & stimulate ciliated
epithelium

Mechanism of action of a direct acting expectorant

 A - Reflex Expectorants

Snakeroot (Senega) roots Ipeca (or Ipecacuanha) roots Liquorice roots of

“Polygala senega L.” and rhizome of Glycyrrhiza glabra L.
“Cephaelis ipecacuanha”
Triterpenoid saponin Isoquinoline alkaloids Triterpenoid saponin
senegin (emetine, cephaeline ) glycyrrhizin

B - Direct-acting Expectorants
(Essential oil- containing drugs)
Eucalyptus oil Thyme oil
(leaves of Eucalyptus globulus) (leaves of Thymus vulgaris )
volatile oil volatile oil
85% eucalyptol (cineole( Thymol (31-71%) and carvacrol (2.5-15%).
expectorant, mucolytic & antiseptic expectorant, mucolytic and antitussive
 Other cough-associated diseases
Disease Definition Etiology
3) Pneumonia Inflammation of Microorganisms (bacteria, viruses, fungi or
lung alveoli & parasites)= infectious pneumonia
abnormal alveolar
filling with fluid

4) Whooping Infectious disease Infection by the bacterium Bordetella pertussis

cough (pertussis) characterized by
severe coughing
spells that end in a
"whooping" sound
when the person
breathes in, mostly
in children
5) Tuberculosis Infectious disease Infection by the bacterium Mycobacterium
characterized by tuberculosis
chronic cough with
blood-tinged
sputum
Antimicrobial herbal drugs for respiratory tract disorders

Lemon (Citrus limon, Rutaceae)

(rich in vitamin C)

Garlic St John’s wort

Golden seal Chamomile

Licorice
Assignment 2:
 Case study
K.H a male, 42 years, suffering from runny,
decongested nose, bone ache, sore throat, fever
38°C. He always uses Afrin® for his decongested
nose but he wish to have a herbal treatment. He
went to the pharmacy asking for OTC herbal
drugs for his case. He does not suffer from any
chronic diesease.
The case study and the essay question will be
delivered as hard copy to Dr. Eman or Dr. Kahled.

Dead line of proposal: 14/11/2017: It wont be

marked, so please do not overload….