Pharmacology & Therapeutics-II-406 [Theory] Spring 2019: Dr Shah AJ 1

Drugs acting on respiratory system or treatment of chest diseases (Oxford Text book
of medicine (OTBM))

The presenting symptoms of chest diseases are few, but the structural and functional
disturbances that these symptoms reflect are numerous and the underlying disease entities
are many. The symptoms of lower respiratory tract disease can be grouped under just
three headings: cough, breathlessness, and chest pain.

Common diseases of the upper respiratory tract are

Diseases of the nose and nasopharynx

Anosmia: total loss of olfactory (smell) sense,

Perforation of the nasal septum

Rhinosporidiosis

Rhinophma

Ozena (severe chronic rhinitis)

Mycosis leptothrica

Epistaxis

Carcinoma of the nares

Carcinoma of the nasopharynx

Lymphoma

Diseases of the pharnasal sinuses

Sinusitis

Diseases of the larynx

Laryngeal papillomatosis etc, various bacteria are involved

Systematic diseases affecting the larynx, such as cystic fibrosis, lipid proteinosis,
myxedema, aromegaly etc.

Carcinoma of the larynx

Paralysis of the vocal cords

Common diseases of the lower respiratory tract are

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 Pharmacology & Therapeutics-II-406 [Theory] Spring 2019: Dr Shah AJ 2

Chronic airway obstruction due to asthma, bronchitis and empysema (destruction of

basement membranes between the alveoli)

Bronhiectasis (permanent abnormal dilatation of one or more large bronchi), lung abscess
(lesion of lung parenchyma) and broncholithiasis/bronchial stones (occurs when calcified
particles in the lymph node or the lung parenchyma erode into a contiguous bronchus.

Diffused infiltrative diseases of the lungs; eg

Inflammatory and neoplastic infiltration
Non cellular (infiltration by edema, fluid, amyloid, etc

Disorders of regulation of respiration, eg

Hypoventilation and hypoventilation
Pulmonary thromboembolism

Hypersensitive reactions of the lung

The eosinophilic phneumonias
Pneumonias from specific exposures such as farmer’s lung
Disease from humidifiers and air conditioners
Maple bark disease
Mushroom-workers’s lung
Bagassosis
Pigeon breeder’s disease (chill, fever, cough, breathlessness etc)

Environmental lung disease

Primary pulmonary hypertension

Neoplasm of the lung

Diseases of the pleura, mediastinum and diaphragm

Core pulmonale (enlargement of the right ventricle secondary to malfunctioning lungs)

Acute respiratory failure

Source: Harrison’s Principles of Internal Medicine 7the edition page 1272-1343.

Common symptoms of all respiratory diseases are cough, breathlessness etc. The current
pharmacology course will cover drugs used to treat cough and some common diseases
such as asthma and COPD

COUGH
Introduction:
Cough, one of the most frequent cardiorespiratory symptoms, is an explosive expiration
with provides a means of clearing the tracheobronchial tree of sections and foreign bodies

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(Harrison’s). Cough is a sudden noisy expulsion of air from the lungs, usually produced
to keep the airways of the lungs free of foreign matters or the clearing of the airways
from foreign matters. Cough is a useful physiological mechanism that serves to clear the
respiratory passages of foreign material and excess secretions.

Mechanism of coughing
Coughing may be initiated either voluntarily or reflexly. As a defensive reflex it has both
afferent and efferent pathways. The afferent limb includes cough receptor with the
sensory distribution of the trigeminal, glasso-pharngeal, superior laryngeal, and vagus
nevers. The efferent limb includes the recurrent laryngeal nerve (that cause glottis
closure), and the spinal nerves (that cause contraction of the throracic and abdominal
musculature).
The sequence of a cough includes an appropriate stimulus which initiates a deep
inspiration. This is followed by
glottis closure,
relaxation of the diaphragm, and
muscle contraction against a closed glottis so as to produce maximally positive intra-
thoracic and intra-airway pressures.

These positive intra-thoracic pressures result in a narrowing of the trachea, produced by

an infolding of its more complaint posterior membrane. Once the glottis opens, the
combination of a large pressure differentiate between the airways and the atmosphere
coupled with this tracheal narrowing produces flow rates through the trachea close to the
speed of sound. The shearing forces which are developed aid in the elimination of mucus
and foreign materials. A tracheostomy short-circuits glottis closure and therefore
decreases the effectiveness of the cough mechanism.

The coughing consists of three phases:

 an inhalation,
 a forced exhalation against a closed glottis, and
 a violent release of air from the lungs following opening of the glottis,
usually accompanied by a distinctive sound.
Coughing can happen voluntarily as well as involuntarily.
Frequent coughing usually indicates the presence of a disease. Many viruses and bacteria
benefit evolutionarily by causing the host to cough, which helps to spread the disease to
new hosts.
Most of the time, coughing is caused by a respiratory tract infection but can be triggered
by choking, smooking, air pollution, asthma, gastroesophageal reflux disease, chronic
bronchitis, heart failure and medications such as ACE inhibitors.

The cough reflex is initiated through chemical or mechanical stimulation of receptors

located in many parts of the respiratory tract, such as, epithelium of the pharynx, larynx,
trachea, bronchi and diaphragm.
The cough reflex is complex, involving the central and peripheral nervous systems, as
well as the smooth muscle of the bronchial tree. It has been suggested that irritation of the
bronchial mucosa causes bronchoconstriction, which, in turn, stimulates cough receptors

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(which probably represent a specialized type of stretch receptor) located in

tracheobronchial passages.
Afferent conduction from these receptors is via fibers in the vagus nerve; central
components of the reflex probably include several mechanisms or centers that are distinct
from the mechanisms involved in the regulation of respiration.

Lecture 2, March 7, 2019