• 1) Inflammation of the mucous membrane of the bronchial tubes
2) asthmatic bronchitis, bronchitis which causes or aggravates
bronchospasm.
3) chronic bronchitis, a condition of the bronchial tree
characterized by cough, hypersecretion of mucus, and
expectoration of sputum over a long period of time, associated
with frequent bronchial infection; usually due to inhalation, over
a prolonged period, of air contaminated by dust or by noxious
gases of combustion.
4) Acute bronchitis is usually a short, severe illness that may
show up along with a cold or follow other viral infections such as
measles or whooping cough.
• The top left illustration shows
the normal pulmonary tree,
while the lower right
illustration at the bottom
shows what happens during an
attack of bronchitis. The
inflammation of the bronchi
and bronchial tubes produces
a buildup of mucus. The
thickened mucus forms a plug
that can block bronchial tubes,
the passages that carry air
from the trachea (windpipe)
to the alveoli (air sacs) of the
lungs. This results in the
difficult breathing
characteristic of bronchitis
• Routine antibiotic treatment of uncomplicated acute bronchitis is
not recommended, regardless of duration of cough. If pertussis
infection is suspected (an unusual circumstance), a diagnostic test
should be performed and antimicrobial therapy initiated
• Both bronchitis and pneumonia are serious diseases affecting
the lower respiratory tract. They can lead to a lot of discomforts
and, if left untreated, may cause other serious conditions. There
are a number of differences between the two.
•
Pneumonia manifests itself in the
• Bronchitis manifests itself
form of high fever, cough and
as a cough with headache,
chills. It is accompanied by rapid
breathing and a certain amount of
chills and a slight fever. A
wheezing. The patient often
patient may also experience
complains of chest pain. Some
a shortness of breath.
patients also feel extremely
exhausted and nauseous. The
symptoms of viral pneumonia
often resemble those of ordinary
flu. There are chills and high fever.
It is often accompanied by
chattering teeth. It may also
produce sputum that is green,
yellow or rust colored. Pneumonia
becomes apparent when the patient
experiences a shortness of breath.
• The treatment for bronchitis is
relatively simple. Once identified
the reasons for the infection, a
course of antibiotics will be
administered. Patient will be
advised rest and will need to avoid
pollution and smoke.
• Pneumonia is more of a serious
affliction. If the patient have been
diagnosed with this disease, will be
prescribed a strong antiviral or
antibiotics. If the condition worsens,
the patient may be hospitalized
anywhere between one and three
days, depending on the seriousness
of condition.
Medications:
• Dozens of antibiotics are
available for treating pneumonia,
but selecting the best drug is
sometimes difficult. Patients with
pneumonia need an antibiotic
that is effective against the
organism causing the disease.
When the organism is unknown,
"empiric therapy" is given,
meaning the doctor chooses
which antibiotic is likely to work
based on factors such as the
patient's age, health, and severity
of the illness.
• Joint guidelines issued in 2007 by the Infectious Disease
Society of America and the American Thoracic Society
(ITSA/ATS) recommend that mild CAP in otherwise healthy
patients be treated with oral macrolide antibiotics
(azithromycin, clarithromycin, or erythromycin).
• Many patients with heart disease, kidney disease, diabetes,
or other co-existing conditions may still be treated as
outpatients. However, they should be given a
fluoroquinolone (moxifloxacin, gemifloxacin, or levofloxacin)
or a beta-lactam (preferably high-dose amoxicillin or
amoxicillin-clavulanate), plus a macrolide, unless they live in
an area with high S. pneumoniae resistance to macrolides.
•
• There are not as many choices for treating viral
pneumonia. Oseltamivir (Tamiflu) and zanamivir
(Relenza) have been the recommended drugs for
influenza A or B infections, but many strains of
influenza A have become resistant. Their use is only
recommended if they are started in the first 48 hours
of symptoms. Taken early, these medications may be
effective in reducing symptoms and duration of
illness.
• Patients with viral pneumonias are at risk for what are called
"superinfections," which generally refers to a secondary bacterial infection,
usually caused by S. pneumoniae, S. aureus, or H. influenzae. Doctors most
commonly recommend treatment with amoxicillin-clavulanate,
cefpodoxime, cefprozil, cefuroxime, or a respiratory fluoroquinolone if
these secondary infections occur.
• Patients with pneumonia caused by varicella-zoster and herpes simplex
viruses are usually admitted to the hospital and treated with intravenous
acyclovir for 7 days.
• No antiviral drugs have been proven effective in adults with RSV,
parainfluenza virus, adenovirus, metapneumovirus, the SARS coronavirus,
or hantavirus. Treatment is largely supportive, with patients receiving
oxygen and ventilator therapy as needed.
• Treatment of RSV in Children. Ribavarin is the first treatment approved for
RSV pneumonia, although it has only modest benefits. The American
Academy of Pediatrics recommends this drug for children who are at high
risk for serious complications of RSV.
Expectorants, more accurately known as bronchomucotropic agents, are drugs used to assist in
the removal of secretions or exudate from the trachea,
bronchi, or lungs. They act by liquifying viscid mucus or
mucopurulent exudates, i.e., they
are decongestants. Therefore, they are used in the
treatment of coughs to help expel these exudates
and secretions.
Antitussives are agents that specifically inhibit or suppress
the act of coughing. They should not be used to suppress
productive cough ing. Expectorants and antitussives are most
commonly used in the symptomatic treatment of the
common cold or bronchitis.
• Coughing is the forceful expulsion of air from the lungs. A cough
may be productive or nonproductive. With a productive cough,
secretions from the lower
respiratory tract are expelled. A nonproductive cough is a dry,
hacking one that produces no secretions. An antitussive is a drug
used to relieve coughing. Many antitussive drugs are combined
with another drug, such as an antihistamine or expectorant, and
sold as nonprescription cough medicine. Other antitussives, either
alone or in combination with other drugs, are available by
prescription only.
ACTIONS
Some antitussives depress the cough center located in the
medulla and are called centrally acting drugs. Codeine and
dextromethorphan are examples of centrally acting antitussives. Other antitussives are peripherally acting drugs, which
act by anesthetizing stretch receptors in the respiratory passages,
thereby decreasing coughing. An example of
a peripherally acting antitussive is benzonatate (Tessalon), libexin.
USES
Antitussives are used to relieve a nonproductive cough.When the cough is
productive of sputum, it should be treated by the primary health care provider
who, based on a physical examination, may or may not prescribe or recommend
an antitussive.
ADVERSE REACTIONS
Use of codeine may result in respiratory depression, euphoria, lightheadedness, sedation, nausea, vomiting,and hypersensitivity reactions. The
more common adverse reactions associated with the antitussives When used as
directed, nonprescription cough medicines containing two or more ingredients
have few adverse reactions. However, those that contain an antihistamine may
cause drowsiness.
CONTRAINDICATIONS
Antitussives are contraindicated in patients with known hypersensitivity to the
drugs. The narcotic antitussives (those with codeine) are contraindicated in
premature infants or during labor when delivery of a premature infant is
anticipated. Codeine is a Pregnancy Category C drug except in the pregnant
woman at term
or when taken for extended periods, when it is considered a Pregnancy
Category D drug.
•
Classification:
一．Central antitussives
1. Dependent central antitussives
2. Independent central antitussives
二．Peripheral antitussives
• Opioid alkaloids.
• Morphine is the most effective drug for the suppression of cough,
but have addiction.
• Mechanism: suppressing of cough center
• Selectively suppress cough center in medulla oblongata
• Potency:
• Suppression of cough: ≈1/10 of morphine
• Analgesia: ≈1/7 of morphine
• Respiratory depression, constipation, tolerance, dependence ＜ that of
morphine
• Pharmacokinetics:
• Well absorbed from oral and injection.
• 10% converted to morphine through demethylation
• Clinical Uses:
• Dry cough
• Adverse Reactions:
• Respiratory suppression in high dose;
• Tolerance and physical dependence with frequently repeated
administration;
• Suppress secretion of bronchial gland and movement of cilia.
•
•
Stereoisomers of opioid molecules that are devoid of
analgesic effects and addiction liability.
Classification:
1)
2)
3)
4)
5)
-orphan-antitussives : dextromethorphan
amido-antitussives: pentoxyverine, clofedanol
piperidine-antitussives: cloperastine
morpholine-antitussives: promolate, fominoben;
others: eprazinone, zipeprol.
• Dextrorotatory stereoisomers of a methylated derivative of
levorphanol
• Clinical Use:
• Dry cough. Often + Antihistamine drug
• Suppression of cough: ≈1/3 of codeine.
• Direct suppression of cough center
• Atropine-like action and local anesthesia action.
• Derivative of diphenhydramine
• Suppression of cough center
• Blocking H1-receptor
•
Inhibiting receptor, afferent nerve, efferent nerve of cough
reflex arc → cough suppression.
1.
2.
local anesthesia action: narcotine, benzonatate;
Alleviative action: extractum glycyrrhizae liquidum, Syrup
•
•
I.
Mucokinetic drugs
Classification:
By the mechanism of action:
1.
2.
Mucus secretagogue drugs: stimulating gastric mucosa →
reflex secretion of bronchial gland↑ → dilution of sputum:
ammonium chloride.
Mucolytic drugs:
1)
2)
3)
4)
break acid mucin: bromhexine
drug-SH
S-S of mucin → Fragmentation: acetylcysteine
Enzymolysis: α-chymotrypsin
Surfactant: tyloxapol----Fog inhalation