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    Dr. Swagath, Hassan

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    Swagath N
    This document discusses cough, its causes, types, diagnosis and treatment. It defines cough as a sudden thrust of air from the lungs through the airways. Coughs are classified as acute (<3 weeks), subacute (3-8 weeks) or chronic (>8 weeks). Common causes of acute cough include upper respiratory infections, allergies and COPD exacerbations. Chronic cough differential diagnosis includes post-nasal drip, GERD, asthma, bronchitis, COPD, heart failure and lung cancer. Treatment involves addressing the underlying cause as well as symptomatic relief with antitussives, expectorants, demulcents and bronchodilators. The drug Dilo-BM is described as an expect

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    Dr. Swagath, Hassan

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    Swagath N
    62 views29 pages
    This document discusses cough, its causes, types, diagnosis and treatment. It defines cough as a sudden thrust of air from the lungs through the airways. Coughs are classified as acute (<3 weeks), subacute (3-8 weeks) or chronic (>8 weeks). Common causes of acute cough include upper respiratory infections, allergies and COPD exacerbations. Chronic cough differential diagnosis includes post-nasal drip, GERD, asthma, bronchitis, COPD, heart failure and lung cancer. Treatment involves addressing the underlying cause as well as symptomatic relief with antitussives, expectorants, demulcents and bronchodilators. The drug Dilo-BM is described as an expect

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    This document discusses cough, its causes, types, diagnosis and treatment. It defines cough as a sudden thrust of air from the lungs through the airways. Coughs are classified as acute (<3 weeks), subacute (3-8 weeks) or chronic (>8 weeks). Common causes of acute cough include upper respiratory infections, allergies and COPD exacerbations. Chronic cough differential diagnosis includes post-nasal drip, GERD, asthma, bronchitis, COPD, heart failure and lung cancer. Treatment involves addressing the underlying cause as well as symptomatic relief with antitussives, expectorants, demulcents and bronchodilators. The drug Dilo-BM is described as an expect

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    62 views29 pages

    Dr. Swagath, Hassan

    Uploaded by

    Swagath N
    This document discusses cough, its causes, types, diagnosis and treatment. It defines cough as a sudden thrust of air from the lungs through the airways. Coughs are classified as acute (<3 weeks), subacute (3-8 weeks) or chronic (>8 weeks). Common causes of acute cough include upper respiratory infections, allergies and COPD exacerbations. Chronic cough differential diagnosis includes post-nasal drip, GERD, asthma, bronchitis, COPD, heart failure and lung cancer. Treatment involves addressing the underlying cause as well as symptomatic relief with antitussives, expectorants, demulcents and bronchodilators. The drug Dilo-BM is described as an expect

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    of 29

    HASSAN

    For the use only of a registered medical practitioner


    Cough
    A cough is a sudden and variable sudden thrust of air from the
    lung and through the air passages associated with phonation,
    which momentarily interrupts the physiology of breathing,
    It is the most common symptom of respiratory disorders
    Serves the functions of defending respiratory tract against noxious
    substances

    Maintains airway patency by removing excessive secretions or foreign body


    from air passages1

    All children experience coughs and colds.

    Coughing in children can be distressing and affects childs sleep,


    school performance and ability to play.
    Clinical Significance
    Cough is cardinal manifestation of respiratory diseases

    Pathologic conditions that


    irritate the airways,

    increase their irritability,

    result in their deformation, or

    increase the tracheobronchial secretions cause cough


    These factors may operate singly or in various combinations
    Three Categories of Cough
    Acute Cough = < 3 Weeks Duration

    Subacute Cough = 3 8 Weeks Duration

    Chronic Cough = > 8 Weeks Duration


    Differential Diagnosis Acute Cough
    Upper Respiratory Tract infections:
    -Viral syndromes, sinusitis viral / bacterial
    Allergies
    Exacerbation of Chronic Obstructive Pulmonary Disease
    (COPD)
    Left Ventricular Heart Failure
    Pneumonia
    Foreign Body Aspiration
    Common Cold/Viral Rhinosinusitis

    Presentation:
    Symptoms Nasal Passages
    Rhinorrhea, Sneezing, Nasal obstruction, Post
    nasal drip

    Signs - +/- Fever, +/- throat irritation,


    normal chest auscultation
    Diagnostic No Laboratory or X-ray
    Common Cold/Viral Rhinosinusitis

    Treatment

    Antihistamine (H1) + Pseudoephedrine

    Treatment Failure

    Viral Rhinosinusitis

    VS
    Bacterial Rhinosinusitis
    Viral vs. Bacterial Rhinosinusitis

    Viral Bacterial

    Most Common Less Common


    Treat empirically Treat in cases of treatment failure
    Treat for set criteria
    Criteria Bacterial Rhinosinusitis

    Treatment failure

    Two of the following signs or symptoms


    1.Maxillary Tooth Ache
    2. Purulent Nasal Discharge
    3. Abnormal Sinus Trans-illumination
    4. Discolored Nasal Discharge
    Treatment

    Antihistamine + Pseudoephedrine
    +
    Oxymetazoline (Afrin)
    +
    Antibiotics against H. influenza and Streptococcus
    pneumonia
    (Bactrim TMP/Sulfa or Amoxacillin)
    Sub-acute Cough 3-8 Weeks
    Subacute Cough Differential Diagnosis

    Post-infectious

    Bacterial Sinusitis

    Asthma
    Post Infectious Cough
    A cough that begins with an acute respiratory tract
    infection and is not complicated* by pneumonia

    *Not complicated = Normal lung exam


    normal chest X-ray
    Post Infectious Cough

    Post Infectious cough will resolve without


    treatment

    Cause = Postnasal drip or Tracheobronchitis


    Chronic Cough
    Duration > 8 Weeks

    Chronic Cough Differential Diagnosis


    Post Nasal Drip (Nose and Sinus Conditions)

    Gastroesophogeal Reflux Disease

    Chronic Bronchitis from Tobacco

    Chronic Obstructive Pulmonary Disease

    Left Ventricular Heart Failure

    Lung Cancer

    Tuberculosis

    Asthma

    Recurrent pulmonary aspiration (congenital anomalies)


    Patients Who Present With Chronic Cough Should
    Receive a Chest X-ray When Possible
    Chest X-ray and Differential Diagnosis

    Normal X-ray Abnormal X-ray

    Post Nasal drip Tuberculosis


    Reflux Disease COPD
    Asthma Heart Failure
    Chronic Bronchitis Lung Cancer
    Cough with Bronchospasm
    Some conditions wherein bronchospasm is cause of cough

    Epithelial damage caused by infection

    Exposure to noxious gases

    Chronic bronchitis

    Asthma

    Allergic rhinitis

    Shields MD. Thorax 2008;63 (Suppl. III) : iii1iii15


    Management of cough
    Whenever possible, treat the underlying cause1

    Specific treatment2
    Antibiotics (e.g. macrolide for pertussis)

    Asthma therapy

    Foreign body removal

    Antihistamines and intranasal steroids for an allergic cough in the pollen season

    Symptomatic Treatment - 1. Antitussive agents2

    2. Mucolytics/ Expectorants3

    3. Pharyngeal demulcents3

    4. Bronchodilators3
    Antitussive agents
    Only for dry unproductive cough or when cough is exhausting

    Mechanism
    Raise threshold of cough centre in CNS

    Or Act in respiratory tract to reduce tussal impulses

    Or both

    Opioids Codeine, Pholcodeine


    Side effects Constipation, Drowsiness, Respiratory Depression at higher doses

    Nonopioids Dextromethorphan
    Advantage - No Constipating Action

    Side effects - Headache, Nausea occasionally

    Barnes P. The Pharmacological basis of Therapeutics 12th ed; 2011. p. 1057-8 CNS Central nervous system
    Tripathi KD . Essentials of Medical Pharmacology, 5th ed; 2003. p 195-198 S/e- Side effects
    Antitussive agents
    Only for dry unproductive cough or when cough is exhausting

    Antihistamines Chlorpheniramine, diphenhydramine,


    Promethazine
    Mechanism - Relief in Cough due to Sedative and Anticholinergic Action

    Side effects - Sedation, Dryness of Mouth

    Tripathi KD . Essentials of Medical Pharmacology, 5th ed; 2003. p 195-198


    Mucolytics / Expectorants
    For Productive Cough
    Bromhexine
    Derivative of alkaloid vasicine from Adhatoda vasaka (Vasaka)

    Mechanism - Depolymerises mucopolysaccharides directly and by liberating


    lysosomal enzymes

    Side effects - rhinorrea, lacrymation, gastric irritation, hypersensitivity

    Ambroxol
    Metabolite of bromhexine, similar properties

    Others
    Sodium citrate, ammonium chloride potassium iodide, guaiphenesin, balsam of
    tolu

    Tripathi KD . Essentials of Medical Pharmacology, 5th ed; 2003. p 195-198


    Pharyngeal demulcents

    Lozenges, cough drops, linctuses containing syrup, glycerine,


    liquorice
    Soothen throat

    Reduce afferent impulses from inflammed/irritated pharyngeal mucosa

    Provide symptomatic relief

    Tripathi KD . Essentials of Medical Pharmacology, 5th ed; 2003. p 195-198


    Bronchodilators
    Used when element of bronchoconstriction is present

    Stimulation of pulmonary receptors may lead to Cough and


    Bronchoconstriction

    Bronchodilators
    1. Relieve cough

    2. Improve effectiveness of cough in clearing secretions

    E.g. salbutamol, terbutaline


    Side effects Most common - muscle tremors; tachycardia and arrhythmias
    are less likely

    Tripathi KD . Essentials of Medical Pharmacology, 5th ed; 2003. p 195-198


    Dilo BM : Composition

    Ambroxol may increase Terbutaline sulphate selective


    quantity and decrease 2 stimulant - help alleviate
    viscosity of tracheobronchial bronchospasm associated with
    secretions cough

    Menthol increases threshold


    Guaiphenesin is an
    of cough receptors located in
    expectorant
    the respiratory tract
    Full prescribing information available on request
    For productive cough when associated with Bronchospasm
    Dose
    Children : 3 times a day
    6 to 12 years : 1 teaspoonfuls (5 ml)
    2 to 6 years : 1/2 teaspoonfuls (2.5 ml)

    Prescribing information for DILO-BM Expectorant 01IND06 19/10/06 JK


    Abbreviated Prescribing Information of Dilo-BM Expectorant
    ACTIVE INGREDIENT: Each 5 ml (one teaspoonful) contains Ambroxol Hydrochloride BP 30 mg, Guaiphenesin IP 50 mg and
    Terbutaline Sulphate IP 1.25 mg in flavoured syrup base containing Menthol IP. INDICATIONS: Treatment of productive
    cough associated with bronchospasm in conditions such as bronchitis, bronchial asthma, chronic obstructive pulmonary
    disease (COPD), bronchiectasis, and emphysema. DOSAGE AND ADMINISTRATION: 3 times daily in following doses:
    Adults - 2 teaspoonfuls (10 ml). Children (6 to 12 years) - 1 teaspoonfuls (5 ml). Children (2 to 6 years) - 1/2 teaspoonfuls (2.5
    ml). CONTRAINDICATIONS: Hypersensitivity to any of the ingredients. WARNINGS AND PRECAUTIONS: Treat
    underlying cause such as specific infection. Caution in patients with hypertension, cardiovascular disease (including
    arrhythmias, coronary insufficiency), uncontrolled diabetes mellitus, hyperthyroidism, history of seizures, or in patients who
    are unusually responsive to sympathomimetic amines. Patients susceptible to hypokalemia should be monitored. DRUG
    INTERACTIONS: Monitor patients receiving concomitant corticosteroids as adverse metabolic effects of terbutaline may be
    exacerbated. Hypokalemia with high doses of 2 agonists may result in increased susceptibility to digitalis induced cardiac
    arrhythmias. Hypokalemia may be enhanced by concomitant aminophyllin or other xanthines, corticosteroids or diuretics.
    Terbutaline reduces serum theophylline concentrations, but may or may not have clinical implications. Dosage may be
    increased if respiratory symptoms persist, while monitoring theophylline side-effects and concentration. Other
    sympathomimetic bronchodilators or epinephrine (except judicious use of an aerosol adrenergic stimulant bronchodilator)
    should not be used concomitantly with terbutaline sulphate. Use with caution in patients treated with monoamine oxidase
    (MAO) inhibitors or tricyclic antidepressants. Furazolidone (MAO inhibiting activity) should not be used concurrently.
    Patients requiring treatment for both bronchospastic disease and hypertension should not be treated with -blockers for
    hypertension as they block pulmonary effect of terbutaline and may produce severe asthmatic attacks in asthmatic patients.
    EFFECTS ON ABILITY TO DRIVE AND USE MACHINES: No special precautions required. PREGNANCY: Prescribe only
    when potential benefits outweigh risks. ADVERSE EFFECTS: Ambroxol: Dermatological findings (e.g. contact dermatitis,
    urticaria, exanthema, itching, pruritic erythema and vesicular eruptions about the nose, upper lips, and cheeks), pharyngeal
    soreness and spasm and gastrointestinal findings (e.g. dry mouth, diarrhea, constipation, nausea and vomiting, and
    sialorrhea). Guaiphenesisn: Occasional gastrointestinal discomfort, nausea and vomiting with very large doses. Terbutaline:
    Most commonly: tremor and nervousness. Others: increased heart rate, palpitations, dizziness, headache, drowsiness,
    vomiting, nausea, sweating, and muscle cramps. Effects generally transient and usually do not require treatment. OVERDOSE:
    Overdose of terbutaline may lead to significant drop in blood pressure.
    Full Prescribing Information available on request from:
    GlaxoSmithKline Pharmaceuticals Limited, Dr Annie Besant Road, Worli, Mumbai 400 030 (India).
    API/01/VD/Aug 07

    Valid upto March 2014

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