This is a title slide titled "Drug Therapy of Cough & COPD." The subtitle emphasizes a focus on pharmacologic and non-pharmacologic approaches.

Drug Therapy of Cough & COPD

Focus on pharmacologic and non-pharmacologic approaches

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Ed)

This presentation agenda outlines four main topics: cough introduction and reflex pathway (slides 3-4), cough pharmacologic therapy like demulcents and antitussives (slides 5-9), and non-pharmacologic cough measures (slide 10). It concludes with a COPD overview, including pathophysiology, pharmacotherapy, guidelines, and monitoring (slides 11-16).

Presentation Agenda

1. Cough Introduction & Reflex Pathway

Overview of cough physiology and reflex arc (Slides 3-4)

2. Cough Pharmacologic Therapy

Demulcents, expectorants, mucolytics, antitussives, antihistamines (Slides 5-9)

3. Non-Pharmacologic Cough Measures

Alternative management strategies for cough relief (Slide 10)

4. COPD Overview & Pharmacotherapy

Pathophysiology, therapy, guidelines, monitoring, effects (Slides 11-16) Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

Cough is a protective reflex that clears airways of irritants, classified as acute if lasting less than 3 weeks or chronic if over 8 weeks. Common causes include infections, asthma, GERD, ACE inhibitors, and COPD.

Introduction to Cough

• Protective reflex clearing airways of irritants.
• Acute: <3 weeks duration.
• Chronic: >8 weeks duration.
• Causes: infections, asthma, GERD, ACEIs, COPD.

Source: Based on Tripathi Ch. 25.

The cough reflex pathway starts when sensory receptors in the larynx and trachea detect irritants, sending afferent signals via the vagus nerve to the medulla's cough center. The center then activates efferent phrenic nerves and signals to recurrent laryngeal and expiratory muscles.

Cough Reflex Pathway

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• Sensory receptors in larynx/trachea detect irritants
• Afferent signals via vagus nerve to medulla
• Cough center activates efferent phrenic nerves
• Efferent to recurrent laryngeal and expiratory muscles

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Ed.)

The slide table on Demulcents & Expectorants lists Honey and Glycerol as demulcents that soothe mucosal irritation for dry cough and throat relief. Guaifenesin is an expectorant that increases bronchial secretions via vagal reflex, used for productive cough and COPD.

Demulcents & Expectorants

{ "headers": [ "Drug", "MOA", "Uses" ], "rows": [ [ "Honey", "Soothes mucosal irritation", "Dry cough relief" ], [ "Glycerol", "Soothes mucosal irritation", "Throat irritation, dry cough" ], [ "Guaifenesin", "Increases bronchial secretions (vagal reflex)", "Productive cough, COPD" ] ] }

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

This slide features a table on mucolytics, listing drugs like Bromhexine (8-16 mg TDS), Ambroxol (30 mg TDS), Acetylcysteine (600 mg BD), and Carbocisteine (750 mg TDS) with their mechanisms and uses. Mechanisms include depolymerizing mucopolysaccharides or cleaving disulfide bonds, primarily for bronchitis, COPD exacerbations, and CF.

Mucolytics

{ "headers": [ "Drug", "Adult Dose", "Mechanism", "Evidence/Uses" ], "rows": [ [ "Bromhexine", "8-16 mg TDS", "Depolymerizes mucopolysaccharides", "Acute/chronic bronchitis" ], [ "Ambroxol (AMB)", "30 mg TDS", "Depolymerizes mucopolysaccharides", "Improves expectoration; COPD" ], [ "Acetylcysteine", "600 mg BD oral", "SH groups cleave disulfide bonds", "COPD exacerbations; CF" ], [ "Carbocisteine", "750 mg TDS", "Mucopolysaccharide polymer cleavage", "Chronic bronchitis; modest benefit" ] ] }

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

Centrally acting antitussives suppress the cough reflex by targeting the medulla's cough center. Codeine (opioid, 10-20mg dose) is potent but risks drowsiness, constipation, and dependence, while safer non-opioid dextromethorphan is preferred for non-productive dry coughs, avoiding use in sputum-producing cases.

Antitussives: Centrally Acting

{ "features": [ { "icon": "🧠", "heading": "Suppress Cough Center", "description": "Act on medulla to inhibit cough reflex centrally." }, { "icon": "💊", "heading": "Codeine (Opioid)", "description": "Dose 10-20mg; potent antitussive for dry cough." }, { "icon": "⚠️", "heading": "Codeine Side Effects", "description": "Drowsiness, constipation, dependence risk." }, { "icon": "🛡️", "heading": "Dextromethorphan (Non-Opioid)", "description": "Safer, non-addictive cough suppression." }, { "icon": "📋", "heading": "Clinical Use", "description": "For non-productive cough; avoid in sputum-producing cases." } ] }

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

Peripherally acting antitussives include local anesthetics like lignocaine nebulizers, which block sensory nerve impulses, and antihistamines such as diphenhydramine and promethazine, which suppress allergic cough. They reduce irritation from post-nasal drip or allergens and are effective for irritant cough with minimal systemic effects.

Antitussives: Peripherally Acting

• Local anesthetics (lignocaine nebulizer): block sensory nerve impulses
• Antihistamines (diphenhydramine, promethazine): suppress allergic cough
• Reduce irritation from post-nasal drip or allergens
• Effective for irritant cough with minimal systemic effects

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

H1 blockers like chlorpheniramine help allergic cough or URTI through sedative effects that promote rest and reduce cough frequency, plus anticholinergic actions that dry secretions for relief. Avoid them in acute cough and reserve for specific indications.

Antihistamines in Cough

• H1 blockers (e.g., chlorpheniramine) useful in allergic cough/URTI
• Sedative effects promote rest and reduce cough frequency
• Anticholinergic actions dry secretions and aid relief
• Avoid in acute cough; reserve for specific indications

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

Non-pharmacologic measures for cough include maintaining hydration, using humidification and steam inhalation, postural drainage, and avoiding irritants like smoking. Honey is recommended for nocturnal cough in children over 1 year old.

Non-Pharmacologic Measures for Cough

• Maintain adequate hydration
• Use humidification and steam inhalation
• Perform postural drainage
• Avoid irritants and smoking
• Administer honey for nocturnal cough in kids >1 yr

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

This section header slide (Section 10) is titled "COPD Management Overview" within the broader topic of Drug Therapy of Cough & COPD. It defines COPD as chronic obstructive pulmonary disease involving airflow limitation, emphysema, and chronic bronchitis, emphasizing GOLD guidelines.

Drug Therapy of Cough & COPD

10

COPD Management Overview

Chronic Obstructive Pulmonary Disease: Airflow limitation, emphysema/chronic bronchitis. GOLD guidelines emphasis.

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

COPD pharmacotherapy includes SABA (Salbutamol) for short-acting relief, LABA (Salmeterol) and anticholinergics (Tiotropium) for long-acting maintenance bronchodilation. ICS (Budesonide) is used for severe exacerbations, with triple therapy (LABA + LAMA + ICS) recommended for advanced cases.

COPD Pharmacotherapy

• SABA (Salbutamol): Short-acting relief bronchodilator
• LABA (Salmeterol): Long-acting maintenance bronchodilator
• Anticholinergics (Tiotropium): Long-acting muscarinic antagonist
• ICS (Budesonide): For exacerbations in severe cases
• Triple therapy: LABA + LAMA + ICS for advanced COPD

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

The GOLD COPD guidelines classify patients into groups A-D based on symptoms and exacerbations. Initial therapy is SABA for low-symptom/low-exacerbation group A, LABA/LAMA for high-symptom/low-exacerbation group B, and triple therapy (ICS + LABA + LAMA) for high-exacerbation groups C and D.

COPD Treatment Guidelines (GOLD)

{ "headers": [ "Group", "Symptoms/Exacerbations", "Initial Therapy" ], "rows": [ [ "A", "Low symptoms, 0-1 exacerbations", "SABA" ], [ "B", "High symptoms, 0-1 exacerbations", "LABA/LAMA" ], [ "C", "Low symptoms, ≥2 exacerbations", "Triple (ICS + LABA + LAMA)" ], [ "D", "High symptoms, ≥2 exacerbations", "Triple (ICS + LABA + LAMA)" ] ] }

Source: Tripathi & GOLD

Monitoring in COPD therapy involves tracking FEV1 for lung function, CAT score for symptom severity, and annual exacerbation frequency. It also requires assessing inhaler therapy adherence and performing periodic lung function tests.

Monitoring in COPD Therapy

• Monitor FEV1 to assess lung function
• Evaluate CAT score for symptom severity
• Track exacerbation frequency annually
• Assess adherence to inhaler therapy
• Perform periodic lung function tests

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

This slide outlines key adverse effects of cough and COPD drugs. Antitussives cause sedation, mucolytics GI upset, beta-agonists tremor, and inhaled corticosteroids oral candidiasis plus pneumonia risk.

Adverse Effects: Cough & COPD Drugs

• Antitussives: Sedation
• Mucolytics: GI upset
• Beta-agonists (COPD): Tremor
• Inhaled corticosteroids (COPD): Oral candidiasis
• Inhaled corticosteroids (COPD): Pneumonia risk

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)

The conclusion slide highlights tailored therapy as key: treat cough's underlying cause and follow stepwise GOLD guidelines for COPD, with precision driving success. It urges applying evidence-based strategies today, followed by a Q&A invitation.

Conclusion

Tailored Therapy Key:

• Cough: Treat underlying cause
• COPD: Stepwise per GOLD guidelines

Closing: Precision in therapy drives success.

Action: Apply evidence-based strategies today.

Q&A

Source: KD Tripathi’s Essentials of Medical Pharmacology (8th Edition)