This is a title slide for a presentation on "Drug Therapy of Cough & COPD." The subtitle indicates a 70% focus on cough therapy.

Drug Therapy of Cough & COPD

70% Cough Therapy Focus

Source: KD Tripathi's Essentials of Medical Pharmacology (8th Ed.) and GOLD 2025 Report

This agenda slide outlines four main sections: Introduction to Cough & COPD (Slides 1-5), Cough Drug Therapies like demulcents and antitussives (Slides 6-10), and COPD Management with bronchodilators and anti-inflammatories (Slides 11-13). It concludes with Guidelines & Monitoring, including GOLD 2025, side effects, and conclusion (Slides 14-16).

Agenda

1. Introduction to Cough & COPD

Overviews, pathophysiology, and treatment goals (Slides 1-5)

2. Cough Drug Therapies

Demulcents, expectorants, antitussives, antihistamines, bronchodilators (Slides 6-10)

3. COPD Management

Bronchodilators, anti-inflammatories, combinations (Slides 11-13)

4. Guidelines & Monitoring

GOLD 2025 guidelines, side effects, monitoring, conclusion (Slides 14-16) Source: KD Tripathi's Essentials of Medical Pharmacology (8th Ed.) & GOLD 2025 Report

A cough is a protective reflex that clears airways of irritants, classified as productive (wet, sputum-producing) or dry (non-productive). Acute coughs last under 3 weeks and are often infection-related, while chronic ones exceed 8 weeks and stem from causes like asthma, GERD, or postnasal drip.

Introduction to Cough

• Cough: Protective reflex to clear airways from irritants
• Types: Productive (wet, sputum-producing) vs. dry (non-productive)
• Acute (<3 weeks): Often due to infections
• Chronic (>8 weeks): Asthma, GERD, postnasal drip

Source: KD Tripathi's Essentials of Medical Pharmacology (8th Ed.), Ch. 25

COPD is a chronic, progressive airflow limitation that includes emphysema and chronic bronchitis (GOLD 2025). It causes symptoms like dyspnea, chronic cough, and sputum production, posing a significant global health burden.

Introduction to COPD

• COPD: Chronic, progressive airflow limitation (GOLD 2025)
• Includes emphysema and chronic bronchitis
• Symptoms: Dyspnea, chronic cough, sputum production
• Significant global health burden (GOLD 2025)

Source: KD Tripathi's Essentials of Medical Pharmacology (8th Ed.); GOLD 2025 Report

The pathophysiology of cough involves afferents from airway receptors traveling via the vagus nerve to the cough center in the medulla oblongata for integration. Efferents from the center then activate respiratory muscles, triggered by mechanical and chemical irritants.

Pathophysiology of Cough

• Afferents via vagus nerve from airway receptors
• Cough center integration in medulla oblongata
• Efferents activate respiratory muscles
• Triggers: mechanical and chemical irritants

Source: Wikipedia - Cough reflex

COPD pathophysiology involves airflow obstruction from small airway disease and emphysema, which features alveolar destruction and loss of elasticity, plus chronic inflammation and mucus hypersecretion. The slide also covers the GOLD ABCD assessment for risk and symptom evaluation.

Pathophysiology of COPD

• Airflow obstruction: small airway disease and emphysema
• Emphysema: alveolar destruction, loss of elasticity
• Chronic inflammation and mucus hypersecretion
• GOLD ABCD assessment for risk and symptom evaluation

Source: KD Tripathi's Essentials of Medical Pharmacology (8th Ed.), GOLD 2025 Report

The goals of drug therapy for cough are to suppress cough and irritation, aid expectoration, and treat the underlying cause. For COPD, the goals are to reduce symptoms and exacerbations, improve quality of life, and prevent disease progression.

Goals of Drug Therapy

• Suppress cough and irritation (Cough)
• Aid expectoration (Cough)
• Treat underlying cause (Cough)
• Reduce symptoms and exacerbations (COPD)
• Improve quality of life (COPD)
• Prevent disease progression (COPD)

Source: KD Tripathi's Essentials of Medical Pharmacology (8th Ed.); GOLD 2025 Report

The slide "Demulcents & Expectorants" features a table listing three drugs: demulcents honey and glycerin, which soothe irritation for dry or irritant coughs, and expectorant guaifenesin, which increases bronchial secretions for productive coughs. Dosages include 1-2 tsp honey in warm water, glycerin lozenges as needed, and 200-400 mg guaifenesin four times daily.

Demulcents & Expectorants

{ "headers": [ "Drug", "Class", "Mechanism", "Dose/Uses" ], "rows": [ [ "Honey", "Demulcent", "Soothes irritation", "1-2 tsp in warm water; dry cough" ], [ "Glycerin", "Demulcent", "Soothes irritation", "Lozenges PRN; irritant cough" ], [ "Guaifenesin", "Expectorant", "↑ bronchial secretions", "200-400 mg QID; productive cough" ] ] }

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

Mucolytics, including acetylcysteine and bromhexine, work by cleaving disulfide bonds in mucus to reduce viscosity. They are indicated for viscid sputum in COPD or cough, with cautions for GI upset like nausea and vomiting.

Mucolytics

• Agents: Acetylcysteine, Bromhexine
• Mechanism: Cleave disulfide bonds in mucus
• Indications: Viscid sputum in COPD/cough
• Cautions: GI upset (nausea, vomiting)

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

Opioid antitussives like codeine suppress the central cough center (10-20 mg dose) but risk constipation, nausea, dependence, and respiratory depression, so use cautiously in severe cases. Nonopioid options like dextromethorphan act as NMDA antagonists (15-30 mg dose) with only mild dizziness/nausea, no addiction or respiratory risks, and are preferred for dry cough.

Antitussives: Opioid & Nonopioid

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

This slide outlines antihistamines like diphenhydramine, which block H1 receptors to curb allergic coughs and induce sedation for nocturnal relief. It also covers bronchodilators like salbutamol, offering β2 agonist action for bronchial relaxation and rapid symptom relief in acute episodes.

Antihistamines & Bronchodilators for Cough

{ "features": [ { "icon": "🔒", "heading": "H1 Receptor Blockade", "description": "Diphenhydramine antagonizes H1 receptors, reducing allergic cough response." }, { "icon": "😴", "heading": "Sedating Properties", "description": "Induces drowsiness to aid relief of nocturnal cough." }, { "icon": "🫁", "heading": "β2 Agonist Action", "description": "Salbutamol relaxes bronchial smooth muscle via β2 stimulation." }, { "icon": "⚡", "heading": "Rapid Symptom Relief", "description": "Provides quick bronchodilation for acute cough episodes." } ] }

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

The slide features a table on COPD bronchodilators, categorizing classes (SABA, LABA, LAMA, Combo) with examples, durations, and GOLD 2025 initial use recommendations. SABAs like Salbutamol provide short-acting rescue (4-6 hours) for Group A, while LABAs (12 hours), LAMAs (24 hours), and combos (12-24 hours) serve as maintenance for Groups A/B or B/E.

COPD Bronchodilators

{ "headers": [ "Class", "Example", "Duration", "GOLD 2025 Initial Use" ], "rows": [ [ "SABA", "Salbutamol", "4-6 hours", "Group A (rescue)" ], [ "LABA", "Salmeterol", "12 hours", "Group A/B (maintenance)" ], [ "LAMA", "Tiotropium", "24 hours", "Group A/B (maintenance)" ], [ "Combo", "e.g., Formoterol/Tiotropium", "12-24 hours", "Group B/E (dual)" ] ] }

Source: GOLD 2025 Report & KD Tripathi 8th Ed.

This slide outlines anti-inflammatory agents for COPD, including ICS (e.g., Budesonide) for eosinophilic cases, PDE4 inhibitor (Roflumilast) for severe chronic bronchitis, and triple therapy (LABA/LAMA/ICS) for frequent exacerbators. It also covers mucolytics for better mucus clearance and fewer exacerbations, plus influenza and pneumococcal vaccines to prevent infections.

Anti-inflammatory & Other Agents in COPD

• ICS (Budesonide): Reduce exacerbations in eosinophilic COPD
• PDE4 inhibitor (Roflumilast): Severe COPD with chronic bronchitis
• Mucolytics: Improve mucus clearance, reduce exacerbations
• Vaccines (Influenza, Pneumococcal): Prevent respiratory infections
• Triple therapy (LABA/LAMA/ICS): For severe, frequent exacerbators

Source: KD Tripathi 8th Ed., GOLD 2025

The slide features a table on combination therapies for respiratory conditions, listing options like Codeine + Expectorant, LABA + LAMA, Triple Therapy (LABA/LAMA/ICS), and Antitussive + Bronchodilator. It details their components, benefits such as cough suppression, improved FEV1, symptom relief, and exacerbation reduction, with evidence from Tripathi and GOLD 2025.

Combination Therapies

{ "headers": [ "Combination", "Components", "Benefits", "Evidence" ], "rows": [ [ "Codeine + Expectorant", "Opioid + Mucolytic", "Cough suppression + mucus clearance", "Tripathi" ], [ "LABA + LAMA", "Beta2 + Muscarinic agonist", "Improved FEV1, symptom relief", "GOLD 2025" ], [ "Triple Therapy", "LABA/LAMA/ICS", "Exacerbation reduction", "GOLD 2025" ], [ "Antitussive + Bronchodilator", "Codeine + SABA/LABA", "Acute cough relief in overlap", "Tripathi" ] ] }

Source: GOLD 2025 & Tripathi (8th Ed.)

The GOLD 2025 Classification guidelines slide outlines treatment recommendations by patient group. Group A starts with SABA monotherapy, Group B uses LABA/LAMA dual therapy, and Groups C/D recommend triple therapy.

Guidelines: GOLD 2025 Classification

!Image

• Group A: Initial monotherapy with SABA
• Group B: LABA/LAMA dual therapy
• Groups C/D: Triple therapy recommended

Source: GOLD 2025 Report

The slide outlines key antitussive side effects like constipation and dependence, plus monitoring via spirometry and symptom assessment. It concludes with tailored guideline-based therapy to optimize cough and COPD management, followed by Q&A and thanks.

Side Effects, Monitoring & Conclusion

**Key Side Effects:

• Antitussives: Constipation, Dependence

Monitoring:

• Spirometry, Symptom Assessment

Summary:

• Tailored Therapy per Guidelines

Closing: Optimize cough & COPD management. Q&A**

Thank You!

Source: KD Tripathi's Essentials of Medical Pharmacology (8th Ed.) & GOLD 2025 Report