respiratory conditions - blackignition.co.za · symptoms similar to sar, less intense,...
TRANSCRIPT
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RESPIRATORY
CONDITIONS
RESPIRATORY STRUCTURES
& FUNCTIONS
UPPER
Respiratory Tract
LOWER
Respiratory Tract
Mouth
Nose
Pharynx
(Larynx)
Larynx
Trachea
Bronchi/Bronchioles
Alveoli/Lungs
THE RESPIRATORY TRACT
The Sinuses
Maxillary Frontal
Ethmoid Sphenoid
UPPER RESPIRATORY TRACT
Inspiration
Normal
Expiration
Forced
Normal
Forced
Only diaphragm
contracts
Abdominal/internal
intercostals contract
External intercostals
contract
Diaphragm
relaxes
RESPIRATION
MECHANICS OF RESPIRATION
Tidal Volume
Inspiratory
Reserve
Volume
Expiratory
Reserve
Volume
Residual volume
Vital Capacity
RESPIRATION / LUNG CAPACITIES
(FEV1)
ALVEOLUS
Alveolus
Capillary
PO2 = 105
PCO2 = 40
GAS EXCHANGE (PO2/PCO2)
PO2 = 40
PCO2 = 45
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RESPIRATORY
EPITHELIUM
Mucous glands
Goblet cells
Cilia
Mucus-producing cells
Mucociliary escalator (5-
10mm/minute)
MUCOUS MEMBRANE
Clearance
rate
Optimum range
Watery mucus Viscous mucus
MUCOCILIARY CLEARANCE
Mucous
Glycoprotein
Disulfide cross-bridges
Glycoprotein Matrix
MUCOUS
Mucolytic
Mucous
Glycoprotein
Disulfide cross-bridges
Glycoprotein Matrix
MUCOUS
ASTHMA
RESPIRATORY CONDITIONS
UPPER RESPIRATORY CONDITIONS
Otitis Media
Pharyngitis
Allergic Rhinitis
Laryngitis
Tonsillitis
Influenza
Sinusitis
Common Cold
LOWER RESPIRATORY CONDITIONS
Otitis Media
Coughing
Tuberculosis
Asthma CAP
Bronchi-ectasis
Pertussis
The Common Cold • Viral, airborne, contagious
• Nasal, sinuses, ears, bronchi
• Children at greater risk
• Treatments: analgesics, decongestants, antihistamines, cough remedies, rest, increased fluids
Influenza (‘Flu’) • Mutating viral attacks
• Nose, throat, lungs, malaise, dry cough
• Children, elderly
• Secondary infections (sinusitis, OM, bronchitis, CAP)
• Treatments: analgesics, decongestants, antihistamines, cough remedies, antibacterials, bed rest, increased fluids
UPPER RESPIRATORY CONDITIONS
Allergic Rhinitis / Hayfever
1 in 7 people, QoL, starts < 20 yrs
Seasonal (Pollens, spores)
Itching (throat, ears, eyes), sneezing, stuffy/runny nose
Perennial (Dust, fur, feathers, fungi)
Symptoms similar to SAR, less intense, longer-lasting
Combination
Sinusitis
Acute - purulent discharge, pain, swelling & tenderness
Chronic - mild discharge, often asymptomatic
UPPER RESPIRATORY CONDITIONS
Cough Productive (‘Wet’ [phlegm]) cough
Non-productive (‘Dry’) cough
Productive cough Viscosity of phlegm
Force of coughing
Cough therapy Treat the cause
Suppress the cough reflex
Suppress a wet cough?
UPPER RESPIRATORY CONDITIONS
Asthma (Gk: ‘panting’)
Two Types Extrinsic (‘Atopic’) – allergens (dust, stress, exertion,
weather changes)
Intrinsic (‘Non-atopic’) – no allergen (EIA)
Not COPD Emphysema, Chronic Bronchitis (AECB), Bronchiectasis
Treatment: bronchodilator
LOWER RESPIRATORY CONDITIONS
Chronic Bronchitis Emphysema
COPD
Dyspnoea after cough/phlegm
Obese
Blue face
Normal chest
Harsh breathing
Enlarged heart
Airways obstruction reversible
Normal, slightly TLC
Copious, green phlegm
Low O2, raised CO2
R heart failure common, fatal
Dyspnoea before cough/phlegm
Skinny
Pink face
Inflated chest
Quiet breath sounds
Long, thin heart
Airways blockage permanent
TLC
Moderate, white phlegm
Low O2, low CO2
R heart failure rare
LOWER RESPIRATORY CONDITIONS
Gram Positive Streptococcus pneumoniae
Staphylococcus aureus
Gram Negative Moraxella catarrhalis
Haemophilus influenzae
Atypical Mycoplasma pneumoniae
Mycobacterium tuberculosis
Klebsiella pneumoniae
Chlamydia pneumoniae
Antibiotics perform two
types of actions:
Bacterio-static
(inhibits growth)
Bacteri-cidal
(destroys)
Commensals Opportunistic pathogens Symbiosis
RESPIRATORY TRACT INFECTIONS
TREATMENT FOR
RESPIRATORY CONDITIONS
Treatment
for
Coughs & Colds
Antihistamines
Decongestants
Bronchodilators
Expectorants
Analgesics
Antitussives
TREATMENTS FOR COUGH/COLDS
Antihistamines
TREATMENTS FOR COUGH/COLDS
(Des)loratadine
Phenyltoloxamine
Doxylamine
Diphenhydramine
Promethazone
Chlorpheniramine
Brompheniramine
Triprolidine
Antihistamines
Histamine • Inflammatory mediator (allergen-driven)
• Sneezing, coughing, runny / blocked nose
Antihistamines - 2 classes: • Older “first generation”, “sedating” antihistamines
• Newer “second generation”, “non-sedating” antihistamines
ANTIHISTAMINES
Pharmacological management
Antihistamines
Decongestants
Intranasal cromolyn
Anticholinergics
Corticosteroids
Immunotherapy
ALLERGIC RHINITIS
A 3rd generation antihistamine – acts within 30mins
10 times more potent than loratadine in vivo
More potent antagonist at H1 receptors
Less sedation (no BBB), no cardiac AEs (QT)
Has significant anti-inflammatory effects
Has significant decongestant effects
(DES)LORATADINE
Food does not affect its absorption
No clinically relevant drug-drug interaction
No potentiation of adverse psychomotor effects of alcohol
Protects against allergen challenges for up to 24 hours
(DES)LORATADINE
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Early Phase allergic response
The primary effect is the release of histamine
Symptoms are mainly impacting the nose and eyes – running, watery
Sufferers called SNEEZERS and RUNNERS (usually Seasonal AR)
(DES)LORATADINE
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Early Phase allergic response
The primary effect is the release of histamine
Symptoms are mainly impacting the nose and eyes – running, watery
Sufferers called SNEEZERS and RUNNERS (usually Seasonal AR)
Late Phase allergic response
Immune response (white blood cells) kicks in, characterised by inflammation
Symptoms are congestion and stuffiness
Sufferers called BLOCKERS (usually Perennial AR)
(DES)LORATADINE
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Early Phase allergic response
The primary effect is the release of histamine
Symptoms are mainly impacting the nose and eyes – running, watery
Sufferers called SNEEZERS and RUNNERS (usually Seasonal AR)
Late Phase allergic response
Immune response (white blood cells) kicks in, characterised by inflammation
Symptoms are congestion and stuffiness
Sufferers called BLOCKERS (usually Perennial AR)
Desloratadine works in both Early and Late phase AR (2nd generation
antihistamines work only in the early phase)
While not as potent as intranasal steroids (INS), DES nevertheless reduces
inflammation (blocked nose, stuffiness)
Studies show that DES significantly reduces the need for INS or decongestants
(DES)LORATADINE
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Why should I use antihistamine tablets over a nasal spray?
Answer:
Although there is a place for nasal sprays in the treatment of allergic
rhinitis, you can’t use them for long periods of time as you may end up
with rebound. Nasal sprays also lead to nasal ulcerations, nose and
throat irritation, sneezing and changes in taste. Desloratadine is proven
to reduce nasal congestion and inflammation, so when using it for your
allergic rhinitis patients you do not even have to worry about using a
nasal spray or the side effects it comes with, not to mention adding to the
cost of treatment.
(DES)LORATADINE
TREATMENTS FOR COUGH/COLDS
Antitussives
Dextromethorphan
Codeine
Noscapine
Pholcodine
Coughing - protective mechanism
Type of cough determines Tx
Symptom of an underlying disorder
Cough drugs target the cough reflex
CNS-acting drugs raise cough threshold (CNS Cough Centre)
Peripherally-acting drugs decrease RT receptor sensitivity
Indirect effects
• Alter mucociliary factors
• Local analgesic or anaesthetic action on receptors
• Protecting the receptors from irritant stimuli
COUGH SUPPRESSANTS
Non-productive – often from viral infections
Treat underlying disorders (eg. asthma, chronic
bronchitis, heart failure/pulmonary congestion, lung
cancer, oesophageal reflux, post nasal drip, etc)
Provide patient relief from non-productive cough,
particularly if administered at night
COUGH SUPPRESSANTS
TREATMENTS FOR COUGH/COLDS
Decongestants
Phenylephrine
Phenylpropanolamine
L-/pseudo-Ephedrine
Reduce the volume of nasal mucosa • Contraction/shrinking of arterioles supplying the nasal
mucosa
• Opens airways = alpha-adrenergic agonists
Common decongestants: • Pseudoephedrine (new Dimetapp, Colcaps, Demazin,
Flusin, Nurofen C&F, Sinuclear, Sinumax, Degoran)
• Phenylpropanolamine / PPA (old Dimetapp, old Degoran, Colcaps caps, Rinex, Sinuclear, Sinustat, Sinutab selected)
• Phenylephrine (Colcaps, Corenza, Demazin, Grippon, Rinex)
Available orally (tabs, caps, syrup) & topically (gels, sprays, drops)
DECONGESTANTS
TREATMENTS FOR COUGH/COLDS
Bronchodilators
Aminophylline
Orciprenaline
Terbutaline
Expectorants
Ammonium Chloride
Guaiphenesin
Mucolytics
Carbocysteine
Bromhexine
Expectorants
TREATMENTS FOR COUGH/COLDS
Expectorants
Ammonium Chloride
Guaiphenesin
Mucolytics
Carbocysteine
Bromhexine
Expectorants
TREATMENTS FOR COUGH/COLDS
Mucolytic
TREATMENTS FOR COUGH/COLDS
Analgesics
Aspirin
Paracetamol
Acetominophen
Phenacetin
Codeine
NSAID’s (non-steroidal anti-inflammatory drug):
• Ibuprofen (Advil, Nurofen), aspirin (Anadin, GrandPa,
Disprin), & naproxen (Alleve)
• Effective in relieving inflammation, pain & fever
Paracetamol:
• Panado, Calpol, Paramed
• Effective in relieving pain & fever
• Caution with unintentional overdose, as many cold
preparations already contain Paracetamol (Sinumax,
Colcaps, Sinuclear)
• Particular caution with children
ANALGESICS
Antihistamines Decongestants
Bronchodilators Expectorants Antitussives
Analgesics Mucolytics
Phenyltoloxamine
Doxylamine
Pseudoephedrine
L-ephedrine
Paracetamol
Phenacetin
Aspirin
Codeine
Acetaminophen
Carbocysteine
Orciprenaline Guaifenesin Codeine
Aminophylline Dextromethorphan
Phenylpropanolamine
Pholcodine
Noscapine
Ammonium chloride
Diphenhydramine
Promethazone
Triprolidine
Terbutaline
Phenylephrine
Bromhexine
TREATMENTS FOR COUGH/COLDS
This presentation contains forward-looking statements about the company’s operations
and financial conditions. They are based on Litha Healthcare Group Limited’s best
estimates and information at the time of writing. They are nonetheless subject to
significant uncertainties and contingencies many of which are beyond the control of the
company. Unanticipated events will occur and actual future events may differ materially
from current expectations due to new business opportunities, changes in priorities by the
company as well as other factors. Any of these factors may materially affect the
company’s future business activities and its ongoing financial results.
DISCLAIMER
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