Respiratory System

Pharmacotherapy of Asthma
COPD and Allergic rhinitis
 II- Drugs used to treat Rhinitis

• Rhinitis is an inflammation of the mucous membranes of the nose

and is characterized by sneezing, itchy nose/eyes, watery
rhinorrhea, and nasal congestion.

• An attack may be precipitated by inhalation of an allergen (such as

dust, pollen ).

• The foreign material interacts with mast cells coated with IgE
generated in response to a previous allergen exposure

• The mast cells release mediators, such as histamine, leukotrienes,

and chemotactic factors, that promote edema and cellular
infiltration.
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Drugs used to treat Rhinitis

• Combinations of oral antihistamines with decongestants are

the first-line therapies for allergic rhinitis.

• Systemic side effects associated with these oral preparations

(sedation, insomnia, and, rarely, cardiac arrhythmias) have
prompted interest in topical intranasal delivery of drugs.

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Drugs used to treat Rhinitis
• Seasonal allergic rhinitis (hay fever ou rhume des foins) is caused by
deposition of allergens on the nasal mucosa, resulting in an immediate
hypersensitivity reaction

• This reaction usually is not accompanied by asthma because the allergenic

particles are too large to be inhaled into the lower airways (e.g., pollens)

1- Topical Glucocorticoids can be highly effective with minimal side effects,

particularly if treatment is instituted immediately prior to the allergy

• These include:
• Beclomethasone (BECONASE)
• Mometasone (NASONEX)
• Budesonide (RHINOCORT)
• Fluticasone (FLIXONASE)
• Triamcinolone (NASACORT)
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Drugs used to treat Rhinitis
2- Antihistamines (H1 receptors blockers) afford considerable
symptom relief in allergic rhinitis

3- Nasal decongestants rely on alpha adrenergic agonists (e.g.,

pseudoephedrine and phenylephrine) as vasoconstrictors

• Vasoconstricteurs alpha sympathomimétiques utilisable par voie

nasale pour leur effet vasoconstricteur sur les muqueuses rhino
pharyngées ont une action très rapide sur l’obstruction nasale due
à l’oedème des fosses nasales lors des affections rhino
pharyngées.

• EI: sécheresse nasale

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Drugs used to treat Rhinitis

4- Anticholinergic agents such as Ipratropium bromide

(ATROVENT) are effective in inhibiting parasympathetic
reflex–evoked secretions from serous glands lining the nasal
mucosa

Ipratropium bromide (ATROVENT)

Anticholinérgique utilisé par voie nasale (Aerosol).

Induit une inhibition parasympathique des sécrétions réflexes
des glandes séreuses qui tapissent la muqueuse nasale.

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III- Drugs Used To treat COPD (BPCO)
• Chronic obstructive pulmonary disease is a chronic, irreversible obstruction
of airflow.
• Smoking is the greatest risk factor for COPD and is directly linked to the
progressive decline of lung function as demonstrated by Forced Expiratory
Volume (FEV).
• Smoking cessation and/or continued avoidance should be recommended
regardless of stage/severity of COPD and age of patient.
• Inhaled bronchodilators, such as anticholinergic agents (ipratropium
bromide and tiotropium bromide) and β2-adrenergic agonists, are the
foundation of therapy for COPD.
• These drugs increase airflow, alleviate symptoms, and decrease
exacerbation of disease.
• Combinations of an anticholinergic plus a β2 agonist may be helpful in
patients for whom a single inhaled bronchodilator has failed to provide an
adequate response.

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 Drugs Used To treat COPD
• The combination of Salbutamol and Ipratropium bromide (Combivent)
provides greater bronchodilation than with either drug alone.

• Longer-acting drugs, such as Salmeterol and Tiotropium bromide have

the advantage of less frequent dosing.

• ICS should be restricted to patients with an FEV 1 (FEV1) of less than 50

percent predicted and 3 or more exacerbations in the last 3 years (Stage
III or IV).

• Addition of a long-acting β2 agonists such as salmeterol, improves lung

function compared to either a short-acting β2 agonist or steroid alone

FEV: Forced Expiratory Volume in one second: Volume maximum pouvant être rejeté en plus
du volume courant à l'occasion d'une expiration profonde.
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Drugs Used To treat COPD

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 IV-Drugs used to treat Cough
• Codeine is the gold-standard treatment for cough suppression
due to its long history of availability and use.

• Codeine decreases the sensitivity of cough centers in the

central nervous system to peripheral stimuli and decreases
mucosal secretion.

• These therapeutic effects occur at doses lower than those

required for analgesia but still incur common sides effects like
constipation, dysphoria, and fatigue, in addition to its
addictive potential.

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 IV- Drugs used to treat Cough

• Dextromethorphan is a synthetic derivative of morphine

that suppresses the response of the central cough center.

• It has no analgesic effects, has a low addictive profile,

• but may cause dysphoria at high doses, which may explain its
status as a potential drug of abuse.

• Dextromethorphan has a significantly better side effect profile

than codeine

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