1. ANTI-INFLAMMATORY AGENTS
USED IN ASTHMA AND COUGH
SUPPRESSANTS
ANKIT GILANI
DEPT OF PHARMACOLOGY AND TOXICOLOGY
NIPERA1113PC03 (sem-1)
SUBJECT – PC-620

2. ASTHMA
 An inflammatory condition in which there is
recurrent reversible airways obstruction in
response to irritant stimuli that are too weak to
affect non-asthmatic subjects.
symptoms
shortness of
wheezing breath ( especially cough.
in breathing out)

3. PATHOGENESIS

4. characterised by:
 inflammation of the airways
 bronchial hyper-reactivity
 reversible airways obstruction

5. TREATMENT
BRONCHODILATORS
ANTI-INFLAMMATORY
β-Adrenoceptor
agonists, AGENTS
Xanthine drugs , Glucocorticoids ,
Muscarinic receptor Cromoglicate and
antagonists, nedocromil ,
Cysteinyl leukotriene Anti-IgE treatment .
receptor antagonists,
Histamine H1-receptor
antagonists.

6. ANTI-INFLAMMATORY AGENTS
 Mainly glucocorticoids
 Cromoglicate and nedocromil (weak anti-
inflammatory and short duration , now
hardly used for asthma)
 Omalizumab
(humanised monoclonal anti-IgE antibody)

7. Mechanism of glucocorticoids

8.  decrease formation of cytokines, in particular the
Th2 cytokines that recruit and activate eosinophils
and are responsible for promoting the production of
IgE and the expression of IgE receptors.
 Glucocorticoids also inhibit the generation of the
vasodilators PGE2 and PGI2, by inhibiting induction of
COX-2
 By inducing annexin 1, they could inhibit production
of leukotrienes and platelet- activating factor.

9.  Corticosteroids inhibit the allergen-induced
influx of eosinophils into the lung.
 Glucocorticoids up-regulate β2
adrenoceptors, decrease microvascular
permeability, and indirectly reduce
mediator release from eosinophils by
inhibiting the production of cytokines (e.g.
IL-5 and granulocyte-macrophage colony-
stimulating factor) that activate
eosinophils.

10. EXAMPLES :
1) Systemic ( given orally) :
 Prednisone
 Prednisolone
 Methylprednisolone
2) Inhaled :
 Beclometasone
 Budenoside
 Fluticasone
 Mometasone
 Ciclesonide

11. Unwanted effects
Systemic :
Thinning of the skin, Tendency to bruise,
Osteoporosis, Muscle Weakness, Infections
,Hypertension, etc.
inhaled :
Oropharyngeal candidiasis (thrush)
sore throat and croaky voice
[ use of 'spacing' devices, reduces these
problems ]

13. DRUGS FOR COUGH
COUGH : a protective reflex that removes foreign
material and secretions from the bronchi and
bronchioles.
It can be triggered by inflammation in the
respiratory tract, for example by undiagnosed
asthma or chronic reflux with aspiration, or by
neoplasia.
In these cases, cough suppressant (antitussant)
drugs are useful.

14. DRUGS FOR COUGH
Pharyngeal demulcents
Expectorants (mucokinetics)
Antitussives (cough centre suppressants)
Adjuvant antitussives (bronchodilators)

15. MECHANISM OF COUGH SUPPRESSION
 Antitussive drugs act by an ill-defined effect in
the brain stem, depressing the 'cough centre'.
 All opioid narcotic analgesics have antitussive
actions in doses below those required for pain
relief.
 Those used as cough suppressants are members
of the group with minimal analgesic actions and
addictive properties.
 New opioid analogues that suppress cough by
inhibiting release of excitatory neuropeptides
through an action on μ receptors on sensory
nerves in the bronchi are being assessed.

16. EXAMPLES
 Codeine (methylmorphine) is a weak opioid
with considerably less addiction liability than
the main opioids, and is a mild cough
suppressant.
 It decreases secretions in the
bronchioles, which thickens sputum, and
inhibits ciliary activity. Constipation is
common.
 Dextromethorphan and pholcodine are
believed to have fewer adverse effects.