​COPD

●​ etiology (causes) of COPD:

1. Smoking

2. Air pollution (indoor and outdoor)

3. Occupational exposure to dust and chemicals

4. Genetic factors (e.g., alpha-1 antitrypsin

deficiency)

5. Frequent childhood respiratory infections

●​ Pathophysiology

1. Irritants enter lungs

→ Breathing in smoke, dust, or chemicals over a
long time.

2. Inflammation starts
→ Lungs get swollen and irritated.

3. Airways become narrow

→ It becomes hard for air to move in and out.

4. Extra mucus is made

→ Mucus blocks the airways even more.

5. Air sacs (alveoli) get damaged

→ They lose their shape and can't exchange
oxygen properly.

6. Air gets trapped in the lungs

→ Person feels breathless and can't fully exhale.

7. Less oxygen, more carbon dioxide

→ The body doesn't get enough oxygen and can't
remove CO₂ well.

8. Breathing problems get worse over time

→ Lung damage is permanent and keeps
progressing.
 ●​ Treatment

A. Bronchodilators
– Help open up the airways and make breathing
easier.
– Usually taken through inhalers.
– Types:

Short-acting bronchodilators (work fast, for quick

relief)
e.g., Salbutamol (Albuterol)

Long-acting bronchodilators (work longer, for daily

use)
e.g., Salmeterol, Tiotropium

B. Inhaled corticosteroids (ICS)

– Reduce inflammation in the lungs.
– Used in moderate to severe COPD.
– Often combined with long-acting bronchodilators.
e.g., Budesonide + Formoterol

C. Combination inhalers
– Contain both a bronchodilator and a steroid.
– Easier to use and more effective for some people.
e.g., Fluticasone + Salmeterol

D. Phosphodiesterase-4 inhibitors
– Help reduce inflammation and relax the airways.
– Taken by mouth (tablet).
e.g., Roflumilast (used in severe COPD with
frequent flare-ups)

E. Theophylline (less common)

– A tablet that relaxes the airways, but used less
due to side effects.

F. Antibiotics
– Used only when there is a lung infection (like
during a flare-up).
e.g., Azithromycin (sometimes used long-term in
some patients)

2. Stop Smoking

– Most important step to slow lung damage.

– Helps medicines work better.

3. Oxygen Therapy

– For people with very low oxygen levels.

– Helps improve breathing and energy.

4. Pulmonary Rehabilitation

– A special program with breathing exercises,

fitness training, and education.
– Helps you stay active and breathe better.

5. Healthy Lifestyle

– Eat nutritious food, stay active, avoid polluted

areas.
– Drink enough water to loosen mucus.

6. Vaccinations

– Flu and pneumonia vaccines prevent serious

infections.

7. Surgery (for severe COPD only)

– Includes lung volume reduction or lung transplant

in extreme cases.
 ​BRONCHIAL ASTHMA

●​ PATHOPHYSIOLOGY

1. Trigger exposure
→ Something like dust, pollen, smoke, cold air, or
exercise irritates the airways.

2. Airway inflammation
→ The lining of the airways becomes swollen and
red.

3. Muscle tightening (bronchoconstriction)

→ Muscles around the airways tighten, making
them narrower.

4. Mucus production increases

→ Extra thick mucus blocks the already narrow
airways.

5. Airflow becomes limited

→ It becomes hard to breathe, especially when
exhaling.

6. Asthma symptoms appear

→ Coughing, wheezing, shortness of breath, and
chest tightness.

7. Symptoms can be reversed

→ With treatment (like inhalers), the airways can
return to normal, but the condition can flare up
again.

●​ TREATMENT

Got it! Here’s the treatment of bronchial asthma in

a simple and detailed format, just like how I wrote
for COPD earlier:

1. Medicines (Main Treatment for Asthma):

A. Quick-relief medicines (Rescue inhalers)

– Used during an asthma attack or when symptoms
suddenly appear.
– Help relax the airway muscles quickly.
– Example:

Salbutamol (Albuterol) – fast-acting inhaler for

immediate relief.
B. Long-term control medicines (Daily use)
– Taken every day to keep asthma under control
and prevent attacks.
– Types:

Inhaled corticosteroids
– Reduce swelling and inflammation in the airways.
– Example: Budesonide, Fluticasone

Long-acting beta-agonists (LABAs)

– Keep airways open for 12–24 hours.
– Always used with steroids.
– Example: Salmeterol, Formoterol

Combination inhalers
– Have both a steroid and a LABA in one inhaler.
– Example: Fluticasone + Salmeterol, Budesonide +
Formoterol

Leukotriene receptor antagonists

– Tablet that reduces inflammation.
– Example: Montelukast

Theophylline (less common)

– Tablet that relaxes airway muscles, used in some
cases.
C. Biologic medicines (for severe asthma)
– Given as injections in people with severe, allergic,
or eosinophilic asthma.
– Example: Omalizumab, Mepolizumab

D. Antihistamines
– Sometimes used if asthma is related to allergies.

2. Avoid Triggers

– Stay away from things that cause asthma attacks

(like smoke, dust, cold air, pets, perfumes, etc.).

3. Inhaler Technique Training

– Learn the correct way to use inhalers (may use a

spacer for better delivery).

4. Asthma Action Plan

– A written guide made with the doctor that tells

you what to do when asthma is stable, getting
worse, or in emergency.

5. Pulmonary Rehabilitation & Breathing Exercises

– Helps improve breathing strength and control.

6. Vaccinations

– Flu and pneumonia vaccines help prevent serious

infections.

7. Healthy Lifestyle

– Eat nutritious food, avoid stress, stay active (as

advised), and maintain a clean environment.

​Sympathomimetics in treatment of asthma

Sympathomimetics in the treatment of bronchial

asthma:

Sympathomimetics are medications that mimic the

action of the sympathetic nervous system, which
helps relax the muscles around the airways,
making it easier to breathe. These drugs mainly
work by stimulating beta-2 receptors in the lungs.
There are two main types of sympathomimetics
used in asthma treatment:

1. Short-Acting Beta-2 Agonists (SABAs) –

Quick-Relief/Rescue Medications

Purpose: Provide rapid relief during asthma attacks

or sudden symptoms.

How they work: They relax the smooth muscles

around the airways, opening up the air passages
for easier airflow.

Examples:

Salbutamol (Albuterol)

Levalbuterol

Usage: Taken via inhaler or nebulizer for quick

relief (works within minutes, lasts for 4–6 hours).

2. Long-Acting Beta-2 Agonists (LABAs) –

Long-Term Control Medications

Purpose: Used for long-term management to keep

airways open and prevent asthma attacks.
How they work: Similar to SABAs but have a longer
effect, keeping airways open for up to 12 hours.

Examples:

Salmeterol

Formoterol

Usage: Always used with inhaled corticosteroids

(ICS) to reduce the risk of severe asthma flare-ups.
Not for immediate relief.

Key Points about Sympathomimetics:

Short-Acting (SABAs) are used during an asthma

attack or when symptoms suddenly worsen.

Long-Acting (LABAs) are used regularly to prevent

symptoms but never alone (always combined with
steroids for safety).

Side effects: Tachycardia (fast heart rate),

jitteriness, and muscle tremors may occur,
especially with high doses or frequent use.
These medications are critical in relieving acute
asthma symptoms and in maintaining long-term
control of asthma when used correctly.

​Expectorant

Expectorants are medications used to help clear

mucus or phlegm from the airways, lungs, and
respiratory passages. They work by thinning and
loosening the mucus, making it easier to cough up
and expel.

1. Guaifenesin is the most commonly used

expectorant.

2. Expectorants are primarily used to treat

productive coughs.

3. Guaifenesin is available in both prescription and

over-the-counter forms.
4. Expectorants help to thin and loosen mucus in
the respiratory system.

5. They are often combined with other medications

like decongestants or antihistamines.

6. Hydration is important for expectorants to work

effectively.

7. Potassium iodide was one of the earliest

expectorants used in medicine.

8. Expectorants should not be used for dry,

non-productive coughs.

9. Overuse of expectorants may cause side effects

like nausea or dizziness.

10. They are generally considered safe for

short-term use.
 ●​ Drugs

1. Guaifenesin

Mechanism of Action (MOA):

Guaifenesin increases the volume and reduces the
viscosity of respiratory tract secretions by irritating
the gastric mucosa, which indirectly stimulates
respiratory secretions via vagal reflex.

Pharmacology:

Route: Oral

Absorption: Rapidly absorbed

Onset of action: ~30 minutes

Duration: 4–6 hours

Metabolism: Hepatic

Excretion: Renal (as metabolites)

Adverse Effects (AE):

Nausea

Vomiting

Dizziness

Headache

Gastrointestinal discomfort

Uses:

Productive cough

Common cold

Bronchitis

To aid in expectoration of mucus

2. Bromhexine

Mechanism of Action (MOA):

Bromhexine is a mucolytic agent that
depolymerizes mucopolysaccharide fibers in
mucus, making it less viscous. It also stimulates
lysosomal enzyme activity, enhancing mucus
clearance from the respiratory tract.

Pharmacology:

Route: Oral and inhalation

Absorption: Well absorbed orally

Onset of action: 30–60 minutes

Metabolism: In the liver to active metabolite

(Ambroxol)

Excretion: Renal

Adverse Effects (AE):

Gastric irritation

Nausea

Vomiting
Allergic reactions (rash)

Rarely, bronchospasm

Uses:

Acute and chronic respiratory diseases with thick

mucus

Chronic bronchitis

COPD

Asthma (as an adjunct)

Sinusitis

●​ Drug used in constipation

Purgatives are drugs that promote evacuation of

the bowels. They are also called laxatives and are
classified based on their mechanism of action.
 ●​ Purgatives

Classification of Purgatives:

1. Bulk-forming purgatives

Psyllium (Isabgol)

Methylcellulose

Bran

2. Fecal softeners (Stool softeners)

Docusate sodium

Liquid paraffin

Glycerin suppositories

3. Osmotic purgatives
Lactulose

Magnesium sulfate

Magnesium hydroxide

Polyethylene glycol (PEG)

4. Stimulant purgatives (Contact purgatives)

Bisacodyl

Senna

Castor oil

Sodium picosulfate

5. Lubricant purgatives

Mineral oil (Liquid paraffin)

Castor oil (also stimulant)

6. Saline purgatives (subset of osmotic)

Magnesium citrate

Sodium phosphate

Magnesium sulfate

●​ Bulk purgatives

Definition:

Bulk purgatives are natural or synthetic substances

that absorb water in the intestine, swell, and
increase the bulk of stool, stimulating bowel
movement.

Mechanism of Action (MOA):

They absorb water and swell to form a soft, bulky

mass.
The increased volume stimulates peristalsis through
mechanical pressure on the intestinal wall.

Promotes natural bowel movement without

irritation.

Pharmacology:

Route: Oral

Onset of Action: 12–72 hours (slow acting)

Absorption: Not absorbed systemically

Excretion: Mostly unchanged in feces

Common Drugs (Examples):

Psyllium husk (Isabgol)

Methylcellulose

Bran

Adverse Effects (AE):

Abdominal bloating
Flatulence (gas)

Cramping

Esophageal or intestinal obstruction (if not taken

with enough water)

Uses:

Chronic constipation

Irritable bowel syndrome (IBS)

Hemorrhoids (to soften stools)

Post-surgery or postpartum bowel regulation

To regulate bowel habits (in elderly or sedentary

individuals)

Special Facts:

Safest type of laxative for long-term use

Should always be taken with plenty of water

Do not cause dependence or electrolyte imbalance

●​ Osmotic purgatives

●​ Laxatives

Laxatives are substances that promote bowel

movements and are used to treat constipation.
They are classified based on their mechanism of
action:

A. Non-Irritant Laxatives(BULK FOAMING )

1. Bulk-forming Laxatives

Mechanism: Increase stool bulk by absorbing water.

Examples:

Psyllium (Isabgol)
Methylcellulose

Bran

2. Emollient (Stool Softeners)

Mechanism: Soften stool by mixing water and fat

into it.

Examples:

Docusate sodium

Docusate calcium

3. Lubricant Laxatives

Mechanism: Coat stool and intestine to ease

passage.

Examples:
Liquid paraffin

Glycerin suppository

4. Osmotic Laxatives

Mechanism: Draw water into intestines by osmosis.

Examples:

Lactulose

Magnesium sulfate

Polyethylene glycol (PEG)

Sorbitol

B. Irritant (Stimulant) Laxatives

Mechanism: Stimulate intestinal mucosa and nerve

endings to increase motility and secretion.

Examples:
Anthraquinones:

Senna

Cascara

Diphenylmethanes:

Bisacodyl

Sodium picosulfate

Others:

Castor oil (acts via ricinoleic acid)

●​ Irritant laxatives

Here are notes on Irritant (Stimulant) Laxatives,

including their mechanism of action (MOA),
adverse effects, and uses:

Irritant (Stimulant) Laxatives

Mechanism of Action (MOA):

Directly stimulate the enteric nerves in the

intestinal wall.

Increase peristalsis (intestinal movement).

Stimulate secretion of water and electrolytes into

the lumen.

Decrease water absorption from colon.

Examples:

1. Senna – plant-derived anthraquinone

2. Bisacodyl – synthetic diphenylmethane

3. Castor oil – hydrolyzed in intestine to ricinoleic

acid

4. Sodium picosulfate – prodrug activated in colon

Adverse Effects (AEs):

Abdominal cramps and discomfort

Diarrhea with excessive use

Electrolyte imbalance (especially hypokalemia)

Laxative dependence with chronic use

Melanosis coli (brown pigmentation of colon with

long-term use of senna)

Uses:

Short-term relief of constipation

Bowel evacuation before diagnostic procedures

(e.g., colonoscopy)

Preparation for surgery involving the colon

Sometimes used for opioid-induced constipation

(e.g., bisacodyl)