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Summary of Drug Acting on Respiratory Tract :-

Drugs acting on the respiratory tract can be administered by inhalation, enhancing therapeutic effects, minimizing systemic effects and giving rapid relief in acute exacerbations. The majority of inhaled therapy is prescribed for the obstructive airways diseases: asthma and chronic obstructive pulmonary disease (COPD).

Inhaled glucocorticoids act on the respiratory tract to suppress inflammation, decrease airway edema and reduce mucus production. Side effects can be local (such as oropharyngeal candidiasis) or caused by systemic absorption (such as adrenal insufficiency). Bronchodilators include short- and long-acting beta2-adrenocepter agonists and anti-cholinergic drugs. They dilate the bronchi and bronchioles, increasing airflow to the lungs. Due to their action on beta2-adrenergic receptors and muscarinic acetylcholine receptors, respectively, side effects include cardiovascular effects such as tachycardia and hypertension, or anticholinergic side effects such as dry mouth, blurred vision, and constipation. In practice, many of these inhaled medications are integrated as combination inhalers, increasing efficacy and convenience.

Certain drugs are taken orally and act as anti-inflammatory agents. Leukotriene receptor antagonists oppose the actions of leukotrienes, inflammatory mediators causing bronchoconstriction and mucus secretion. Our understanding of selective phosphodiesterase inhibitors, such as roflumilast, is growing, as is interest in monoclonal antibody treatment.

Drugs causing respiratory depression
Barbiturates, benzodiazepines, and opioids are all known to cause respiratory depression. Barbiturates and benzodiazepines act by facilitating the effects of GABA (the main inhibitory neurotransmitter in the CNS) at the α-subunit of the GABAA receptor. Opioids act at μ receptors throughout the body, the effects of which can be both excitatory and inhibitory. These drugs depress the response of the respiratory center in the medulla to hypercapnia (↑ CO2) leading to respiratory depression.

Asthma is predominantly an inflammatory disease with associated bronchospasm, mucosal swelling, and increased mucus production. There is episodic bronchial obstruction causing wheezing, dyspnea, cough, and mucosal edema. In children, the only sign of asthma may be a persistent cough.

A significant proportion of adults with asthma experience bronchospasm after taking aspirin and other nonsteroidal antiinflammatory drugs (NSAIDs). This can be serious and sometimes fatal. Aspirin and other NSAIDs are therefore contraindicated in patients with asthma who have a history of hypersensitivity reactions and should be used with caution in all asthmatics. Acetaminophen can be used by asthmatics to treat mild to moderate pain.

Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is the term used to describe chronic obstructive bronchitis and emphysema, which always coexist, to varying degrees. The characteristic symptoms of COPD are persistent cough, sputum, dyspnea (shortness of breath), and wheezing.

Chronic bronchitis is defined clinically as sputum production on most days for 3 months of 2 consecutive years. Inflammation (most commonly caused by cigarette smoke) causes the bronchial tubes to thicken and scar and produce excess mucus. This mucus cannot be expectorated given that cilia are destroyed as part of the disease process. These factors combine to cause narrowing of the airway lumen and obstruction.