The Respiratory System

1. The Respiratory System

2. The Respiratory System • Minor common disorders of respiratory system and the more serious diseases such as bronchitis ,emphysema and pneumonia can be successfully treated with phytotherapy. • However, we can use decongestants , broncholytics expectorants, demulcents, antivirals, Immune system modulators, anti_allergics,antimuscarinic drugs , platelet_activating factor, Leukotriene antagonists, natural compounds, cough suppressants , and antitussives .

3. Bronchodilators and Decongestants :- Ma huang , Ephedra spp. : Ma huang is an ancient Chinese medicine ,which is now used worldwide. It was the original source of ephedrine, a useful decongestant and bronchodilator. It is used to treat asthma and nasal congestion, in the form of nasal drops. Pseudoephedrine is now used more widely for respiratory congestion as it has fewer CNS stimulatory properties. The medicinal part of this plant is stems and branches.

4. Constituents • Alkaloids, up to about 3%; the major alkaloid is ephedrine. Other alkaloids include pseudoephedrine, norephedrine , • Other components are catechin derivatives • Diterpenes, including ephedrannin A and mahuannin A.

5. Pharmacological effects and Clinical efficacy • Ephedra has been used to treat asthma and hay fever , as a bronchodilator, sympathomimetic, CNS and cardiac stimulant , • Herbalists also use it to treat enuresis, allergies, narcolepsy and other disorders, and anti-inflammatory activity has been observed is extracts. Also used in some types of bradycardia.

6. Pharmacological effects and Clinical efficacy • Continue… • Pseudoephedrine , the isomer of ephedrine, is usually the compound of choice for isolated alkaloid preparations. Ephedra herb is used as antiallergic agent

7. Toxicology • The herb has been abused as a slimming aid, this can be very dangerous if high doses are used for long periods. For example , hypertension and CVS events and exacerbation of hepatitis. The herb isn’t normally considered to cause HTN since the other components , such as the ephedradins, mahuannins and maokonine , are actually hypotensive. However, it should be avoided in cases of thyrotoxicosis , narrow angle glaucoma , and urinary retention. • Therapeutic doses of the herb are up to 30mg of alkaloids , calculated as ephedrine .

8. 2. Theophylline • Although theophylline is a natural xanthine which is found is cocoa , coffee and tea , it is almost invariably used as the isolated compound. It is indicated in reversible airway obstruction particularly in a cute asthma. • Because of narrow therapeutic window of theophylline , and the fact that t1/2 is highly variable between patients, especially smokers, care must be taken. • The usual does is 125-250mg is adults, three times daily , and half of that in children.

9. Theophylline…Continue • Toxicology : S/Es include 1)tachycardia. 2) palpitations. 3)nausea. 4) other GI upsets . these can be reduced by sustained release preparations, which is the usual form of theophylline products.

10. Inhalations: • Essential oil containing drugs are often used with aromatic compounds (especially camphor) as 1) chest rubs, steam inhalations or nasal sprays , for their decongestant properties. They are useful for infants ,children ,asthmatics and pregnant women for whom systemic decongestants aren’t appropriate. 2)They may be used orally, in pastilles, lozenges , or “cough sweets”. Oils distilled from the aerial parts of members of pine family and the Australian Myrtaceae are used frequently. 3)These oils can be used in steam baths.

11. Eucalyptus Oil: • The blue gum tree yields a highly characteristic oil which is widely used as a decongestant and solvent. • Constituents : The oil contains cineole as the major component and eucalyptol.

12. Pharmacological effects and clinical efficacy: • The oil is antiseptic, antispasmodic, expectorant, stimulant and insect repellent. It may be taken internally in small doses, as ingredient of : 1)cough mixtures. 2)sweets and pastilles 3)inhalation. It is applied also externally in the form of 1)linemet , 3)ointment 3)vapor rub . The leave extract and oil has antiseptic effects against variety of bacteria and yeasts .

13. Pharmacological effects and clinical efficacy: • continue…. The oil is also insect repellent • Toxicology : Eucalyptus oil is irritant.

14. Camphor: • Camphor, a pure natural product, is derived from Asian camphor tree. It is combined with the essential oil containing drugs as an aromatic stimulant and decongestant and expectorant. Pharmacological effects and clinical efficacy : Camphor has antiseptic, secretolytic and decongestant effects. Small doses were taken internally for colds, diarrhea, and for other complaints , but now it is used externally .

15. Camphor….continue • Toxicity : Overdose causes vomiting, convulsions and palpitations and can be fatal. If used externally in therapeutic doses, it is well tolerated .

16. Menthol: • Menthol is a monoterpene extracted form mint oils , or made synthetically. Whole peppermint oil is used in herbal combinations to treat colds and influenza and for colic, etc. But isolated menthol is effective decongestant used in nasal sprays and inhales. • Toxicity : Menthol can be irritant and toxic in over dose , but is well tolerated in normal usage.

17. Anti-allergics: • Most antihistamines are synthetic in origin. They are the most potent drugs used as anti_allergics,e.g: Cetirizine, desloratidine, fexofenadine or chlorpheniramine .

18. 1) Khella “toothpick plant” : • Khella “toothpick plant” : The used part is the fruits and the botanical drug has been used as an anti_spasmodic in renal colic, for asthma, and as a coronary vasodilator for angina. • Constituents : bitter principles: khellin, visnagin.

19. Khella “toothpick plant” :…..continue • Pharmacological effects and clinical efficacy : khellin, visnagin are vasodilators , with calcium channel blocking and spamolytic activity. • Khellin was the starting material for development of several semi_synthetic derivatives such as : • Sodium cromoglycate , which is widely used as prophylactic treatment for asthma ,hay fever and other allergic conditions, in the form of an inhaler or eye drops. • Nifedipine ( CCB and vasodilator ): used for heat diseases. • Amiodarone : cardiac anti-arrhythmic.

20. 2) Butterbur: • Butterbur : The root and herb are used. • Constituents :it contains : • eremophinolides. • Flavonoids. • Toxic alkaloids may be present, usually in higher concentrations in the root. Pharmacological effects and clinical efficacy: Butterbur is: • used for asthma (extracts inhibit leakotriene synthesis and are spasmolytic ), colds, headaches and urinary tract disorders. • Used as antihistamine for seasonal allergic rhinitis. (Butterbur extract is as potent as cetirizine ).

21. Butterbur:….continue • used as prophylactic treatment for migraine. • has anti-inflammatory activity Toxicology: • Internal use isn’t recommended unless the alkaloids are present in negligible amounts or removed from preparations. • Maximum intake of alkaloids should be less than 1Mg daily for fewer than 6 weeks per year.

22. Expectorants and Mucolytics • Balm of Gilead (poplar buds): • The buds and the bark of these species are used. • Constituents : • Phenolic glycosides. • Volatile oil. • Flavonoids. • Lignans. • Pharmacological effects and clinical efficacy : • Balm of Gilead is an expectorant , stimulant , antipyretic and analgesic.

23. Expectorants and Mucolytics…continue • It is a common ingredient of herbal cough mixtures, and also ointments used for rheumatic and other muscular pains. • The phenolic glycosides and the volatile oil constituents have antiseptic and expectorant activity. Toxicology : • Balm of Gilead is generally nontoxic ,except for patients who are allergic to salicylates.

24. Expectorants and Mucolytics…continue • Thyme and Wild Thyme: • The leaves are used. • Constituents: • The active principle is the volatile oil thymol and Carvocrol • Flavonoids.

25. Expectorants and Mucolytics…continue Pharmacologic effects and clinical efficacy: • Thyme, and oil of thyme, are carminative, antiseptic, antitussive ,expectorant • They are used for coughs, bronchitis, sinusitis, whooping cough and other respiratory disorders. Toxicology : Thyme is irritant and toxic in large and overdose.

26. Expectorants and Mucolytics…continue • Sage: • The leaves are the used part. Constituents: • Volatile oil. • Diterpene bitters picrosalvin, carnosolic acid, • Flavonoids.

27. Expectorants and Mucolytics…continue • Pharmacological logical effects and clinical efficacy: • An infusion of sage is used as a gargle or mouthwash for pharyngitis, tonsillitis , sore gums , mouth ulcers, and other disorders. • sage extracts and oil have antimicrobial activity. • The flavonoids and phenolic acids have anti_viral and anti_inflammatory activity. • Sage enhance memory, supported by anticholinesterase activity.

28. Expectorants and Mucolytics…continue • Senega: • The roots are the used part. • Constituents: Triterpenoid saponins: senegin. • Pharmacological effects and clinical efficacy: • Senega is used primarily for chronic bronchitis, catarrh, asthma ,and croup. • Senega usually taken orally as an infusion.

29. Expectorants and Mucolytics…continue Saponins are the active constituents , have mucolytic, anti-inflammatmy, antiseptic activity and immunopotentiating activity to protein and vital antigens. Senega extracts, senegins is hypoglycemic in rodents , and potent inhibitors of alcohol absorption. Toxicology: The saponins are irritant and hemolytic. Nausea and vomiting are the most common adverse effects. When taken orally, it doesn’t appear to cause problems expect in high doses or in sensitive individuals.

30. Expectorants and Macolytics…continue • Ivy : • Ivy is a saponin containing expectorant. • Both leaves and berries are used. Constituents: • Saponins. • Flavonoids. Pharmacological effects and clinical efficacy: • Ivy extracts are used for bronchitis and catarrh, as an expectorant.

31. Expectorants and Mucolytics…continue The saponins and sapogenins are the main active ingredient they are expectorant and have antifungal , antimutagenic effects. Ivy extracts are used in cosmetics preparations to treat cellulite. Both saponin and the flavonoid fractions are spasmolytic . Toxicology: Like all saponin containing drugs, Ivy can be irritant and allergenic.

32. Expectorants and Macolytics…continue • Tolu balsam: • The used part is the resin which is collected from incisions in the bark. • Constituents: • Cinnamic and benzoic acids. • Their esters such benzyl benzoate and cinnamyl cinnamate. • Ester with resin.

33. Expectorants and Mucolytics…continue • Pharmacological effects and clinical efficacy: 1.Balsam of tolu is expectorant, stimulant, antiseptic and demulcent which is used in cough mixtures and as lozenge base. 2.It has antibacterial activity , due to the benzyl benzoate and benzyl cinnamate content. • Toxicology: Tolu balsam can cause allergic reactions.

34. Expectorants and Macolytics…continue • Ipecacuanha, Ipecac , Emetic roots: • The used part is the roots. • Constituents: Alkaloids isoquinoline group are the active principles, the most important are : • Cephaline. • Emetine.

35. Expectorants and Macolytics…continue Pharmacological effects and clinical efficacy: • Ipecac extracts used in many cough preparations, both elixirs because of their expectorant activity. • Emetic • Antiamoebic • GIT antiseptic. Toxicology: Ipecac causes vomiting in large doses and the alkaloids are cytotoxic.

36. E. Cough suppressants • Cough is a reflex action and symptoms of the disease such as asthma and cold due to nasal drip. Cough suppressants may be useful in some instances but efficacy is not fully proven and in some cases it will cause sputum retention When we use cough suppressants? 1-Children who are highly susceptible to respiratory depression caused by opiate. 2-with sever cases of lung cancer with sever cases of cough we can use dextromethorphan (semi synthetic opiate) and codeine

37. Codeine It is found in opium in the form of phosphate salt pharmacological effects: Treatment of cough (antitussive) 10-20mg every four hour Treatment of diarrhea 240mg daily in divided dose Mild narcotic analgesic Toxicity of codeine : Sedation Constipation In large dose it will cause respiratory distress Addiction and its liability to abuse

38. F. General phytomedicine used in cold and influenza Demulcent and emollient Demulcent is an agent that form a soothing film over mucous membrane relieving minor pain Emollient is a substance that soften and soothing the dry skin Elder Flower (flowers and berries are used ) The constituents : Triterpenes including : ursolic acid oleonolic acid derivatives Flavonoids : rutin , quercetin

39. Elder flower is used as an infusion or herbal tea and as a mixture of peppermint for cold and influenza because : 1- It induce perspiration 2- It increase inflammatory cytokines 3- It has a direct antiviral action The dose is 3g of flower infused with 150ml of hot water Toxicity Elder Flowers are non toxic and no side effect have been reported Pharmacological effect

40. 2- Linden flower(flowers are used) Constituents Volatile oil (linalool , geraniol , cineole) Flavonoids (hesperidin,quercetin,astralagin Mucilage of arabinose Pharmacological effects Colds, cough and influenza symptoms It induce perspiration For nervous disorders Polysaccharides are smoothing and adhere to epithelial tissue producing a demulcent effect

41. 3- mallow flower (flowers and leaves are used) Constituents: Mucilages are the main constituent Flavonoids glycosides Anthocyanins (malvin) Pharmacological effects : Mallow is demulcent and pectoral , so an infusion is made for cold and cough The mucilage from the leaves is anti-inflammatory with anti-complement activity

42. 4- marshmallow leaf and root Constituents Mucilage consisting of a number of polysaccharide (galactose , rhamnose , galacturonic acid and glucuronic acid) Favonoids (quercetin , kaempferol) Pharmacological effects Both roots and leaves are used internally as a demulcent for irritable coughs and throat Extracts of both are used for gastric and urinary inflammation They may applied as a soothing poultice(كمادة) and vulnerary دواء لائم للجراح The most common use of extracts is the making of confectionery

43. Constituents : Mucilage composed of acidic polysaccharide Flavonoids and triterpenes Pyrrolizidine alkaloids Pharmacological effects Coltsfoot is used for pulmonary complaints ,irritating or spasmodic, cough ,whooping cough ,bronchitis ,laryngitis and asthma. The polysaccharides are anti-inflammatory and immuno-stimulating, as well as demulcent , and the flavonoids also have anti- inflammatory and antispasmodic action. Colts foot leaves and flowers

44. Toxicology Pyrrolizidine alkaloids cause hepatotoxicity on high dose not in daily dose

45. Immunostimulants 1- Echinacea (Roots are used) Constituents Caffeic acid derivatives including echinacoside (echinacin) , cichoric acid Alkylamides which are unsaturated fatty acid Pharmacological effects: Treatment of respiratory and urinary track infection Topically for slow healing wounds Pain and inflammatory skin condition and toothache Echinacea are often combined with garlic for the treatment of cold and allergic reactions

46. 2- Astragalus(roots are used) Constituents Triterpenoids saponins (astragalosides) Polysaccharide known as astregaloglucans Pharmagological effects : It is used for colds and upper respiratory infections , it is used prophylactically It is used as an adjunctive in the treatment of cancer and appear to potentiate the action of interferon It is also have antioxident , hapatoprotective and antiviral activity