1. Introduction to Pharmacology
Mucus

2. Mucus Controlling Strategies
First, remove causative factors.
Smoking/Pollution, Allergans
Second, Optimize the tracheobronchial clearance.
1. Assure well hydrate
2. Cough and deep breath
3. CPT
4. Use a bronchodilator (May
be used early for
bronchospasm)
5. Use Mucolytics
Use expectorants
Third, reduce inflammation
Treat infection
Use corticosteriods
Mucolytic breaking down, chemical breakdown of mucopolysaccharide by drug agents referred to as mucolytics
Expectorant promotes expectoration increasing production or decreasing viscosity

3. Terminology
Mucus – Total secretion from the mucous membranes including surface goblet cells and submucosal glands.
Sputum – Expectorated secretions that contain respiratory tract as well as oro- and nasopharyngeal secretions.
Gel – A macromolecular description of part of the respiratory secretion that has structure because of intermolecular attractions along with the properties of viscosity and elasticity.

4. Terms (cont)
Sol – A macromolecular description of the respiratory secretion in true solution with the physical property of viscosity; designated as “airway surface fluid.”
Glycoprotein – A protein with covalently attached oligosacchride units. The principle constituent of mucus; a high molecular weight glycoprotein gives mucus its viscosity.

5. Terms (cont)
Oliogosaccharide – A sugar that is the individual carbohydrate unit of glycoproteins.
Mucoactive – A term used for any agent that has an effect on mucus secretion.
Mucolytic – Breaks down the structure of mucus usually reducing viscosity and elasticity.
Act to change the properties of mucus, making it easier to be removed by cough or suctioning. Mucolytic
Mucopolysaccharide:
Amino sugars
Amino acids
Alternating
Connected by disulfide bonds

6. Terms (cont)
Mucokinetic – An effect of improving the mobilization and clearance of respiratory mucus secretions.
Mucospissic – An effect of increasing the viscosity and elasticity of mucus secretion.
Expectorant – An agent improving the expectoration of respiratory secretions.

7. Mucocilliary Physiology
Approximately 100 ml of mucus is secreted each day for the average adult. These secretions are excreted by submucosal glands and surface goblet cells. Once the mucus is in the airway it is propelled up the tracheobroncial tree via ciliated epithelium cells. The cilia on the surface of these cells wave the mucus up the airway.

8. Mucocilliary Physiology (cont)
The cilia are allowed to wave freely due to the sol layer (watery) of the mucus being found between the cilia. If this layer becomes more viscous than the waving ceases. As the cilia continue to wave, it mobilizes the gel layer up the airway. The average individual only expectorates 10% of the mucus produced with the remainder being absorbed by the inspired air, lymphatic system, or capillaries.

9. How Disease can Effect Mucus Clearance
Disease, infection, or inflammation can cause hypersecretion of mucus. If too much mucus is produced the mucociliary escalator gets overloaded.
Disease, infection, or inflammation can also increase viscosity and elasticity of the mucus. Therefore, slowing down ciliary movement.
Mucociliary escalator
Failure results in occlusion of the airway with thick viscous secretions
Tell me which disease processes tend to have abnormal mucociliary function?
Bronchitis, asthma, CF

10. How Disease can Effect Mucus Clearance (cont)
If secretions are retained due to mucociliary impairment, then the patient is set up for infection. Microbes thrive in warm humid environment. This is especially the case if retained mucus is present. Mucus is an excellent nutrition substance for microbes to grow and multiply.

11. Acetylcysteine Brand name: Mucomyst
Indications: Treatment of excessive thick, viscous mucus secretions, after other secretion clearing procedures have failed.
Dose: 20% solution – 3–5 ml via SVN
10% solution – 6-10 ml via SVN
May be directly instilled via ET tube or
bronchoscope

12. Acetylcysteine (cont)
Hazards: BRONCHOSPASM, airway inflammation, N/V, rhinorrhea, mechanical obstruction due to rapidly mobilization of thick secretions.
Mode of Action: Breaks down the disulfide bonds in the mucus.

13. Dornase Alfa Brand name: Pulmozyme
Indications: Daily management of CF. It’s the only agent that appears to breakdown viscosity without effecting elasticity.
Dose: 1.0 mg in 2.5 ml of clear colorless sol.
Delivered by itself via Hudson T
Updraft II or the Marquest Acorn II
Nebulizers.

14. Dornase Alfa (cont)
Side effects: voice alteration, pharyngitis, laryngitis, rash, chest pain, and conjunctivitis
Mode of Action: Breaks down the DNA.

15. Amiloride
Indications: Investigated in CF patients. Through inhaling it was theorized that it would reverse the ion exchange defect found in CF.
Not used today

16. Other Mucoactive Agents
Sodium Bicarbonate
Bland aerosol therapy