How Do Other Pulmonary Drugs Work?

Other pulmonary drugs are medications that are not categorized into any of the specific classes of pulmonary drugs. Each of the other pulmonary drugs works in unique ways and is used in the treatment and diagnosis of diverse pulmonary conditions.

The medications that are grouped under other pulmonary drugs include:

• Acetylcysteine: Acetylcysteine, also known as N-acetylcysteine, is a mucolytic agent which breaks up the proteins in the mucus and reduces its viscosity, making it easier to cough up and clear from the lungs. Acetylcysteine also has anti-inflammatory and antioxidant properties.
• Alpha-1 proteinase inhibitor: Alpha-1 proteinase inhibitor is a purified substance derived from human plasma. Alpha-1 proteinase inhibitor works by inhibiting neutrophil elastase, an enzyme produced by immune cells known as neutrophils, which breaks down elastic tissue in the lungs and stimulates the secretion of mucus.
• Mannitol inhalation: The precise mechanism of mannitol is not known. Mannitol is an osmotic agent and it is thought to work by drawing water from the lung cells into the airway, which rehydrates and thins the mucus, and facilitates its clearance from the lungs.
• Nitric oxide gas: Inhaled nitric oxide gas relaxes the smooth muscles of pulmonary blood vessels and dilates them, reducing pulmonary hypertension and improving blood flow to the lungs.

Other pulmonary drugs may be administered through the following routes:

• Oral inhalations as powders or solutions nebulized into a fine mist
• Intravenous (IV) infusions
• Ventilators

The uses of other pulmonary drugs include the following:

Acetylcysteine

FDA-approved

• To thin the mucus and relieve chest congestion in pulmonary diseases such as:
  • Asthma
  • Emphysema
  • Bronchitis
  • Cystic fibrosis
• Diagnostic bronchography
• Acetaminophen overdose

Off-label

• Prevention of contrast agent-associated nephrotoxicity administered orally
• Keratoconjunctivitis sicca (dry eyes), administered as eye drops

Orphan designation

• Prevention of ototoxicity (toxicity to ears that can affect hearing and balance) caused by platinum-based chemotherapy to treat pediatric cancers

Alpha-1 proteinase inhibitor

FDA-approved

• Alpha-1 antitrypsin deficiency (alpha-1 proteinase inhibitor deficiency), an inherited condition that affects the lungs and liver

Orphan designation

• Diabetes mellitus type-I
• Bronchopulmonary dysplasia, a lung condition that develops in newborns who have required breathing assistance
• Graft-versus-host disease, a condition in which the donor cells attack the host cells after a transplant
• Cystic fibrosis

Mannitol inhalation

FDA-approved

• Bronchial hyperresponsiveness assessment
• Cystic fibrosis

Nitric oxide gas

FDA-approved

• Hypoxic (low oxygen level) respiratory failure in newborns

Orphan designation

Pediatric

• Prevention of chronic lung disease in premature newborns
• Cystic fibrosis

Adults

• Acute respiratory distress syndrome (ARDS)
• Pulmonary arterial hypertension (PAH)
• Cystic fibrosis
• Sickle cell crises
• Diagnosis of sarcoidosis
• Idiopathic pulmonary fibrosis
• Nontuberculous mycobacterial infections

Side effects of other pulmonary drugs vary with each type of drug. A few of the most common side effects include:

• Acetylcysteine:
  • Bronchoconstriction
  • Bronchospasm
  • Chest tightness
  • Disagreeable odor
  • Drowsiness
  • Increase in bronchial secretions
• Alpha-1 proteinase inhibitor:
  • Elevation of liver enzymes ALT and AST
  • Headache
  • Pharyngitis (throat inflammation)
  • Cough
  • Chills and fever
  • Chest pain
• Mannitol inhalation:
  • Cough
  • Hemoptysis (coughing up blood)
  • Headache
  • Throat irritation and pain
  • Nausea
  • Rhinorrhea (nasal discharge)
• Nitric oxide gas:
  • Hypotension (low blood pressure)
  • Withdrawal
  • Atelectasis (complete or partial collapse of a lung’s lobe or an entire lung)
  • Hematuria (blood in the urine)
  • Hyperglycemia (high blood glucose levels)
  • Infection, cellulitis, and sepsis

Information contained herein is not intended to cover all possible side effects, precautions, warnings, drug interactions, allergic reactions, or adverse effects. Check with your doctor or pharmacist to make sure these drugs do not cause any harm when you take them along with other medicines. Never stop taking your medication and never change your dose or frequency without consulting your doctor.

Generic and brand names of some of the other pulmonary drugs include:

• acetylcysteine
• alpha 1 proteinase inhibitor
• Aralast NP
• Aridol
• Bronchitol
• Genosyl
• Glassia
• INOmax
• mannitol inhalation
• N-acetylcysteine
• nitric oxide gas
• Prolastin C
• Zemaira