What medications are suitable for a patient with acute respiratory symptoms (cough, wheezing, runny nose) and hypertension?

Management of Respiratory Symptoms with Hypertension

For a patient presenting with cough with expectoration, runny nose, wheezing, and hypertension (180/100 mmHg), the first-line treatment should include nebulized salbutamol (albuterol) 5 mg plus ipratropium bromide 500 μg, administered with oxygen, along with systemic corticosteroids.

Assessment and Diagnosis

The patient's presentation suggests an acute respiratory condition with:

• Productive cough with expectoration
• Nasal congestion (runny nose)
• Wheezing on examination (suggesting bronchospasm)
• Breathing difficulties
• Hypertension (180/100 mmHg)

These symptoms are consistent with an acute exacerbation of either asthma or COPD.

Initial Medication Management

First-line Bronchodilator Therapy:

• Nebulized salbutamol (albuterol): 2.5-5 mg 1
• Ipratropium bromide: 500 μg added to the nebulized beta-agonist 1, 2
  • This combination provides superior bronchodilation compared to salbutamol alone 1
  • Ipratropium is the only recommended inhaled anticholinergic agent for cough suppression in respiratory infections and chronic bronchitis 2

Corticosteroid Therapy:

• Systemic corticosteroids: Prednisolone 30-60 mg orally or hydrocortisone 200 mg IV 1
  • Essential for reducing airway inflammation

Nebulizer Administration:

• Important: In patients with elevated CO2 levels or COPD, use compressed air rather than oxygen to drive the nebulizer to avoid worsening hypercapnia 1
• For patients without CO2 retention, oxygen can be used to maintain saturation >92% 1

Management of Hypertension

The patient's blood pressure (180/100 mmHg) requires attention but should be addressed after stabilizing the respiratory condition:

• Avoid beta-blockers (including eye drops) as they can worsen bronchospasm 2
• If antihypertensive therapy is needed, consider:
  • Calcium channel blockers (amlodipine, nifedipine) which have shown some benefit in reducing cough 2
  • Angiotensin receptor blockers if the patient has been on ACE inhibitors (which can cause cough) 2

Monitoring and Follow-up

• Re-evaluate the patient every 15-30 minutes after each treatment 1
• Monitor for adverse effects of salbutamol including:
  • Tremors (20%)
  • Tachycardia (1%)
  • Hypertension (1%) 3
• If PEF improves to >75% of predicted, continue ambulatory treatment 1
• If signs of severity persist or PEF <50% after initial treatment, consider hospitalization 1

Additional Considerations

For Chronic Bronchitis:

• Central cough suppressants (codeine, dextromethorphan) may be considered for short-term symptomatic relief 2
• Peripheral cough suppressants (levodropropizine, moguisteine) are recommended for short-term relief 2

For Upper Respiratory Infection:

• Central and peripheral cough suppressants have limited efficacy and are not recommended 2
• Over-the-counter cold medications are generally not recommended 2

Important Cautions

1. First treatment with beta-agonists should be supervised, as they may rarely precipitate angina in susceptible individuals 1

2. Avoid ACE inhibitors if the patient has a persistent cough, as they can exacerbate this symptom 2

3. Regular use of short-acting beta-agonists is not recommended for long-term management; they should be used as-needed 4

4. Mucolytic drugs have variable results and are not generally recommended for COPD without further studies 2

5. Zinc preparations are not recommended for acute cough due to common cold 2