====== Respiratory Pharmacology ======

==== Respiratory diseases fall into two fundamentally different categories: ====

<WRAP center round important 70%>
  * AIRWAY PROBLEM → obstruction & bronchospasm → bronchodilators + inhaled anti-inflammatories
  * 
  * PARENCHYMAL PROBLEM → alveolar injury & fibrosis → antifibrotics & immunosuppression
</WRAP>

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<WRAP group>
<WRAP half column>

===== Obstructive Physiology =====
=== Airway Disease ===
<WRAP info>
  * Problem: Air Cannot Get OUT Of The Lung
  * Usually Reversible
</WRAP>

==== Core Disorders ====
  * [[respiratory:asthma|Asthma]]
  * [[respiratory:copd|COPD]]
  * [[respiratory:exacerbations|Acute Exacerbations]]
  * [[respiratory:asthma_copd_step_therapy|Step Therapy Quick Guide]]

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==== Bronchodilators ====
  * [[respiratory:beta2_agonists|β2-Agonists (SABA/LABA)]]
  * [[respiratory:antimuscarinics|Antimuscarinics (SAMA/LAMA)]]
  * [[respiratory:methylxanthines|Methylxanthines]]

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==== Controllers (Reduce Inflammation) ====
  * [[respiratory:inhaled_corticosteroids|Inhaled Corticosteroids]]
  * [[respiratory:leukotriene_modifiers|Leukotriene Modifiers]]
  * [[respiratory:mast_cell_stabilizers|Mast Cell Stabilizers]]

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==== Severe Asthma Biologics ====
  * [[respiratory:biologics|Biologics Master Page]]
  * [[respiratory:biologics:anti_ige|Anti-IgE]]
  * [[respiratory:biologics:anti_il5|Anti-IL-5 / IL-5R]]
  * [[respiratory:biologics:anti_il4_13|Anti-IL-4/13]]
  * [[respiratory:biologics:anti_tslp|Anti-TSLP]]

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==== Symptom Relief ====
  * [[respiratory:antitussives_expectorants|Cough & Mucus Therapy]]
  * [[respiratory:allergic_rhinitis|Allergic Rhinitis]]
  * [[respiratory:smoking_cessation|Smoking Cessation]]

</WRAP>

<WRAP half column>

===== Restrictive Physiology =====
=== Parenchymal Disease ===
<WRAP info>
  * Problem: Lung Tissue Cannot Expand  
  * Usually Progressive
</WRAP>

==== Interstitial Lung Disease ====
  * [[respiratory:ild:overview|ILD Overview]]
  * [[respiratory:ild:ipf|Idiopathic Pulmonary Fibrosis]]
  * [[respiratory:ild:sarcoidosis|Sarcoidosis]]
  * [[respiratory:ild:hypersensitivity_pneumonitis|Hypersensitivity Pneumonitis]]

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==== Antifibrotic Therapy ====
  * [[respiratory:ild:antifibrotics|Antifibrotic Master Page]]
  * [[respiratory:ild:nintedanib|Nintedanib]]
  * [[respiratory:ild:pirfenidone|Pirfenidone]]

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==== Immune-Mediated Lung Disease Treatment ====
  * [[immunology:steroids:systemic_glucocorticoids|Systemic Corticosteroids]]
  * [[immunology:dmards:mycophenolate|Mycophenolate]]
  * [[immunology:dmards:azathioprine|Azathioprine]]
  * [[immunology:biologics:rituximab|Rituximab]]

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==== Key Clinical Distinction ====
<WRAP center round tip 90%>
  * Wheezing → bronchodilators  
  * Velcro crackles → antifibrotics  

They treat completely different diseases.
</WRAP>

</WRAP>
</WRAP>

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===== High-Yield Comparison =====

<WRAP center round box 50%>
^ Feature ^ Airway Disease ^ Parenchymal Disease ^
| Physiology | Obstructive | Restrictive |
| Primary issue | Narrow airways | Scarred alveoli |
| Reversibility | Often reversible | Progressive |
| Main therapy | Bronchodilators ± ICS | Antifibrotics / Immunosuppression |
| Clinical goal | Improve airflow | Slow decline |
</WRAP>

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===== How to Think About Dyspnea =====

<WRAP center round box 80%>
  * Wheeze → Airway Drugs  
  * Crackles → Fibrosis Drugs  
  * Hypoxia Out Of Proportion → ILD Workup
</WRAP>

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