Respiratory Agents - Non-Bronchodilator Agents

Inhaled corticosteroids

used for chronic asthma (not acute asthma attacks) - anti-inflammatory, stabilize cell membranes that release harmful bronchoconstrictors and leukocytes, increase responsiveness of bronchial smooth muscle to beta-adrenergic stimulation - takes several weeks before full effects are seen

Local SE of low doses used - inhaled corticosteroids

reduced systemic effects - local mucosal dryness and irritation, pharyngeal irritation and coughing, dry mouth, oral fungal infections, but may cause increased IOP

Examples of inhaled corticosteroids

beclomethasone dipropionate (Beclovent), budesonide (Pulmicort Turbuhaler), dexamethasone sodium phosphate (Decadron Phosphate Respihaler), flunisolide (AeroBid), triamcinolone acetonide (Azmacort), ciclesonide (Omnaris)

Nursing implications for inhaled corticosteroids

teach patients to gargle and rinse mouth with lukewarm water after use to prevent oral fungal infections, teach patients to monitor disease with a peak flow meter, encourage use of a spacer device to ensure successful inhalations, teach patient how to keep inhalers and nebulizer equipment clean after uses

If a bronchodilator and corticosteroid inhalers are both ordered…

use the bronchodilator several minutes before the corticosteroid - this opens the airways first, so the steroid can work better

Patient education for inhalers

ensure that the patient can self-administer the medication - provide demonstration and return demonstration, ensure that the patient knows the correct time intervals for inhalers, provide a spacer if the patient has difficulty coordinating breathing with inhaler activation, ensure that the patient knows how to keep track of the number of doses in the inhaler device

Leukotrienes

substances released when a triggers - ex. cat dander or dust, starts a series of chemical reactions in the body - cause inflammation, bronchoconstriction, and mucus production resulting in coughing, wheezing, SOB

Leukotriene receptor antagonists

an oral, non-bronchodilating, newer asthma med class - prophylaxis and long-term treatment and prevention of asthma in adults and children 12 years of age and older - not meant for management of acute asthmatic attacks

Examples of leukotriene receptor antagonists

montelukast (Singulair), zafirlukast (Accolate), zileuton (Zyflo)

Method of action for leukotriene receptor antagonists

prevent smooth muscle contraction of bronchial airways, decrease mucus secretion, prevent vascular permeability, decrease neutrophil and leukocyte infiltration to the lungs, preventing inflammation

Nursing implications for leukotriene receptor antagonists

monitor for adverse effects (HA, nausea, dizziness, liver dysfunction, insomnia), teach patient the purpose of the therapy, advise patients to check with HCP before taking OTC or prescription meds to determine drug interactions, assess LFTs before beginning therapy and throughout, teach patient to take medications every night on a continuous schedule, even if symptoms improve (improvement should be seen in about one week)

General respiratory nursing implications

perform a thorough respiratory assessment, teach patients to take meds exactly as prescribed (ensure patients know how to use inhalers and MDIs, have patients perform return demonstrations of their use), always check with their HCP before taking OTC meds/supplements, monitor for therapeutic effects (decreased dyspnea, wheezing, restlessness, anxiety, improved respiratory patterns with return to normal rate and quality, improved activity tolerance and increased ease of breathing), monitor for adverse effects

Respiratory health promotion

encourage patients to take health promotion measures - adequate fluid intake, compliance with medical treatment, compliance with vaccination schedule, avoid excessive fatigue, heat, extremes in temperature, caffeine, avoid exposure to conditions that precipitate bronchospasm (air pollutants, allergens, smoking, stress)