Respiratory Medications

Theresa Till Ed.D, RN,CCRN

Pathophysiology of Asthma HYPERRESPONSIVENESS OF AIRWAYS

that results in: Usually, reversible constriction of bronchial

smooth muscle (bronchoconstriction). Hypersecretion of mucus Mucosal inflammation and edema

(Considered more a disease of inflammation than obstruction: obstruction occurs secondarily)

Triggers to Asthma

Asthma(narrowed airways)

Asthma

Chronic Bronchitis

Usually caused by smoking or inhaled irritants.

“Mega” mucous Airway inflammation Irreversible

EmphysemaAlveolar Destruction

Emphysema

IRREVERSIBLE destruction of alveolar walls which decreases surface area for gas exchange.

Loss of lung elasticity: “springs” that hold open alveolar walls are “sprung” and collapse.

Air becomes trapped and distal airways hyperinflate and rupture.

Quit smoking

Major cause of COPD.

Nicotine Patch

Medications that Treat Respiratory Disease

Steroids–REDUCE INFLAMMATION.–CONSIDERED A DRUG OF

PREVENTION–Not used acutely–Best to use spacer (aerochamber)

to decrease systemic effects. –Rinse & spit after use.–Commonly ends in “sone,” “olone”

Bronchodilators

Fast acting USED ACUTELY. Open airways. Most bronchodilators are

given via nebulizer, MDI or DPI. Beta adrenergic agonists (erol, enol)

Common side effects are palpitations &, tachycardia. Note: If patients are using more than one canister a month (200puffs), their disease is in poor control. Don’t use as “fire extinguisher.” Ask why is fire breaking out?

BronchodilatorsBronchodilators

(fast or slow acting) work by relaxing muscle walls and thereby making the air passage larger.

Bronchodilators

– Methylxanthines: theophylline Aminophylline second line drug given when extra treatment is needed. Given IV or PO. Most common side effects of aminophylline are tachycardia, shakiness, and palpitations.

– Anticholinergics: relax bronchial smooth muscle but less effective than beta agonists.

– http://www.use-inhalers.com/

Respiratory PreventativesMast Cell Stabilizers

Not used acutely. Used to prevent an exacerbation of asthma.

Examples of mast cell stabilizers: • Cromolyn (Intal)• Nedocromil (Tilade)• Inhibit histamine release from mast cells

thus decreasing immune response.

Respiratory PreventativesLeukotriene Modifiers

– Not used acutely. Used to prevent an exacerbation of asthma

– Leukotriene Modifiers: interfere with synthesis or block the action of leukotrienes which cause inflammation. Examples are:

• “lukast

• Montelukast (Singulair)

Valuable Miscellaneous Interventions

Respiratory and Physical Therapy

Encourage to attend pulmonary rehabilitation classes (exercise supervised by professionals)

Breathing retraining (handout)– Purse-lip– Diaphragmatic (abdominal breathing)

Increase exercise tolerance Effective coughing

– Flutter mucus clearance device– Acapella- hand-held device that loosens

secretions via vibrations & positive pressure Teach patients to assess sputum Avoid conversation with exercise

Metered Dose Inhalers

Common treatment.

Note location of MDI when a spacer or aerochamber is not used.

Peak Flow Meters

Flutter Mucus Device

COPD

Abdominal Breathing

Pursed Lip Breathing

http://www.bing.com/videos/search?q=teaching+pursed+lip+breathing+animation&qs=n&form=QBVR&pq=teaching+pursed+lip+breathing+animation&sc=0-30&sp=-1&sk=#view=detail&mid=76EC2961EE65A64565A976EC2961EE65A64565A9

Nutritional Therapy

Weight loss and malnutrition are common

• Pressure on diaphragm from a full stomach causes dyspnea

• Difficulty breathing while eating leads to inadequate consumption

• Drink fluids in between meals• Rest at least 30 minutes prior to eating• Frequent small meals (high calorie and protein)• Prepare foods in advance

Respiratory Therapy

Aerosol nebulization therapy

–Deliver suspension of fine particles of liquid (medication) in a gas

–Easy to use

–Must be kept clean at home to prevent bacterial growth

Managing Oxygen Liter Flow Outdated information: Never exceed 2

liters of oxygen per nasal cannula for patients with chronic lung disease because can knock out drive to breath. This can occur but is rare.

New standard is to use oxygen saturation level as guide to how much oxygen to deliver. Increase oxygen level to maintain therapeutic oximetry. If Sp02↓ with ↑ O2, stop.

Hinkle, MD, SIU Chief of Pulmonary Medicine