Asthma Management and Inhalation Methods

• Asthma is a chronic respiratory condition characterized by recurrent and reversible airflow obstruction, often triggered by allergens, cold air, exercise, or emotional stress.

Asthma Symptoms

• Wheezing
• Shortness of breath
• Chest tightness
• Coughing

Inhalation Methods

• Metered Dose Inhaler (MDI)
• Dry Powder Inhaler (DPI)
• Nebulizers

Metered Dose Inhaler (MDI)

• Delivers medication through a propellant that forces air into the mouth.

Dry Powder Inhaler (DPI)

• Delivers medication without using a propellant.

Nebulizer

• Turns medication into a mist for inhalation.

Inhalation Key Points

• Separate puffs by at least 1 minute.
• Spacers can enhance medication delivery, especially for children.

Inhaler Patient Education

• Verify the patient's ability to self-administer medication.
• Demonstrate and have them return demonstrate.
• Ensure the maintenance of dose counts.

Asthma Management Drugs

• Bronchodilators
• Anti-inflammatory drugs
• Leukotriene receptor antagonists
• IgE antagonists

Bronchodilators

• Beta-adrenergic agonists are a type of bronchodilator used for asthma.

Anti-Inflammatory Drugs

• Corticosteroids are a type of anti-inflammatory drug used for asthma.

Rapid-Acting Drugs

• Albuterol is a rapid-acting medication for asthma.

Long-Term Control Drugs

• Salmeterol is a long-term control medication for asthma.

Bronchodilator Mechanism of Action

• Induces muscle relaxation and bronchodilation, providing only symptomatic relief and serving as a first-line therapy for asthma attacks.

Beta Agonist Adverse Effects

• Insomnia
• Restlessness
• Tachycardia
• Palpitations
• Vascular headache
• Tremor
• Arrhythmias

Tachycardia Consideration

• Xopenex should be considered if the patient is tachycardic.

Anticholinergic Mechanism of Action

• Prevents bronchial constriction and airway narrowing by blocking acetylcholine (ACH) receptors.

Inhaled Glucocorticoids Mechanism of Action

• Consistently reduces airway inflammation and is a first-line therapy for daily asthma management, not for acute asthma attacks.

Inhaled Glucocorticoids Adverse Effects

• Pharyngeal irritation
• Dry mouth
• Oral fungal infections (thrush)

Inhaled Glucocorticoids Nursing Implications

• Instruct patients to gargle and rinse their mouth with lukewarm water after each use to prevent thrush.

Bronchodilator and Corticosteroid Combination

• Use the bronchodilator several minutes before the corticosteroid.

Oral Glucocorticoids

• Use if inhaled versions or beta-agonists are ineffective.

Oral Glucocorticoids Side Effects

• Adrenal suppression
• Osteoporosis
• Hyperglycemia
• Peptic Ulcer Disease (PUD)

Leukotriene Receptor Antagonists (LTRAs)

• Block inflammation, bronchoconstriction, and mucus production, reducing coughing, wheezing, and SOB.

LTRAs Nursing Implications/Patient Education

• For prophylaxis and chronic treatment of asthma in adults and children over 12, not for acute asthma attacks, and should be taken at the same time every day.

Viral Rhinitis Management

• Use antihistamines, nasal decongestants, antitussives, and expectorants for symptom relief but do not eliminate the pathogen.

Over-the-Counter Medicine for Children

• Only for children older than 2 years old, as it can cause drowsiness and affect respiratory drive in younger children, potentially leading to death.

Antihistamines Mechanism of Action

• Blocks histamine from binding to H1 receptor sites, preventing adverse effects like runny nose and sneezing.

Antihistamines for Upper Respiratory Infections

• Relieves runny nose symptoms due to anticholinergic effects.

Antihistamines Patient Education

• Patients with allergies should take them regularly, as H1 blockers are more effective in preventing histamine actions rather than reversing them.

Types of Antihistamines

• First generation: centrally acting, more sedating (e.g., Benadryl).
• Second generation: peripherally acting, less sedating, and longer duration of action (e.g., Claritin).

Antihistamines Adverse Effects

• Dry mouth
• Difficulty urinating
• Constipation
• Changes in vision
• Drowsiness

Antihistamine Nursing Implications

• Instruct about possible sedation.
• Advise against driving or operating heavy machinery.
• Discourage alcohol or other CNS depressants.

Types of Decongestants

• Adrenergic.
• Glucocorticoids.

Adrenergic Decongestants Mechanism of Action

• Stimulates alpha1-adrenergic receptors on nasal blood vessels, causing vasoconstriction and shrinkage, and consider the potential for crossover effects as local vasoconstrictors.

Oral Versus Topical Adrenergic Decongestants

• Oral: prolonged decongestant effects, but delayed onset (benefit: no rebound congestion).
• Topical: prompt onset with potent effect; however, can cause rebound congestion with overuse.

Intranasal Glucocorticoids Mechanism of Action

• Reduces nasal passage inflammation, decreasing congestion (e.g., Fluticasone/Flonase).

Nasal Decongestants Nursing Implications

• Systemic adrenergic decongestants may cause hypertension, palpitations, and Central Nervous System (CNS) stimulation.

Antitussives (Cough Suppressants)

• Used to stop or reduce coughing, particularly for nonproductive coughs, and are available in opioid and nonopioid forms.

Opioid Antitussives Mechanism of Action

• Suppresses the cough reflex by direct action in the medulla (e.g., Codeine).

Nonopioid Antitussives Mechanism of Action

• Suppresses cough reflex by numbing stretch receptors in the respiratory tract, preventing cough reflex stimulation (e.g., Robitussin-DM).

Opioid Antitussive Effects

• Sedation
• Respiratory depression
• Lightheadedness
• Nausea
• Vomiting
• Constipation

Nonopioids Antitussive Effects

• Dizziness
• Drowsiness
• Headache

Antitussive Nursing Implications

• For nonproductive coughs.
• Instruct to avoid driving or operating heavy equipment.

Expectorants Mechanism of Action

• Reduces viscosity of secretions by breaking down and thinning them out, promoting coughing (e.g., Mucinex).

Expectorants Nursing Implications

• Used for productive coughs only.
• Patients should increase fluid intake to help loosen and liquefy secretions.

Explore asthma, a chronic respiratory condition with symptoms like wheezing and shortness of breath. Learn about inhalation methods such as Metered Dose Inhalers (MDI), Dry Powder Inhalers (DPI), and nebulizers, along with key points for effective medication delivery and patient education.