Download Respiratory Disorders

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
Emphysema
Alveolar 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?

Bronchodilators
 Bronchodilators
(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 Preventatives
Mast 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 Preventatives
Leukotriene 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=t
eaching+pursed+lip+breathing+animatio
n&qs=n&form=QBVR&pq=teaching+pur
sed+lip+breathing+animation&sc=030&sp=1&sk=#view=detail&mid=76EC2961EE6
5A64565A976EC2961EE65A64565A9
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