Respiratory Disorders 

Asthma:a recurrent, reversible SOB when lung airways become narrowed

• componenets:
• bronchospasm
• inflammation & edema
• production of mucous 
• NAEPP - provide guidelines for diagnosis & treatment 

Chronic Obstructive Pulmonary Disease (COPD):

- consists of chronic bronchitis & emphysema

- precipitated by prolonged exposure to bronchial irritations - such as smoke 

• Chronic Bronchitis: inflammation of bronchi & has excessive secretion of mucous 
• Emphysema: air spaces enlarge in response to obstruction of alveolar walls 

Bronchodilators

Drug: 

• albuterol (Proventil) - inhaled, 1st choice 
• onlhy can be used as often as ordered - too much leads to increased HR, nervousness, shakiness
• epinephrine (Adrenalin) - subQ 
• usually only given in ER for resp. distress 
• salmeterol (Serevent) - Long-Acting
• used for COPD & asthma 
• maintenance ONLY 

Action: stimulate Beta 2, causing bronchodilation by relaxing bronchial smooth muscle 

Use: asthma; salmeterol (COPD & asthma) 

Adverse: increased HR / increased force of contraction (these drugs can also stimulate Beta 1) 

Contraindications: cardiac tachyarrhythmias / severe CAD / HTN / DM 

Nursing Implications: 

• teach prevention of attacks & to avoid triggers (cig smoke, perfumes, animals, etc) 
• teach use of inhaler 
• wait 3-5 minutes in between puffs 
• rinse mouth to prevent fungal infections 
• may use spacer
• bronchodilator first, then other inhaler (opens airways then 2nd inhaler gets deep down in lung 
• mark rescue inhaler for easy ID 

Anticholingergics 

Drug: 

• ipratropium (atrovert) - not for rescue 
• tiotropium (spiriva) - not for rescue (24 hour) 

Action: block action of acetylcholine in bronchial smooth muscle/ prevents bronchoconstriction 

Use: maintenance therapy for bronchitis/emphysema - only used to prevent attacks from occuring 

Adverse: nervousness / headache / hypotension / GI distress 

Corticosteroids 

Drug: 

• afluticasone (Flonase)
• beclomethasone (Beclovent)
• budesonide (Pulmicort)
• triamcinolone (Azmacort)
• dexamethasone (Decadron)
• methylprednisone (IV) 
• prednisone (PO) 

Action: stabilize membrane of cells that release bronconstricting substances, suppresses inflammation, decreases mucous production, decreases edema 

Use: asthma, COPD, emphysema 

Adverse: inhaled avoids systemic problems / impaired growth in children / dry mouth / cough / plus addtl effects  

Nursing Implications: 

• usually not given in acute attack - come into play if Beta 2 meds don't work 
• May be given alone or w/ bronchodilator 
• use conticosteroid inhaler last (use bronchodilator first) 
• gargle after use for risk of fungal infections 
• IV & PO used during acute probs when pt can't be controled with inhaled route 

Mixed Inhalers 

Drug: 

• ipratropium/albuterol (Combivent, DuoNeb) 
• anticholingergic and short term beta-2
• Fluticasone/salmeterol (Advair) 
• inhaled steroid and long acting beta-2

Use: for maintenance only, NOT rescue

Xanthines 

Drug: 

• theophyline (Theo-dur, Aminophyline) 

Action: causes bronchodilation by dilating airways

Use: asthma / emphysema / chronic bronchitis 

Adverse: CNS stimulation / increased cardiac output / restlessness / convulsions / tachycardia 

• Toxicity: 
• siezures 
• arrhythmias
• if below 5, pt at risk for asthmatic attack
• if above 15, toxicity occurs 

Nursing Implications: 

• not first line agent ( due to narrow therapy range) 
• therapeutic level 5 - 15 mcg/mL
• frequent lab draws required
• coming out of favor b/c hard to keep pt regulated on this drug 

Leukotriene Modifiers 

Drug: 

• zafirlukast (Accolate) 
• montelukast (Singulair) 

Action: prevent leukotrienes from binding to receptors, leading to a reduction in bronchoconstriction, inflammation, mucus production, and airway edema 

Use: asthma along w/ bronchidilators and steroids (not a single use only drug) (PREVENTION ONLY) 

Adverse: N/V/ headache / infection

Contraindications: liver disease 

Nursing Implications: 

• monitor liver enzymes
• take 1 hour before or 2 hour after meals for best absorption 

Anti-Histamines 

Drug: 

• diphenhydramine (Benadryl) - 1st gen. 
• binds with central & peripheal receptions, causing CNS depression
• fexofenadrine (Allegra) - 2nd gen. 
• loratadine (Claritan) - 2nd gen. 

Action: antagonize the action of histamine by occupying receptor sites, working against vasodilation & inflammation 

Use: seasonal allergic rhinitis 

Adverse: drowsiness problems w/ 1st. gen. 

Nursing Implications: 

• teach safety about drowsiness 
• give w/ food 
• for seasonal allergies, take regularly 

Nasal Decongestants 

Drug: 

• pseudoephedrine (Sudafed)
• oxymetazoline (Afrin) 
• phenylephrine (NeoSynephrine) 

Action: shrinks engorged nasal mucosa 

Use: relief of nasal congestion 

Contraindications: severe HTN / CAD 

Nursing Implications: 

• usually only used in kids ages 6+ 

Anti-Tussives 

Drug: 

• non-narcotic: dextromethorphan (Benylin) 
• narcotic: codeine or hydrocodone added to syrup (aids w/ sleep trouble) 

Action: suppress cough center in the medulla 

Use: to relieve dry hacking cough 

Adverse: dizziness / sedation (opioid added) / nausea 

Nursing Implications: 

• assess cough 
• use @ night if using opioid 
• no ETOH 
• increase fluids 
• if combined with opioid, don't operate machinery, don't drive 

Expectorants 

Drug: 

• guaifenesin (Mucinex, Robitussin) 

Action: relieves productive cough caused by thin respiratory secretions 

Use: to suppress reproductive cough 

Nursing Implications: 

• take only as needed
• can be combined in cold remedy formula