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Comprehensive Guide to Respiratory Drugs: Asthma and Lung Diseases

Explore asthma, emphysema, and other lung diseases, along with cough and cold treatments, smoking cessation, and drug therapy. Learn about treatment options and management strategies for various respiratory conditions.

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Comprehensive Guide to Respiratory Drugs: Asthma and Lung Diseases

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  1. Chapter 9 Respiratory Drugs

  2. Chapter 9 Topics • Asthma • Emphysema • Other Lung Diseases • Cough and Cold • Smoking Cessation

  3. Learning Objectives • Differentiate the pulmonary diseases • Learn the pathophysiology and treatment of asthma • Define the goals of asthma treatment • Discuss the pathophysiology and treatment of emphysema and chronic bronchitis

  4. Learning Objectives • Describe other diseases related to the lungs • Be aware of the reemergence of tuberculosis and of treatment for this disease

  5. Learning Objectives • Understand how the antitussives, expectorants, decongestants, and antihistamines differ, and be able to describe their uses • Know why some drugs are prescribed for their side effects • Outline smoking cessation plans and supportive therapy

  6. Asthma • Inflammatory disease that affects the airways causing a reversible airway obstruction • Intermittent attacks are precipitated by specific triggering events • Causes a decrease in the amount of oxygen and carbon dioxide exchanged

  7. Asthma Classes • Allergic • Present in 35%-55% of patients

  8. Asthma Classes • Allergic • Present in 35%-55% of patients • Exercise Induced

  9. Asthma Classes • Allergic • Present in 35%-55% of patients • Exercise Induced • Nonallergic

  10. Upper and Lower Respiratory Tracts

  11. Exchange of Oxygen and Carbon Dioxide

  12. Asthma • Asthmatic lung is more sensitive to lower doses of allergens • Asthma has shown to have genetic predisposition

  13. Asthma Characteristics • Reversible small airway obstruction • Progressive airway inflammation • Increased airway responsiveness to stimuli These characteristics translate into: • Wheezing • Dyspnea • Acute and Chronic Cough

  14. Asthma Attack – 1st Response • Triggered by an antigen-antibody reaction • Causes degranulation of mast cells: histamine released • Results in bronchospasm and mucus production that plugs the small airways

  15. Asthma Attack – 2nd Response • Bronchoconstriction with delayed, sustained reactions • Causes self-sustaining inflammation

  16. Asthmatic Response

  17. Peak Flow Meter • Assesses severity of disease and aids in determining course of therapy • Measures maximum flow rate in forced expiratory maneuvers

  18. Goals of Asthma Care • Sleep well every night • Be able to go to work or school every day • Be free from wheezing all day • Have good control of coughing • Be able to continue with activities and exercise • Tolerate medicines well

  19. Asthma Therapy • Know the triggers and try to avoid them • Accurately use a Peak Flow Meter regularly • Be aware of status asthmaticus and the treatment for it. **This is a medical emergency.**

  20. Stepwise Approach to Asthma Therapy Step 1. Short-acting oral or inhaled beta-2 agonist (less than once a week); no daily medications

  21. Stepwise Approach to Asthma Therapy Step 1. Short-acting oral or inhaled beta-2 agonist (less than once a week); no daily medications Step 2. Short-acting oral or inhaled beta-2 agonist (not to exceed three to four times in one day); daily medications (e.g., inhaled corticosteroids)

  22. Stepwise Approach to Asthma Therapy Step 3.Short-acting oral or inhaled beta-2 agonist; daily medications (e.g., inhaled corticosteroid and long-acting bronchodilator)

  23. Stepwise Approach to Asthma Therapy Step 3.Short-acting oral or inhaled beta-2 agonist; daily medications (e.g., inhaled corticosteroid and long-acting bronchodilator) Step 4. Short-acting oral or inhaled beta-2 agonist; daily medications; inhaled corticosteroid, long-acting bronchodilator, long-acting beta-2 agonist, and oral corticosteroids long term

  24. Asthma Drug Therapy • Treatment should start at the most appropriate step • Start with an aggressive initial approach • Rescue corticosteroids may be used at any time • Treatment should be reviewed every 3-6 months • For exercise-induced asthma, using terbutaline or albuterol before exercise gives protection for 2 hours

  25. Devices Used in Asthma Therapy • Uses a stream of air that flows through liquid medication to make a fine mist to be inhaled • Very effective • Must be cleaned and taken care of to reduce risk of contamination Nebulizer

  26. Devices Used in Asthma Therapy • Metered Dose Inhaler (MDI) • Contains medication and compressed air • Delivers a specific amount of medication with each puff

  27. Devices Used in Asthma Therapy • Metered Dose Inhaler (MDI) • Contains medication and compressed air • Delivers a specific amount of medication with each puff • Spacer • Used with MDIs to help get medication into the lungs instead of depositing on the back of the throat

  28. Devices Used in Asthma Therapy • Dry powder inhalers • Starting to replace MDIs • The patient turns the dial and a capsule full of powder is punctured • The patient then inhales the powder

  29. Drug List Asthma AgentsBronchodilators • albuterol (Proventil, Proventil HFA, Ventolin, Ventolin HFA) • epinephrine (EpiPen) • formoterol (Foradil) • ipratropium (Atrovent) • ipratropium-albuterol (Combivent) • isoetharine (Beta-2)

  30. Drug List Asthma AgentsBronchodilators • isoproterenol (Isuprel) • levalbuterol (Xopenex) • metaproterenol (Alupent) • pirbuterol (Maxair) • salmeterol (Serevent) • terbutaline (Brethine) • tiotropium (Spiriva)

  31. albuterol (Proventil, Proventil HFA, Ventolin, Ventolin HFA) • Used in cases of airway obstruction • Relaxes bronchial smooth muscle with little effect on heart rate • HFAs do not contain chlorofluorocarbons which deplete the ozone

  32. levalbuterol (Xopenex) • Isomer of albuterol • Has fewer side effects than albuterol • Must be used with a nebulizer • Vials should be stored in foil package; once the foil is opened, vials must be used within 1 to 2 weeks

  33. salmeterol (Serevent) • Indicated for maintenance therapy • Has a long duration of action • Onset of action is 30-60 minutes • Should not be used in rescue situations • Available in MDI and dry powder inhaler

  34. ipratropium (Atrovent) • Blocks ACh in bronchial smooth muscle causing bronchodilation • Used for prevention of attacks, not rescue situations

  35. Atrovent Dispensing Issues • If patient is allergic to peanuts, they may be allergic to the suspending agent in this inhaler Warning!

  36. ipratropium-albuterol (Combivent) • Combination bronchodilator • Should inquire about peanut allergy as well

  37. Drug List Asthma AgentsXanthine Derivatives • aminophylline (Truphylline) • theophylline

  38. Drug List Asthma AgentsLeukotriene Inhibitors • montelukast (Singulair) • zafirlukast (Accolate) • zileuton (Zyflo)

  39. Leukotrienes • Increase edema, mucus, and vascular permeability • 100 to 1,000 times more potent than histamine • Inhibitors block the synthesis of or the body’s response to leukotrienes

  40. montelukast (Singulair) • Indicated for the prophylaxis and chronic treatment of asthma • Do not use to treat acute attacks • Approved for use in children over 12 months • Used once a day • Available in tablet and chewable tablet

  41. Drug List Asthma AgentsCorticosteroids • beclomethasone (Beconase,Vanceril) • budesonide (Pulmicort, Rhinocort) • dexamethasone (Decadron) • flunisolide (AeroBid) • fluticasone (Flonase, Flovent) • hydrocortisone (Solu-Cortef)

  42. Drug List Asthma AgentsCorticosteroids • methylprednisolone (Medrol Dose-Pack, Solu-Medrol) • mometasone furoate (Nasonex) • prednisolone (Orapred, Pediapred) • prednisone (Deltasone) • triamcinolone (Azmacort, Nasacort AQ)

  43. Corticosteroids • Anti-inflammatory agent to suppress the immune response • Inhibit late-phase inflammatory reaction • Reserved for more difficult cases

  44. Corticosteroid Side Effects • Primary: • Oral candidiasis • Irritation and burning of the nasal mucosa • Hoarseness • Dry mouth

  45. Corticosteroid Side Effects • If used for a long period of time, it can cause: • Growth of facial hair in females • Breast development in males • Weight gain • “buffalo hump” – “moon face” • Easy bruising – Edema

  46. Corticosteroid Dispensing Issues • Patient should rinse mouth with water after using these inhalers to prevent oral candidiasis • Patient should be taught how to correctly use these medications Warning!

  47. fluticasone (Flonase, Flovent) • Flonase is a nasal spray used for allergies • Flovent is an MDI that comes in 3 different strengths • May take 2 weeks to reach maximum benefit

  48. budesonide (Entocort EC, Pulmicort Respules, Pulmicort Turbuhaler, Rhinocort) • Pulmicort Turbuhaler – dry powder inhaler that is breath activated and is easier to use • Coughing is a less frequent side effect

  49. mometasone furoate (Nasonex) • Decreases the amount of inflammation- causing chemicals that are released • Reverses dilation and permeability of vessels • May be used in children over 12 to prevent allergy symptoms

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