Respiratory Meds
Respiratory pharmacology doesn't have to give you heart palpitations (unlike some of these meds might!). Let's break down the most common respiratory drugs into easily digestible categories.
Bronchodilator Brigade: Opening Those Airways
Beta-2 Agonists: The Quick Relief Team
Short-Acting (SABAs): Albuterol, Levalbuterol
Onset: 5-15 minutes, Duration: 4-6 hours
Think: "Rescue" meds for acute symptoms
Long-Acting (LABAs): Salmeterol, Formoterol
Duration: 12+ hours
Never use alone for asthma (black box warning!)
Side Effects: Tremors, tachycardia, jitteriness
How to explain to patients: "These relax the muscles around your airways, like loosening a tight belt."
Anticholinergics: The Underappreciated Heroes
Short-Acting: Ipratropium
Onset: 15-30 minutes, Duration: 6-8 hours
Long-Acting (LAMAs): Tiotropium, Umeclidinium
Duration: 24+ hours, once-daily dosing
Side Effects: Dry mouth, urinary retention (rarely)
COPD Superstar: Often more effective for COPD than asthma
How to explain to patients: "These prevent your airways from squeezing closed by blocking certain nervous system signals."
Methylxanthines: The Old Guard
Examples: Theophylline
Narrow therapeutic window: Frequent blood level monitoring needed
Side Effects: Nausea, vomiting, cardiac arrhythmias
Modern Usage: Largely replaced by safer alternatives
How to explain to patients: "This is an older medication that helps open airways and strengthens breathing muscles, but we need to monitor blood levels carefully."
Anti-Inflammatory Arsenal: Fighting the Fire
Inhaled Corticosteroids (ICS): The Inflammation Fighters
Examples: Fluticasone, Budesonide, Beclomethasone
Mechanism: Reduce airway inflammation, not for acute relief
Side Effects: Oral thrush, hoarseness, dysphonia
Pro Tip: Always rinse mouth after use!
How to explain to patients: "These reduce swelling in your airways, like applying ice to a sprained ankle. They prevent flare-ups but won't help during an attack."
Leukotriene Modifiers: The Alternative Approach
Examples: Montelukast (Singulair)
Oral administration: Good for patients with poor inhaler technique
Side Effects: Headache, potential neuropsychiatric effects
Best For: Asthma with allergic rhinitis
How to explain to patients: "These block chemicals that cause both allergies and asthma, which is why they help with both breathing and nasal symptoms."
Combination Therapies: The Power Duos
ICS + LABA: Advair (fluticasone/salmeterol), Symbicort (budesonide/formoterol)
Benefit: Better control than either component alone
Convenience Factor: Increases compliance with reduced number of inhalers
LAMA + LABA: Anoro (umeclidinium/vilanterol)
COPD Game-Changer: Different mechanisms for maximizing bronchodilation
Once-daily: Improved adherence for patients
Inhaler Teaching in 30 Seconds
For MDIs:
Shake well
Exhale completely
Create a seal with lips around mouthpiece OR hold 1-2 inches away (spacer preferred)
Begin slow, deep breath and then actuate
Continue inhaling slowly
Hold breath for 10 seconds
Wait 30-60 seconds between puffs
Tomorrow: The respiratory assessment shortcuts that will make you look like a seasoned pro!