Respiratory Meds
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
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