Heather Carballo, Dana Horton,
Claudette Johnson, Kimberly Kusch
Goals
Quick relief of
symptoms
Controlling
inflammation
Types
Controller (LABA)
• Corticosteroids
• Long Acting Beta Agonists
(LABA’s)
• Leukotriene modifiers (LTRA)
• Cromolyn & Nedocromil
• Methylxanthines: (Sustainedrelease theophylline
Relievers (SABA)
Easing flare-ups
• Short acting
bronchodilators
• Corticosteroids
• Anticholinergics
(Lehne, 2013)
Short Acting Bronchodilators
Long Acting Bronchodilators
(LABA)
Keeps swelling and mucus from
developing in the airways
Must be taken EVERY day even
when not having symptoms
Inhaled corticosteroids (ICS’s) are
the most common and effective
way to control asthma
Help prevent asthma
exacerbations from developing!
(Lehne, 2013)
SABA
Mild Intermittent
• Reliever only prn
Both control and rescue
medications come in MDI
(metered dose inhalers) and
nebulized forms
Mild Persistent
• Controller/Reliever
Moderate Persistent
• Controller plus long-acting
bronchodilator and reliever
Control medications
are also available in dry powder
discs, breath actuated inhalers
and pill form
Severe Persistent
• Controller plus long-acting
bronchodilator and reliever
(Asthma Organization, 2012)
(Lehne, 2013; Schiffman & Szeftel, 2012)
Short-acting Inhaled Bronchodilators
Proventil, Ventolin (Albuterol)
Xopenex (Levalbuterol)
Maxair Autohaler (Pirbuterol)
Alupent (Metaproterenol)
 For relief of acute
symptoms or as preventive
treatment prior to exercise
Potential adverse effects

Tremors, tachycardia,
headache
Therapeutic issues
 Drugs of choice for acute

bronchospasm
Systemic Corticosteroids
Pediapred
Prelone
Prednisone
Orapred
 Prevents progression of
moderate to severe
exacerbations, reduces
inflammation
Potential adverse effects
 Short-term- increased
appetite, fluid retention,
mood changes, facial
flushing, stomachache
 Long term- growth
suppression, hypertension,
glucose intolerance,
muscle weakness,
cataracts
(Lehne, 2013; Mayo Clinic, 2012; McCance & Huether, 2010)
Herbal Therapy
Ephedra (Ma Huang)
Dangerous and should
be avoided
 Potent CNS and CV
stimulant
 Can be a precursor for
methamphetamine
 FDA recently banned its
use

Many other herbal folk
remedies used by different
cultures

(Lehne, 2013; McCance & Huether, 2010)
(Schiffman & Szeftel, 2012)
Corticosteroids: Pulmicort, QVAR, Alvesco,
AeroSpan, Flovent

Pharmacokinetics: Peak concentration in thirty minutes for inhaled therapy, 34%
distributed in the lungs and systemic availability is 39%. Rapidly metabolized and
excreted in urine and feces (Pulmicort Pharmacology, 2006).

Pharmacodynamics: Rapid onset of action, asthma improvement demonstrated within
24 hours after starting treatment although full benefits may take one to two weeks to
be seen. When orally inhaled there is a direct effect on the respiratory
system(Pulmicort Pharmacology, 2006).

Drug Interactions: certain antibiotics, antidepressants, and ketoconazole (Pulmicort
Pharmacology, 2006).

Side effects: Runny nose, sore throat, white patches in mouth, nose bleed,
headache(Pulmicort Pharmacology, 2006).

Adverse effects: Worsening respiratory symptoms, wheezing, vision changes and
weakness(Pulmicort Pharmacology, 2006).
Long Acting Beta Agonist: Brovana, Perforomist,
Arcapta, Serevent Diskus

Pharmacokinetics: These medications typically work locally within the
lungs. Taking plasma levels will not indicate therapeutic effects. These
medications are 96% protein binding and are excreted in the feces and
urine. The usual half life of these medications are usually fairly long, on
average about 5-7 days (Kim, 2009).

Pharmacodynamics: Effects of these medications usually last about 12
hours. Causes bronchodilation by relaxing smooth muscles in the airway
(Kim, 2009)

Drug Interactions: Erithromycin, beta blockers, MAOI’s, antidepressants,
non-potassium sparing diuretics (Kim, 2009.)

Side effects: Headache, nasal congestion, nausea/vomiting, skeletal muscle
pain.

Adverse effects: Bronchospasms which could cause worsening respiratory
effects, irritation or swelling of the airway, hypertension, increased heart
rate, hypokalemia (Kim, 2009).
Assess respiratory status.
Overall physical exam with vital signs
should be conducted.
Assess patient’s knowledge of
medication administration and lab
values as needed.
Assess for side effects and knowledge of
side effects as well as compliance with
medication regimen.
(Stanley et al., 2008)
Risk for ineffective breathing pattern
related to noncompliance with
medication regimen
Risk of ineffective airway clearance
related to improper use of asthma
medications
Anxiety related to inability to manage
disease process as evidenced by
patient stating they are overwhelmed
Deficient knowledge related to
medication administration as evidenced
by improper use of metered dose
inhaler.
(Stanley et al., 2008)
Patient will identify 5 signs of worsening
respiratory status.
Patient will identify 5 potential side
effects of each medication they are
taking.
Patient will verbalize their asthma
treatment plan and discuss why it is
important along with any concerns.
Patient will demonstrate proper
administration of a metered dose
inhaler.
(Stanley et al., 2008)
Nurse will provide written and verbal
education on respiratory status.
Nurse will provide written and verbal
education on the patient’s
medications and side effects.
Nurse will discuss treatment plan
with patient and discussion of any
anxiety as well as provide written
information.
Nurse will provide videos to patient on
use of meter dose inhaler and will assist
with return demonstration by patient.
(Stanley et al., 2008)
Patient’s condition improved.
Patient’s condition stabilized.
Patient’s condition deteriorated.
(Stanley et al., 2008)
 Health Care Provider
 Community Resources
 Public Health
Department
 Patient Education
Tools*
 Your Voice-Advocacy
 School Nurse
Take Control of your Asthma
American Lung Association. (2012). Learning more about Asthma. Retrieved from
http://www.lung.org/lung-disease/asthma/
Gulanick, M., & Myers, J. (2011). Nursing Care Plans (7th ed.). St. Louis: Mosby Elsevier.
Kaufman, G. (2012). Asthma: assessment, diagnosis, and treatment adherence. Nurse Prescribing, 10(7), 331-338.
Kim, D. (2009). Evaluation of Long Acting Beta Agonists. Allergy and Immunology , 8, 933-940.
Lehne, R.A. (2013). Pharmacology for nursing care. (8th ed.) St. Louis: Saunders Elsevier. 967-981.
Mayo Clinic. (2011). Asthma inhalers: Which one's right for you? Retriever from
http://www.mayoclinic.com/health/asthma-inhalers/HQ01081
McCance, K.L. & Huether, S.E.(2010). Pathophysiology: The biologic basis for disease in adults and children.
(6th ed.). St. Louis: Mosby Elsevier.1285-1286.
Pulmicort Pharmacology. (2006). Retrieved November 9, 2012, from Drug List 1:
www.1stdruglist.com/pumicort.html
Schiffman, G. & Szeftel, A. (2012). What asthma medications to use. MedicineNet. Retrieved from
http://www.medicinenet.com/asthma/page9.htm#what_medications_are_used_in_the_treatment_of_asthma