Several types of medications are usually used to treat patients with various respiratory diseases. A medication’s mechanism of action depends on the target outcome. Medications are classified as adrenergic, antiadrenergic, cholinergic, anticholinergic and muscarinic. This classification depends on their action in stimulating or blocking the effect of a specific neurotransmitter (e.g., norepinephrine and acetylcholine) on different receptors1.

 

Adrenergic bronchodilators are widely used by respiratory therapists, to treat patients with diseases that result in decreased airflow or airway obstruction. Patients with asthma, emphysema, bronchitis and cystic fibrosis usually have a better outcome by using adrenergic bronchodilators. For instance, using a short acting Beta-2-adrenergic agent will be ideal with status asthmaticus or patients with acute airway obstruction. Conversely, patients with controlled asthma or chronic obstructive disease tend to use long acting agents. Also, racemic epinephrine is the choice of medication to treat post extubation swelling, croup and epiglottitis. Adrenergic bronchodilators have a stimulation effect on the alpha, beta 1 and beta 2 receptors. They act in increasing heart rate, blood pressure and relaxation of bronchial smooth muscles1.

 

Even though adrenergic bronchodilators have a great role in treating patients, respiratory therapists should keep in mind special considerations while using these medications. Several side effects may occur with the usage of bronchodilators. Tremor, restlessness, insomnia and weakness are examples of the adverse effects of bronchodilators on the central nervous system. Increased heart rate, palpitation, peripheral vasoconstriction that could result in higher level of blood pressure, bronchial irritation, and edema, are adverse effects of these medications on both the pulmonary and cardiovascular systems 2.

 

To assess the effectiveness or the adverse effects of bronchodilator treatment, regular patient assessment is needed. Pulmonary function test and peak flow meter would be a useful indicator to monitor the effectiveness of the therapy; that is by assessing the reversibility of the airway obstruction through measuring airflows. Additionally, arterial blood gas results and saturation via pulse oximetry will give a beneficial idea about the adequacy of oxygenation and ventilation in COPD and asthmatic patients1. Moreover, continuous hemodynamic monitoring in addition to the patients’ appearance will reflect the response to the treatment and the patient condition.

 

Respiratory therapists should be knowledgeable about various medications that are used routinely in the practice of respiratory care, in addition to their adverse effects. This will help them in choosing the appropriate medication for each patient with a specific cardiopulmonary disease.

 

 

Reference:

  • -Egan’s Fundamentals of Respiratory Care book.
  • Clinical Practioner’s Poket Guide To Respiratory Care by .Dana Oakes .