Chapter 37: Respiratory Drugs

Severe asthma presentations including status asthmaticus represent life-threatening emergencies requiring immediate intervention. Chronic obstructive pulmonary disease encompasses distinct conditions of chronic bronchitis and emphysema, with cigarette smoke exposure and alpha-1 antitrypsin deficiency identified as primary etiological factors affecting lung tissue destruction and airway obstruction. Therapeutic strategies employ multiple drug classes with distinct mechanisms. Beta-adrenergic agonists function as either rapid-acting rescue agents or long-acting maintenance medications, with recognition that long-acting formulations require concurrent anti-inflammatory therapy to prevent adverse outcomes. Anticholinergic medications block parasympathetic bronchoconstriction, while xanthine derivatives provide dual bronchodilation and respiratory drive enhancement but necessitate therapeutic drug monitoring to prevent toxicity. Non-bronchodilating approaches target inflammatory pathways through leukotriene receptor antagonism, corticosteroid-mediated inflammation reduction, phosphodiesterase-4 inhibition, and emerging monoclonal antibody therapies designed for severe asthma resistant to conventional treatments. Nursing responsibilities encompass comprehensive respiratory assessment, medication history evaluation, proper inhalation technique instruction, and vigilant monitoring for adverse effects ranging from cardiovascular stimulation to immunosuppression and psychiatric manifestations. Age-related considerations address pediatric growth concerns and geriatric metabolism alterations, while safety protocols emphasize distinguishing rescue from maintenance agents and preventing medication administration errors across diverse delivery systems.