Bronchodilator Nursing Implications
Bronchodilators Nursing Responsibilities
Bronchodilators are a class of medications that act on the bronchi to relax and open the airways in the lungs. They are commonly prescribed for a number of respiratory diseases, including asthma and chronic obstructive pulmonary disease (COPD).
Bronchodilators require prescription from a certified medical prescriber. It is not recommended for patients to take herbal products, over the counter solutions, or homeopathic agents which are advertised to mimic the action of bronchodilators because they are not approved by the FDA and their effectiveness is questionable.
Indications of Bronchodilators
Bronchodilators are generally indicated for the following medical conditions:
- Chronic obstructive pulmonary disease (COPD)
- Allergic reactions
- Other related conditions that can manifest difficulty of breathing
These illnesses cause bronchospasm, or the constriction of the airways. Bronchodilators “dilate” or widen the airways so that air can come in and out of the lungs.
Long-acting bronchodilators should always be taken with corticosteroids in the treatment of asthma. This means that the asthma patient may have to use at least 2 separate inhalers.
However, there are currently new drugs that combine bronchodilators and corticosteroids in a single inhaler for the patient’s convenience. In COPD, bronchodilators can be given on their own, with the addition of corticosteroids in severe cases or when the patient has an acute exacerbation.
Actions of Bronchodilators
In treating asthma, the prescriber has a range of bronchodilators to utilize as appropriate. Bronchodilators are classified into 3 groups: beta-2 antagonists, anticholinergic agents, and xanthine derivatives.
- Beta-2 antagonists. These medications block the beta-2 adrenergic receptors of cells, which result to the relaxation of the smooth muscles that surround the bronchi. The patient’s shortness of breath is usually resolved with the use of beta-2 antagonists as bronchodilators.
- Anticholinergic agents. This group of bronchodilators block acetylcholine’s constrictive action on the bronchial tubes. As they block the chemical, the airways relax and allow air to get in and out.
- Xanthine derivatives. These bronchodilators resemble the natural-occurring xanthine, which includes theobromine and caffeine. The exact action of xanthine derivatives is still not fully known, but they are also prescribed to help the smooth muscles around the airways to relax.
Types of Bronchodilators
The types of bronchodilators based on how quick they work include short-acting and long-acting bronchodilators. There are short-acting and long-acting beta-2 antagonists available, and the same is true with anticholinergics.
- Short-acting bronchodilators. These fast-acting medications are delivered through the inhalation route. Short-acting inhalers work within a few minutes of administration, but the action only lasts for about 5 hours. Short-acting bronchodilators are ideal for the quick relief of shortness of breath. As such, this type of bronchodilators is usually prescribed as PRN or as needed only; thus, they are also referred to as “rescue” bronchodilators. Patients who require multiple doses of short-acting bronchodilators to remain symptom-free need to be reviewed and be prescribed with long-acting bronchodilators.
- Long-acting bronchodilators. This type of bronchodilators take time to act on the airways, but the therapeutic effect can last for 12 to 24 hours. As such, they are usually administered once or twice a day. Long-acting bronchodilators are ideal for daily use to control symptoms of asthma and other breathing problems.
Forms of Bronchodilators
Bronchodilators are commonly administered through inhalation. The different forms of bronchodilator inhalers are:
- Metered dose inhalers – the medication is contained in a pressurized canister which the patient presses down to trigger the propellant and release the drug
- Dry powder inhalers – the bronchodilator is in powder form and there is no propellant
- Soft mist inhalers – these have no propellants and deliver the medication in the form of an aerosol cloud; longer-lasting and slower-moving compared to metered dose inhalers which mean more medication is delivered to the lungs
- Nebulizer – the liquid form of a bronchodilator is dropped into the nebulizer cup; the patient then inhales the medication from the mouthpiece while the compressor of the nebulizer machine is turned on.
2. Syrups – oral route
3. Tablets – oral route
Side Effects and Adverse Effects of Bronchodilators
The general side effects of bronchodilators include:
- Nervous or shaky feeling
- Tachycardia or rapid heart rate
- Gastrointestinal upset
- Trouble sleeping
- Muscle aches or cramps
- Dry mouth
- Hoarseness of voice
Bronchodilators rarely cause adverse events. As with most medications, the healthcare team should monitor for any signs of allergy to bronchodilators, such as worsening bronchospasm and difficulty of breathing after inhalation.
The adverse effects of bronchodilators that require immediate medical intervention include:
- low potassium level
Contraindications and Cautions for Bronchodilators
Pregnant or breastfeeding women can usually use their inhalers as normal, but it is for precaution that they should inform their physician regarding the use of bronchodilators and all other drugs that they routinely take.
Asthma may have some effects on pregnancy, and therefore the pregnant patient must be monitored closely to ensure that the symptoms are well controlled.
Bronchodilators may cause hypokalemia or low potassium level in the blood if they are taken in excessive doses.
Therefore, the serum potassium level is monitored especially in patients who are either newly placed on bronchodilators, or are often experienced acute exacerbations and require often use of their inhalers.
Patients starting on bronchodilators may need to temporarily stop operating heavy machinery due to the possible side effect of nervousness or shakiness.
Trouble sleeping is another side effect that can be resolved by teaching the client on relaxation techniques, good sleep hygiene, and the administration of sleep-inducing medication as needed.
Bronchodilators are ideally administered before meals to help the patient breathe better when eating and drinking.
Drug Interactions with Bronchodilators
Some medications may interact with bronchodilators. These include:
- Digoxin – some bronchodilators may decrease serum digoxin levels
- Beta-blockers – may bock the effect of beta-adrenergic bronchodilators, causing bronchospasm in patients with asthma
- Tricyclic anti-depressants and monoamine oxidase inhibitors (MAOI) – these drugs have an additive effect on the vascular system, which can increase the heart rate and/or blood pressure levels; they should not be used consequently with bronchodilators; there should be a 2-week gap between the use of MAOIs and tricyclic anti-depressants and starting bronchodilators
- Loop diuretics – these medications are not encouraged to be used together as beta-adrenergic bronchodilators already have the possibility to lower serum potassium levels
- Anticholinergic drugs – combining anticholinergic bronchodilators with other anticholinergic drugs may worsen their side effects
- St. John’s wort – may decrease serum levels of xanthine derivatives
Nursing Care Plans for Patients on Bronchodilators
Possible Nursing Diagnoses
- Acute Pain (Gastrointestinal)
- Risk for Hypokalemia
- Risk for Electrolyte Imbalance (Hypokalemia)
|Nursing Interventions for Bronchodilators||Rationales|
|Assess the patient for signs and symptoms of asthma, COPD, or other respiratory condition.||To confirm the indication for administering bronchodilators.|
|Check the patient’s allergy status.||Alternatives to bronchodilators should therefore be considered in case of allergy.|
|Assess if the patient is pregnant or lactating.||Pregnant and breastfeeding women with asthma can continue taking their bronchodilators daily but will be closely monitored by their physician.|
|Assess the patient’s ability to self-administer the inhaler.||To check for any potential problems with administration.|
To ensure that the right form of bronchodilators is given through the right route.
|Check the patient’s blood glucose and serum potassium levels. Check for current medications that include loop diuretics, MAOI, tricyclic antidepressants, beta-adrenergic drugs, and digoxin as these should be used cautiously with bronchodilators.||An increased risk of hypokalemia may occur when bronchodilators are administered with other medications that reduce potassium levels like diuretics. Caution is highly warranted as hypokalemia is greatly associated with dysrhythmia and heart failure.|
Nursing Planning and Intervention
|Nursing Interventions for Bronchodilators||Rationales|
|Administer bronchodilators at the same time each day, ideally before meals.||Bronchodilators taken before meals can help the patient breathe better when eating or drinking.|
|Use spacers with some bronchodilators and teach proper oral hygiene.||To ensure optimal absorption and therapeutic action by bronchodilators.|
To avoid oral thrush.
|Administer oral antifungal treatment if needed.||To manage oral thrush which is a common side effect of long-term bronchodilator use.|
|Educate the patient about the action, indication, common side effects, and adverse reactions to note when taking bronchodilators. Instruct the patient on how to self-administer bronchodilators.||To inform the patient on the basics of bronchodilators, as well as to empower him/her to safely self-administer the medication.|
|Monitor the patient’s fecal elimination.||Long-term or potent bronchodilators may cause diarrhea.|
|Advise the patient to rinse the mouth with water after using the inhaler.||To reduce the risk of developing oral thrush.|
|Towards the end of the course of bronchodilators, inform the patient if the dosage of bronchodilators needs to be tapered down.||Abruptly stopping some types of bronchodilators may cause withdrawal symptoms such as lightheadedness and dizziness.|
|Routinely check for the serum potassium level of the patient, especially if they are on loop diuretics.||Bronchodilators can cause hypokalemia. The occurrence of hypokalemia is more likely if the patient is also on loop diuretic therapy.|
|Nursing Interventions for Bronchodilators||Rationales|
|Ask the patient to repeat the information about bronchodilators.||To evaluate the effectiveness of health teaching on bronchodilators.|
|Monitor the patient’s serum electrolyte levels.||To ensure that the bronchodilators did not cause any electrolyte imbalance (particularly hypokalemia).|
|Monitor the patient’s response to bronchodilators.||To check if the bronchodilators are effective or if the dose needs to be adjusted.|
|Monitor for any muscle cramps or gastrointestinal upset and treat these symptoms as they appear.||Bronchodilators may cause GI upset, diarrhea, and muscle cramps.|
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