Inhaled Steroids
Inhaled steroids have been found to be a very effective treatment for bronchospasm. The drug of choice depends on the individual patient’s response; a patient may have little response to one agent and do very well on another.
Inhaled Steroids: Generic and Brand Names
Here is a list of some of the most commonly encountered inhaled steroids.
| Classification | Generic name | Brand name |
| Inhaled steroids | beclomethasone | Beclovent |
| budesonide | Pulmicort | |
| ciclesonide | Alvesco | |
| fluticasone | Flovent | |
| triamcinolone | Azmacort |
What are Inhaled Steroids?
Inhaled steroids are used to decrease the inflammatory response in the airway.
- Inhaling the steroid tends to decrease the numerous systemic effects that are associated with steroid use.
- It is usually useful to try another preparation if one is not effective within 2 to 3 weeks.
Therapeutic actions
The desired actions of inhaled steroids include:
- Decrease the inflammatory response in the airway.
- Increase airflow and facilitate respiration.
- Promotion of beta-adrenergic receptor activity, which may promote smooth muscle relaxation and inhibit bronchoconstriction.
Indication of Inhaled Steroids
Inhaled steroids are indicated for the following:
- Prevention and treatment of asthma.
- Treatment of chronic steroid-dependent bronchial asthma.
- Used as adjunctive therapy for asthma patients who do not respond to traditional bronchodilators.
Pharmacokinetics
These drugs are rapidly absorbed from the respiratory tract, but they from 2 to 3 weeks to reach effective levels.
| Route | Onset | Peak | Duration |
| Inhalation | Slow | Rapid | 8-12 h |
| T 1/2 | 2 to 3 hours | ||
| Metabolization | Liver | ||
| Excretion | Urine | ||
Contraindications and Cautions
The contraindications and cautions for patients using inhaled steroids include the following:
- Emergency use. Inhaled steroids are not for emergency use and are not for use during an acute asthma attack or status asthmaticus.
- Pregnancy or lactation. They should not be used during pregnancy or lactation unless the benefit to the mother clearly outweighs any potential risk to the fetus or the nursing baby.
- Active respiratory infection. These preparations should be used with caution in any patient who has an active infection of the respiratory system because the depression of the inflammatory response could result in serious illness
Adverse effects
Adverse effects of using inhaled steroids include the following:
- CNS: Irritability, headache.
- Respiratory: Rebound congestion, epistaxis, local infection.
Nursing considerations for Inhaled Steroids
Nursing considerations for a patient using inhaled steroids include the following:
Nursing Assessment
History taking and physical exam of a patient using inhaled steroids include:
- Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
- Assess temperature to monitor for possible infections.
- Monitor blood pressure, pulse, and auscultation to evaluate cardiovascular response.
- Assess respirations and adventitious sounds to monitor drug effectiveness.
- Examine the nares to evaluate for any lesions that might lead to systemic absorption of the drug.
Nursing Diagnosis and Care Planning
Nursing diagnoses related to drug therapy might include the following:
- Risk for injury related to immunosuppression.
- Acute pain related to local effects of the drug.
- Deficient knowledge regarding drug therapy.
Nursing Implementation with Rationale
Nursing interventions for patients using inhaled steroids include:
- Not for immediate relief. Do not administer inhaled steroids to treat an acute asthma attack or status asthmaticus because these drugs are not intended for the treatment of acute attack and will not provide the immediate relief needed.
- Proper tapering of steroids. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenaline insufficiency with sudden withdrawal.
- Use decongestant drops. Have the patient use decongestant drops before using the inhaled steroid to facilitate penetration of the drug if nasal congestion is a problem.
- Oral care. Have the patient rinse the mouth after using the inhaler because this will help to decrease systemic absorption and decrease GI upset and nausea.
- Monitor for signs of infection. Monitor the patient for any sign of respiratory infection; continued use of steroids during acute infection can lead to serious complications related to the depression of the inflammatory and immune responses.
- Educate the client. Provide patient teaching, including the drug name and prescribed dosage, measures to help avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance.
- Ensure the effectiveness of the drug. Instruct the patient to continue to take the drug to reach and then maintain effective levels (drug takes 2 to 3 weeks to reach effective levels).
- Provide support. Offer support and encouragement to help the patient cope with the disease and the drug regimen.
Evaluation
Evaluation of a patient using inhaled steroids include:
- Monitor patient response to the drug (improved breathing).
- Monitor for adverse effects (nasal irritation, fever, GI upset).
- Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and measures to take to increase the effectiveness of the drug).
- Monitor the effectiveness of other measures to ease breathing.
Practice Quiz: Inhaled Steroids
Here’s a 5-item quiz for this inhaled steroids study guide. Please visit our nursing test bank page for more NCLEX practice questions.
1. A Cromolyn sodium (Intal) inhaler is prescribed to a client with asthma. A nurse provides instructions regarding the side effects of this medication. The nurse tells the client that which undesirable effect is associated with this medication?
A. Insomnia
B. Constipation
C. Wheezing
D. Hypotension
1. Answer: C. Wheezing
- Option C: Cromolyn Sodium (Intal) is used to prevent asthma attacks in people with bronchial asthma. Undesirable side effects associated with the use of inhaler is wheezing, cough, nasal congestion, bronchospasm, and throat irritation.
2. A nurse is about to administer Albuterol (Ventolin HFA) 2 puff and Budesonide (Pulmicort Turbohaler) 2 puff by metered dose inhaler. The nurse plans to administer by?
A. Alternating with a single puff each, starting with albuterol.
B. Alternating with a single puff each, starting with budesonide.
C. Budesonide inhaler first then the albuterol.
D. Albuterol inhaler first then the budesonide.
2. Answer: D. Albuterol inhaler first then the budesonide.
- Option D: If two different inhaled medications are prescribed and one of the medications contains a corticosteroid, administer the bronchodilator (Albuterol) first and the corticosteroid (Budesonide) second. This will allow for the widening of the air passages by the bronchodilator, making the corticosteroids more effective.
3. A nurse teaches a client about the use of a respiratory inhaler. Which action by the client indicated a need for further teaching?
A. Removes the cap and shakes the inhaler well before use.
B. Presses the canister down with finger as he breathes in.
C. Inhales the mist and quickly exhales.
D. Waits 1 to 2 minutes between puffs if more than one puff has been prescribed.
3. Answer: C. Inhales the mist and quickly exhales.
- Option C: The client should be instructed to hold his or her breath at least 10 to 15 seconds before exhaling the mist.
4. A client with acute asthma is prescribed short-term corticosteroid therapy. What is the rationale for the use of steroids in clients with asthma?
A. Corticosteroids promote bronchodilation.
B. Corticosteroids act as an expectorant.
C. Corticosteroids have an anti-inflammatory effect.
D. Corticosteroids prevent the development of respiratory infections.
4. Answer: C. Corticosteroids have an anti-inflammatory effect.
- Option C: Corticosteroids have an anti-inflammatory effect and act to decrease edema in the bronchial airways and decrease mucus secretion.
- Options A, B, D: Corticosteroids do not have a bronchodilator effect, act as expectorants, or prevent respiratory infections.
5. The nurse is teaching the client how to use a metered dose inhaler (MDI) to administer a Corticosteroid drug. Which of the following client actions indicates that he is using the MDI correctly? Select all that apply.
A. The inhaler is held upright.
B. Head is tilted down while inhaling the medication.
C. Client waits 5 minutes between puffs.
D. Mouth is rinsed with water following administration.
E. Client lies supine for 15 minutes following administration.
5. Answer: A and D.
- Option A: The inhaler is held upright.
- Option D: Mouth is rinsed with water following administration.