Corticosteroids - Inhaled: Nursing Pharmacology

Overview

• Inhaled corticosteroids are medications used to decrease lung inflammation, commonly prescribed for asthma and COPD patients.
• They help reduce symptom frequency and prevent exacerbations.

Common Inhaled Corticosteroids

• Fluticasone (Flovent)
• Beclomethasone (Qvar)
• Budesonide (Pulmocort)
• Mometasone (Asmanex)

Mechanism of Action

• Suppress gene expression for inflammatory proteins in respiratory epithelial cells.
• Decrease inflammatory and immune cell migration into lungs.
• Reduce production/release of inflammatory mediators (e.g., histamine, leukotrienes).
• Result in reduced airway inflammation, edema, and mucus production.

Indications

• Persistent asthma
• Chronic Obstructive Pulmonary Disease (COPD)

Administration

• Route: Inhalation (INH)

Side Effects

• Localized:
  • Oropharyngeal and esophageal thrush (Candida albicans)
  • Sore throat, hoarseness, cough
• Systemic (less common):
  • Hypercortisolism
  • HPA axis suppression
  • Increased appetite, weight gain
  • Osteoporosis, increased fracture risk
  • Decreased bone growth rate in children

Contraindications and Cautions

• Active respiratory infections (e.g., pneumonia, tuberculosis)
• Severe allergies to milk proteins or lactose
• Caution in patients with cataracts or glaucoma

Nursing Considerations

Assessment and Monitoring

• Monitor peak expiratory flow, symptom frequency, nighttime awakenings, activity tolerance, and side effects.

Client Education

• Use on a fixed schedule; not for acute episodes.
• Proper inhalation technique; use a spacer with MDI.
• Rinse and gargle post-administration to avoid thrush.
• Wait one minute between puffs if multiple doses are prescribed.
• Administer short-acting bronchodilators 5 minutes before corticosteroids if prescribed.
• Promote bone health through diet and exercise.
• Take steps to avoid respiratory infections due to increased risk.