6 Integrated Respiratory Medication Practice
Learn how to select, use, monitor, and reassess respiratory medications for asthma and COPD while recognizing important safety concerns.
Relievers and controllers
Respiratory medication decisions depend on the condition being treated and the goal of treatment. Short-acting bronchodilators relieve acute bronchospasm, while controller therapies help reduce future symptoms and risk. These practice principles do not replace patient-specific clinical judgment or emergency care.
Asthma control and LABA safety
Frequent albuterol use and waking at night with cough suggest poor asthma control and a need for clinical reassessment, not simply repeated increases in rescue medication. Frequent short-acting beta-2 agonist use is a warning sign.
Salmeterol is a long-acting beta-2 agonist (LABA), not a rescue medicine. In asthma, should not be used without -containing treatment because it is associated with increased risk of serious asthma-related outcomes.
Before treatment is changed, review the diagnosis, symptoms and exacerbation history, adherence, inhaler technique, triggers, and written action plan. A clinician should select or adjust an ICS-containing regimen and ensure the patient has an appropriate reliever.
ICS technique and COPD decisions
After using an , rinse the mouth with water and spit it out; do not swallow the rinse. Review inhaler technique and whether a spacer is appropriate for the specific device.
ICS use can cause oral candidiasis and hoarseness. Assess persistent mouth symptoms rather than ignoring them. The patient should not stop controller therapy on their own; a clinician can address suspected thrush and review the dose and technique.
When considering an ICS-containing regimen for COPD, weigh potential benefit against risks, including pneumonia and local effects such as oral candidiasis. Relevant factors include exacerbation history, coexisting asthma, and other clinical factors that predict benefit; ICS is not automatically required for everyone with COPD. Teach mouth rinsing and spitting after each dose, advise reporting signs of infection or persistent mouth symptoms, and review response and adverse effects at follow-up.
Anticholinergic safety
Ipratropium and long-acting muscarinic antagonists (LAMAs) have anticholinergic effects. Before adding treatment, the prescriber should review the patient's combined and relevant risks.
Assess for worsening urinary retention and eye pain, blurred vision, or other symptoms concerning for acute narrow-angle glaucoma. Teach the patient to use the device as directed and avoid spraying mist into the eyes. New eye pain or sudden vision changes warrant prompt medical advice.
and mental health changes
is a controller option, not a rescue medicine for sudden wheezing. Do not give an extra dose to treat an acute attack; use the patient's prescribed reliever and action plan.
New nightmares or thoughts of self-harm require immediate contact with a health professional. FDA advice is to stop and promptly contact a health professional if new behavior or mood changes occur. Thoughts of self-harm require urgent safety assessment, and immediate danger calls for emergency help.
and secretion clearance
If worsening wheeze and increased work of breathing develop during nebulized treatment, stop the treatment and promptly assess for worsening bronchospasm. Give an appropriate prescribed bronchodilator and escalate care according to severity and local protocol. can unpredictably cause airway obstruction or bronchospasm; progressive bronchospasm is a reason to discontinue it.
As mucus becomes thinner, the volume of secretions may increase. A patient with a weak or ineffective cough may need help clearing secretions, including suction when clinically indicated.
treatment and monitoring
For an acute , short-acting inhaled beta-2 agonists, with or without a short-acting anticholinergic, are commonly used initially. A clinician may prescribe a brief course of systemic corticosteroid for a significant exacerbation.
Monitor breathing, oxygenation, and response to treatment. With beta-2 agonists, monitor heart rate, tremor, and other signs of adverse effects. With systemic corticosteroids, monitor for issues such as elevated blood glucose, mood or sleep changes, and infection risk as appropriate. Worsening respiratory distress requires urgent escalation.
Ongoing reassessment
Across asthma and COPD care, reassess inhaler technique, adherence, response, and safety. Match medication to the condition and treatment goal, distinguish acute relievers from controllers, and address adverse effects without making unsupervised changes to controller therapy.