Respiratory Medication

Original Editor - Hing Long Yip Top Contributors - Hing Long Yip

Introduction

Most patients who suffers from cardiopulmonary conditions are medically managed with different types of respiratory medication. Each medication is unique in its mechanism of action, hence it is important for physiotherapist in this field to understand the implications to patient in order to deliver safe and effective treatment and management.

Classification

Respiratory medication can be classified into three main subtypes: Reliever, symptom controller, preventer and combination.[1]

Reliever - Normally short acting bronchodilator.[2] Examples: short-acting beta 2 agonist (SABA), short- acting muscarinic antagonist (SAMA), Methylxanine.

Symptom Controller - Long acting bronchodilator.[3] Examples, long-acting beta 2 agonist (LABA), long-acting muscarinic antagonist (LAMA).

Preventer - Anti-inflammatory, Corticosteroid, mast cell stabiliser.

Combination - Mix of the above three for increase effectiveness.[4][5]

Route of administration

Similar to all other medication, respiratory drug can be taken using various ways depending on its type, mode of action and side effects.

Inhale - The most common route is inhaling through an inhaler. Different medications comes in with different designs to fit their own property. The two common inhalers in the market are metered dose inhaler (MDI) and dry powder inhaler (DPI). A spacer could be used along with a MDI to improve deposition and reducing the risks of oral candidiasis (thrush).[6] It is also made to reduce the needs of hand-breath coordination, and is more suitable for children, people with poor hand function and those of severe dyspnoea.[6]

This is a direct way to deposit medication particles onto the airways or the lung tissues. It is also one of the role as a respiratory physiotherapist to educate patients the correct technique when using their inhaler. Correct technique is required to maximise deposition of the particles to reach its optimal effects.

Technique of using a MDI. Source: YouTube

Technique of using a MDI with spacer. Source: YouTube

Technique of using a DPI. Source: YouTube

Other routes: Some mediations can be delivered through oral and intravenous (IV) routes. Physiotherapist is less commonly involve in education and administration, however it is equally important to understand the mechanisms and side effects when delivering the professional services.

References

  1. Montuschi P (2006) Pharmacological treatment of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 1(4): 409-23
  2. Ram F & Sestini P (2003) Regular inhaled short acting beta2 agonists for the management of stable chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. Thorax 58: 580-4
  3. Kew K, Mavergames C & Walters J (2013) Long-acting beta2-agonists for chronic obstructive pulmonary disease. Cochrane Database Syst Rev 3, CD010177
  4. Dahl R, Chuchalin A, Gor D et al., (2006) EXCEL: A randomised controlled trial comparing salmeterol/fluticasone propionate and formoterol/budesonide combinations in adults with persistent asthma. Respiratory Medicine 100(7): 1152-62
  5. Nie H, Zhang G, Liu M et al (2013) Efficacy of theophylline plus salmeterol/fluticasone propionate combination therapy in patients with asthma. Respiratory Medicine 107(3): 347-54
  6. 6.0 6.1 1. Main E, Denehy L, Webber B, Pryor J, Ammani Prasad S. Cardiorespiratory physiotherapy.