Respiratory Medication

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

Introduction

Respiratory medication is prescribed as part of management for patient suffers from pulmonary diseases. 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.

Role as a physiotherapist

Physiotherapist is required to understand the mode of action and side effects of patient's medication in order to safely carried treatment. There are occasion that medication will hinder or improve symptoms, such as shortness of breath. Hence, physiotherapist will have to factor in the effects of medication and plan treatment accordingly.

Depending on the place a physiotherapist works in, part of the duty might be explaining the correct technique of using medication, for instance using MDI. Physiotherapist will need to be able to clearly demonstrate and making sure a patient is able to use the medication effectively at home.

References

  1. Montuschi P. Pharmacological treatment of chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease. 2006 Dec;1(4):409.
  2. Ram FS, Sestini P. Regular inhaled short acting β2 agonists for the management of stable chronic obstructive pulmonary disease: Cochrane systematic review and meta-analysis. Thorax. 2003 Jul 1;58(7):580-4.
  3. Karner C, Stovold E. Long‐acting beta2‐agonists for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews. 2012(10).
  4. Dahl R, Chuchalin A, Gor D, Yoxall S, Sharma R. EXCEL: A randomised trial comparing salmeterol/fluticasone propionate and formoterol/budesonide combinations in adults with persistent asthma. Respiratory medicine. 2006 Jul 1;100(7):1152-62.
  5. Nie H, Zhang G, Liu M, Ding X, Huang Y, Hu S. Efficacy of theophylline plus salmeterol/fluticasone propionate combination therapy in patients with asthma. Respiratory medicine. 2013 Mar 1;107(3):347-54.
  6. 6.0 6.1 Main E, Denehy L, Webber B, Pryor J, Ammani Prasad S. Cardiorespiratory physiotherapy.