SABAs and LABAs
SABAs are most commonly used for what purpose in asthma management?
Quick relief of acute symptoms
Rationale: Short‑acting beta‑agonists provide rapid bronchodilation for rescue therapy.
What are inhaled corticosteroids primarily used for?
Treat airway inflammation
Rationale: Inhaled corticosteroids reduce inflammation and swelling in the airways, improving long‑term control of asthma and COPD.
Inhaled anticholinergics work by blocking which nervous system?
Parasympathetic nervous system
Rationale: Blocking parasympathetic tone prevents bronchoconstriction, allowing airways to remain open.
Because COPD causes persistent airflow limitation that is not fully reversible, this class of bronchodilators is a cornerstone of long-term maintenance therapy.
What are long-acting bronchodilators (LABAs or LAMAs)?
Rationale:
In COPD, structural airway damage limits reversibility. LABAs and LAMAs provide sustained bronchodilation, improve exercise tolerance, and reduce exacerbations, making them preferred for daily maintenance.
When a patient uses both a bronchodilator and an inhaled steroid, which medication should be taken FIRST?
Bronchodilator (SABA)
Rationale: Opening the airways first allows better deposition of the inhaled steroid
LABAs differ from SABAs primarily in which way?
Duration of action
Rationale: LABAs provide long‑term bronchodilation but do not act quickly enough for rescue.
Name one common inhaled corticosteroid.
Budesonide or fluticasone
Rationale: These are commonly prescribed inhaled steroids for chronic respiratory conditions.
Name one inhaled anticholinergic medication.
Ipratropium or tiotropium
Rationale: These medications are commonly used to manage obstructive airway diseases.
In asthma, airway obstruction is often reversible. In COPD, obstruction persists due to this structural change in the lungs.
What is destruction of alveoli and airway remodeling?
Rationale:
COPD involves chronic inflammation and tissue destruction, especially in emphysema, leading to loss of elastic recoil and permanent airflow limitation—unlike asthma, which is largely reversible.
A patient is wheezing, short of breath, and anxious. Which medication should the nurse administer FIRST?
SABA
Rationale: Acute bronchospasm requires rapid bronchodilation—airway and breathing are priority (ABCs).
Why should LABAs never be used alone in asthma patients?
Increased risk of asthma‑related death
Rationale: LABA monotherapy does not treat airway inflammation and increases mortality risk; they must be combined with inhaled corticosteroids.
Inhaled corticosteroids improve asthma control by reducing what key underlying problem?
Airway inflammation
Rationale: Treating inflammation reduces frequency and severity of asthma symptoms over time.
Which inhaler class reduces secretions and bronchospasm but does not treat inflammation?
Anticholinergics
Rationale: These medications open airways but do not reduce underlying inflammation.
Adding an inhaled corticosteroid to COPD therapy is most appropriate for patients with frequent exacerbations because ICS target this component of COPD pathophysiology.
What is chronic airway inflammation?
Rationale:
While COPD is primarily obstructive, patients with frequent exacerbations benefit from anti-inflammatory effects of ICS, particularly when eosinophilic inflammation is present.
Why would inhaled anticholinergics NOT be the first choice during an acute asthma attack?
Slower onset of action
Rationale: Acute bronchospasm requires rapid bronchodilation, typically with a SABA
Which type of beta‑agonist is typically scheduled rather than PRN?
LABA
Rationale: LABAs are used for long‑term control, not rescue.
Patients receiving inhaled corticosteroids should do what after administration of the medication?
What does this prevent?
Rinse their mouth to prevent oral thrush
What patients should be cautious while taking anticholinergics?
Patients with urinary retention, glaucoma, or taking other anticholinergic medications
Rationale: Anticholinergics decrease smooth muscle contraction and secretions, potentially worsening these conditions.
During a COPD exacerbation, low-flow oxygen is used carefully to avoid worsening this pathophysiologic condition.
What is carbon dioxide retention (hypercapnia)?
Rationale:
Some COPD patients rely on hypoxic drive to stimulate breathing. Excessive oxygen can reduce respiratory drive, leading to CO₂ retention and respiratory acidosis, so oxygen therapy is titrated to maintain safe—but not excessive—oxygen saturation.
A patient with COPD presents with increased shortness of breath, audible wheezing, and an SpO₂ of 86% on room air.
What comes first?
Apply low-flow oxygen therapy
Rationale:
Airway and breathing take priority. COPD patients may require carefully titrated oxygen to improve hypoxia while avoiding excessive oxygen delivery. Oxygenation is addressed before medications or diagnostics.
A patient with asthma is prescribed a LABA inhaler without an inhaled corticosteroid. What should the nurse do?
Question the order
Rationale: LABAs must not be used as monotherapy in asthma due to increased mortality risk.
A patient stops using their inhaled corticosteroid because they “feel better.” Why is this unsafe?
Inflammation can return, leading to worsening asthma control
Rationale: Inhaled steroids must be taken consistently to maintain airway stability
This inhaled anticholinergic is short-acting and is commonly used for quick symptom relief in COPD but not as a rescue medication for acute asthma exacerbations.
What is ipratropium bromide (Atrovent)?
Rationale:
Ipratropium bromide is a short-acting muscarinic antagonist (SAMA) that works by blocking acetylcholine at muscarinic receptors, leading to bronchodilation. It is frequently used in COPD management and may be added in severe asthma exacerbations, but it is not a first-line rescue medication, unlike SABAs such as albuterol.
This medication class is avoided as monotherapy in asthma because it does not treat the underlying inflammatory process and may increase the risk of severe exacerbations.
What are long-acting beta-2 agonists (LABAs)?
Rationale:
Asthma is primarily an inflammatory disease. LABAs provide bronchodilation but do not reduce inflammation, so they must always be combined with an inhaled corticosteroid (ICS) in asthma to reduce the risk of worsening symptoms and asthma-related death.
A patient with a known history of asthma is struggling to speak, using accessory muscles, and has minimal air movement on auscultation.
What comes first?
Administer a short-acting beta-agonist (SABA)
Rationale:
This patient is experiencing severe bronchoconstriction, a life-threatening airway problem. Rapid bronchodilation with a rescue inhaler or nebulized SABA is critical to restore airflow before further assessment or teaching.