Asthma/COPD Inhaler Comparison: Bronchodilators vs Corticosteroids vs Leukotriene Modifiers
A patient grabs their fluticasone inhaler during an acute asthma attack — it does nothing to open the airways, and precious minutes are lost. The NCLEX tests whether you know which drug rescues, which controls, and which one is swallowed, not inhaled.
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- Relax bronchial smooth muscle
- Corticosteroid: ↓ airway inflammation
- Block leukotriene receptors
- ★SABA = rescue for acute symptoms
- Anti-inflammatory controller
- Not for acute attacks
- Anti-inflammatory controller
- Allergic & exercise-induced asthma
- Not for acute attacks
- Inhaled
- SABA onset within minutes
- Inhaled
- Full effect takes days to weeks
- Oral tablet (montelukast)
- Once daily in the evening
- Assess respiratory status & peak flow
- Assess respiratory status & peak flow
- Assess respiratory status & peak flow
- Monitor HR
- ↑ albuterol use = poor control
- Monitor for thrush
- Growth in children
- Monitor mood & behavior changes
- Tachycardia, tremor, jitteriness
- Oral candidiasis (thrush), hoarseness
- Headache
- GI upset
- ★Never LABA alone in asthma (death risk)
- Spacer ↓ oral thrush risk
- Taper if long-term high dose
- ★Black box: neuropsychiatric events
- Caution: tachydysrhythmias, hyperthyroidism
- Caution: active oral/respiratory infection
- Caution: history of psychiatric disorder
- Demonstrate correct inhaler technique
- Use SABA first, wait, then other inhalers
- Demonstrate correct inhaler technique
- Rinse mouth after each use
- Take daily even when symptom-free
- Take daily even when symptom-free
Bronchodilators
- Relax bronchial smooth muscle
Inhaled Steroids (ICS)
- Corticosteroid: ↓ airway inflammation
Bronchodilators
- ★SABA = rescue for acute symptoms
Inhaled Steroids (ICS)
- Anti-inflammatory controller
- Not for acute attacks
Bronchodilators
- Inhaled
- SABA onset within minutes
Inhaled Steroids (ICS)
- Inhaled
- Full effect takes days to weeks
Bronchodilators
- Assess respiratory status & peak flow
Inhaled Steroids (ICS)
- Assess respiratory status & peak flow
Bronchodilators
- Monitor HR
- ↑ albuterol use = poor control
Inhaled Steroids (ICS)
- Monitor for thrush
- Growth in children
Bronchodilators
- Tachycardia, tremor, jitteriness
Inhaled Steroids (ICS)
- Oral candidiasis (thrush), hoarseness
Bronchodilators
- ★Never LABA alone in asthma (death risk)
Inhaled Steroids (ICS)
- Spacer ↓ oral thrush risk
- Taper if long-term high dose
Bronchodilators
- Caution: tachydysrhythmias, hyperthyroidism
Inhaled Steroids (ICS)
- Caution: active oral/respiratory infection
Bronchodilators
- Demonstrate correct inhaler technique
- Use SABA first, wait, then other inhalers
Inhaled Steroids (ICS)
- Demonstrate correct inhaler technique
- Rinse mouth after each use
- Take daily even when symptom-free
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Bronchodilator first to open, steroid second to calm — never reverse the order in an acute attack.
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