Inhaled Steroids

Learn about inhaled steroids in this nursing pharmacology guide for student nurses! Get to know its uses, side-effects, nursing considerations and more.

Inhaled steroids have been found to be a very effective treatment for bronchospasm. The drug of choice depends on the individual patient’s response; a patient may have little response to one agent and do very well on another.

Inhaled Steroids: Generic and Brand Names

Here is a list of some of the most commonly encountered inhaled steroids.

• Inhaled steroids:
  • beclomethasone (Beclovent)
  • budesonide (Pulmicort)
  • ciclesonide (Alvesco)
  • Fluticasone (Flovent)
  • triamcinolone (Azmacort)

What are Inhaled Steroids?

Inhaled steroids are used to decrease the inflammatory response in the airway.

• Inhaling the steroid tends to decrease the numerous systemic effects that are associated with steroid use.
• It is usually useful to try another preparation if one is not effective within 2 to 3 weeks.

Therapeutic actions

The desired actions of inhaled steroids include:

• Decrease the inflammatory response in the airway.
• Increase airflow and facilitate respiration.
• Promotion of beta-adrenergic receptor activity, which may promote smooth muscle relaxation and inhibit bronchoconstriction.

Indication of Inhaled Steroids

Inhaled steroids are indicated for the following:

• Prevention and treatment of asthma.
• Treatment of chronic steroid-dependent bronchial asthma.
• Used as adjunctive therapy for asthma patients who do not respond to traditional bronchodilators.

Pharmacokinetics

These drugs are rapidly absorbed from the respiratory tract, but they from 2 to 3 weeks to reach effective levels.

Route	Onset	Peak	Duration
Inhalation	Slow	Rapid	8-12 h

Half-life (T1/2)	Metabolization	Excretion
2 to 3 hours	Liver	Urine

Contraindications and Cautions

The contraindications and cautions for patients using inhaled steroids include the following:

• Emergency use. Inhaled steroids are not for emergency use and are not for use during an acute asthma attack or status asthmaticus.
• Pregnancy or lactation. They should not be used during pregnancy or lactation unless the benefit to the mother clearly outweighs any potential risk to the fetus or the nursing baby.
• Active respiratory infection. These preparations should be used with caution in any patient who has an active infection of the respiratory system because the depression of the inflammatory response could result in serious illness

Adverse effects

Adverse effects of using inhaled steroids include the following:

• CNS: Irritability, headache.
• Respiratory: Rebound congestion, epistaxis, local infection.

Nursing considerations for Inhaled Steroids

Nursing considerations for a patient using inhaled steroids include the following:

Nursing Assessment

History taking and physical exam of a patient using inhaled steroids include:

• Assess for possible contraindications and cautions: acute asthmatic attacks and allergy to the drugs, which are contraindications; and systemic infections, pregnancy, or lactation, which require cautious use.
• Perform a physical examination to establish baseline data for assessing the effectiveness of the drug and the occurrence of any adverse effects associated with drug therapy.
• Assess temperature to monitor for possible infections.
• Monitor blood pressure, pulse, and auscultation to evaluate cardiovascular response.
• Assess respirations and adventitious sounds to monitor drug effectiveness.
• Examine the nares to evaluate for any lesions that might lead to systemic absorption of the drug.

Nursing Diagnosis and Care Planning

Nursing diagnoses related to drug therapy might include the following:

• Risk for injury related to immunosuppression.
• Acute pain related to local effects of the drug.
• Deficient knowledge regarding drug therapy.

Nursing Implementation with Rationale

Nursing interventions for patients using inhaled steroids include:

• Not for immediate relief. Do not administer inhaled steroids to treat an acute asthma attack or status asthmaticus because these drugs are not intended for the treatment of acute attack and will not provide the immediate relief needed.
• Proper tapering of steroids. Taper systemic steroids carefully during the transfer to inhaled steroids; deaths have occurred from adrenaline insufficiency with sudden withdrawal.
• Use decongestant drops. Have the patient use decongestant drops before using the inhaled steroid to facilitate penetration of the drug if nasal congestion is a problem.
• Oral care. Have the patient rinse the mouth after using the inhaler because this will help to decrease systemic absorption and decrease GI upset and nausea.
• Monitor for signs of infection. Monitor the patient for any sign of respiratory infection; continued use of steroids during acute infection can lead to serious complications related to the depression of the inflammatory and immune responses.
• Educate the client. Provide patient teaching, including the drug name and prescribed dosage, measures to help avoid adverse effects, warning signs that may indicate problems, and the need for periodic monitoring and evaluation, to enhance patient knowledge about drug therapy and to promote compliance.
• Ensure the effectiveness of the drug. Instruct the patient to continue to take the drug to reach and then maintain effective levels (drug takes 2 to 3 weeks to reach effective levels).
• Provide support. Offer support and encouragement to help the patient cope with the disease and the drug regimen.

Evaluation

Evaluation of a patient using inhaled steroids include:

• Monitor patient response to the drug (improved breathing).
• Monitor for adverse effects (nasal irritation, fever, GI upset).
• Evaluate the effectiveness of the teaching plan (patient can name drug, dosage, adverse effects to watch for, specific measures to avoid them, and measures to take to increase the effectiveness of the drug).
• Monitor the effectiveness of other measures to ease breathing.

Recommended Resources

Our recommended nursing pharmacology resources and books:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase which will help support us. Thank you! For more information, check out our privacy policy.

See Also

Here are other nursing pharmacology study guides:

• Nursing Pharmacology – Study Guide for Nurses
  Our collection of topics related to nursing pharmacology
• Pharmacology Nursing Mnemonics & Tips
  These nursing mnemonics aim to simplify the concepts of pharmacology through the use of a simple, concise guide.
• Generic Drug Name Stems Cheat Sheet
  Learn about these generic drug name stems to help you make sense of drugs easier!
• Common Drugs and Their Antidotes
  A guide to drug antidotes that nurses should be familiar about.
• IV Fluids and Solutions Guide & Cheat Sheet
  Get to know the different types of intravenous solutions or IV fluids in this guide and cheat sheet.
• Drug Dosage Calculations NCLEX Practice Questions (100+ Items)
  Care to take the challenge? This quiz aims to help students and registered nurses alike grasp and master the concepts of medication calculation.

Drug Guides ^NEW!

Individual drug guides and nursing considerations for the most common medications used in nursing pharmacology:

• Acetaminophen (Tylenol)
• Aspirin
• Atorvastatin (Lipitor)
• Enoxaparin (Lovenox)
• Furosemide (Lasix)
• Gabapentin
• Hydromorphone (Dilaudid)
• Lisinopril
• Metoprolol
• Morphine

References and Sources

References and sources for this study guide about Inhaled Steroids.

• Hinkle, J. L., & Cheever, K. H. (2018). Brunner and Suddarth’s textbook of medical-surgical nursing. Wolters kluwer india Pvt Ltd.
• Karch, A. M., & Karch. (2011). Focus on nursing pharmacology. Wolters Kluwer Health/Lippincott Williams & Wilkins. [Link]
• Kew, K. M., & Seniukovich, A. (2014). Inhaled steroids and risk of pneumonia for chronic obstructive pulmonary disease. Cochrane Database of Systematic Reviews, (3).
• Katzung, B. G. (2017). Basic and clinical pharmacology. McGraw-Hill Education.
• Lehne, R. A., Moore, L. A., Crosby, L. J., & Hamilton, D. B. (2004). Pharmacology for nursing care.