Learning Outcomes
By the end of this section, you should be able to:
- 25.2.1 Identify the characteristics of corticosteroid drugs used to treat respiratory disorders.
- 25.2.2 Explain the indications, actions, adverse reactions, and interactions of corticosteroid drugs used to treat respiratory disorders.
- 25.2.3 Describe nursing implications of corticosteroid drugs used to treat respiratory disorders.
- 25.2.4 Explain the client education related to corticosteroid drugs used to treat respiratory disorders.
Corticosteroids, specifically inhaled corticosteroids (ICs), play a vital role in the management of respiratory conditions such as asthma and COPD. These medications are designed to reduce inflammation and suppress the immune response in the airways (see Figure 25.3) (Cleveland Clinic, 2023a). By targeting the underlying inflammation, corticosteroids help to control symptoms, prevent exacerbations, and improve lung function. Inhaled corticosteroids are typically administered through inhalation devices directly into the lungs, allowing for targeted delivery to the respiratory system while minimizing systemic side effects. They are considered a cornerstone of long-term respiratory treatment, often used in combination with other bronchodilators for optimal control (Williams, 2018).
Table 25.8 lists common corticosteroids used for lower respiratory system disorders and typical routes and dosing for adult clients.
| Drug | Routes and Dosage Ranges |
|---|---|
| Beclomethasone (Beclovent, Qvar) |
40–80 mcg twice daily by oral inhalation, approximately 12 hours apart. |
| Prednisone (Deltasone, Prednicot, Sterapred) |
Initial dose: 5–60 mg orally daily in single dose or as 2–4 divided doses. Maintenance dosage is given daily or every other day (immediate release only). Use lowest dose that will maintain adequate clinical response. Dosage must be individualized, and constant monitoring is needed. |
| Methylprednisolone (Medrol, Solumedrol) |
Oral: 4–48 mg daily depending on the disease treated. After favorable response is noted, determine maintenance dosage by decreasing until lowest dosage that will maintain adequate clinical response is achieved. Intramuscular: 4–120 mg acetate daily. Intramuscular or intravenous (IV): 10–40 mg succinate, with subsequent doses dictated by client’s clinical response and condition. This medication should be used for more acute situations, like exacerbations. |
| Fluticasone (Flovent HFA) |
88 mcg (2 inhalations of 44 mcg fluticasone propionate) twice daily by oral inhalation, approximately 12 hours apart. |
| Budesonide (Pulmicort) |
Recommended initial dose: 360 mcg twice daily by oral inhalation. In some adult clients, an initial dose of 180 mcg twice daily may be adequate. Maximum dose: 720 mcg twice daily. |
Adverse Effects and Contraindications
Side effects of corticosteroid drugs include candidiasis (an oral fungal infection), hoarseness, cough, and increased susceptibility to infection. Clients should not stop corticosteroids abruptly because adrenal insufficiency may occur. Those with hypersensitivity to the drug, systemic fungal infections, and recent live vaccines should not use corticosteroids. Corticosteroids can affect potassium levels and sleep patterns, so both should be monitored during treatment. Corticosteroids can also cause weight gain, so weight should be monitored. Corticosteroids can modulate the immune system, so clients should be educated on signs and symptoms of infection to report (Cleveland Clinic, 2023a).
Table 25.9 is a drug prototype table for corticosteroids featuring prednisone. It lists drug class, mechanism of action, adult dosage, indications, therapeutic effects, drug and food interactions, adverse effects, and contraindications.
| Drug Class Corticosteroid Mechanism of Action Anti-inflammatory effects primarily by stabilizing the membranes of leukocyte lysosomes, reducing inflammation Suppresses the immune response Stimulates bone marrow activity Has an impact on protein, fat, and carbohydrate metabolism |
Drug Dosage Initial dose: 5–60 mg orally daily in single dose or as 2–4 divided doses. Maintenance dosage is given daily or every other day (immediate release only). Use lowest dose that will maintain adequate clinical response. Dosage must be individualized, and constant monitoring is needed. |
| Indications Asthmatic conditions COPD Therapeutic Effects Decrease in inflammation leading to fewer bronchospasm symptoms |
Drug Interactions Antidiabetic drugs Nonsteroidal anti-inflammatory drugs (NSAIDs) Cyclosporine Food Interactions No significant interactions |
| Adverse Effects Headache Oral candidiasis Weight gain Hypokalemia GI upset/ulcer risk Hyperglycemia Insomnia Mood disturbances |
Contraindications Hypersensitivity Caution: Recent myocardial infarction Gastrointestinal ulcer Hypertension Osteoporosis Growth and development of infants and children on prolonged corticosteroid therapy should be carefully observed. |
Nursing Implications
The nurse should do the following for clients who are taking corticosteroid drugs:
- Assess for hypersensitivity.
- Monitor blood pressure, sleep patterns, and potassium levels.
- Weigh client regularly and report weight gain.
- Monitor glucose levels in clients with diabetes.
- Monitor for signs and symptoms of infection.
- Provide client teaching regarding the drug and when to call the health care provider. See below for client teaching guidelines.
Client Teaching Guidelines
The client taking a corticosteroid should:
- Take the drug as prescribed without skipping doses or stopping therapy.
- Take oral corticosteroids with food to avoid gastrointestinal (GI) upset.
- Rinse mouth out after inhalation corticosteroids to reduce risk of candidiasis (thrush).
- Report all adverse reactions including weight gain, GI upset, sleep disturbances, and mood disturbances.
- Report any signs of infection such as fever or sore throat.
- Weigh themselves daily. Report a weight gain of more than 2–3 pounds over 24 hours or 5 pounds in a week.
- Monitor glucose carefully (if they have diabetes).
- Wear a medical ID bracelet indicating use of corticosteroids.
The client taking a corticosteroid should not:
- Stop taking the drug abruptly because this can lead to adrenal insufficiency. Drug will need to be reduced gradually, especially after long-term therapy.
Unfolding Case Study
Part B
Read the following clinical scenario to answer the questions that follow. This case study is a follow-up to Case Study Part A.
Harold Watson’s health care provider calls him at home to discuss the results of his x-ray. The provider confirms the diagnosis of COPD and discusses a treatment plan with Harold. Part of the plan is a prescription for a beclomethasone inhaler.