Respiratory Medications
Inhalers, biologics, and cold and cough products
| Class | Examples | Key points |
|---|---|---|
| SABA (short-acting β2 agonist) | albuterol, levalbuterol | Quick relief. Tachycardia, tremor, nervousness, low K⁺. Needing it often = poor control. |
| LABA (long-acting) | salmeterol, formoterol, vilanterol | Never alone in asthma: always with an inhaled steroid. Formoterol works quickly, so ICS-formoterol can be used as a reliever. |
| Antimuscarinics | ipratropium (short); tiotropium, umeclidinium (long) | Dry mouth; caution in narrow-angle glaucoma and urinary retention (BPH). Keep spray out of eyes. |
| Inhaled corticosteroids | budesonide, fluticasone, beclomethasone | Control inflammation; not for quick relief. Thrush and hoarseness: spacer, rinse and spit. |
| ICS-formoterol | budesonide-formoterol | Preferred asthma reliever and maintenance-and-reliever therapy (GINA). Updated |
| Leukotriene modifier | montelukast | Oral, evening. Boxed warning: mood changes, agitation, nightmares, suicidal thoughts. |
| Biologics | omalizumab, mepolizumab, benralizumab, dupilumab, tezepelumab | Injections for severe asthma (some for COPD). Watch for anaphylaxis after doses (especially omalizumab). |
| Methylxanthine | theophylline | Narrow range; toxicity: tachycardia, vomiting, seizures. Caffeine adds to effects; many interactions. |
Cold, allergy and cough products
- First-generation antihistamines (diphenhydramine, chlorpheniramine): sedation, anticholinergic effects; avoid in older adults. Second-generation (loratadine, cetirizine) cause less drowsiness.
- Decongestants (pseudoephedrine): raise BP and HR; avoid in uncontrolled hypertension. Nasal sprays (oxymetazoline): max ~3 days (rebound congestion). Oral phenylephrine is ineffective as a decongestant (FDA advisory committee 2023; FDA proposed removing it in 2024).
- Dextromethorphan: serotonin syndrome with SSRIs/MAOIs.
- Benzonatate: swallow whole (chewing numbs the throat; dangerous for young children).
- No OTC cough and cold medicines for children under 4 (US labeling).
Systemic corticosteroids (short-term)
- Prednisone, methylprednisolone for exacerbations.
- Take in the morning with food.
- High glucose (check in diabetes), insomnia, mood changes, fluid retention, increased appetite.
- Longer courses: taper (see Endocrine).
Inhaler order
Bronchodilator first, then the steroid. Same medicine: wait 30–60 sec between puffs.