Relief inhalers are well-known in the world of respiratory therapy, sometimes not for the best reasons. Some respiratory therapists loathe using inhalers and see them as a temporary solution for an ongoing issue. AARC member and Teaching Fellow of the Department of Respiratory Therapy at Georgia State University, Doug Gardenhire, EdD, RRT, RRT-NPS, FAARC, helps us explain why over-reliance on these inhalers can be counterproductive to a patient’s long-term health.
What are relief inhalers?
Short acting beta agonists (SABAs) are often referred to as relief inhalers to treat acute airflow obstruction in obstructive airway diseases such as asthma and chronic obstructive pulmonary disease (COPD). Albuterol and levalbuterol are the most commonly prescribed SABAs in the U.S.; however, epinephrine and racemic epinephrine are available over-the-counter. These agents are available at any local drug store, and although they may be able to treat airway obstruction, they have many more side effects than prescription agents.
How does over-reliance affect patients?
These inhalers are very common and have been around for decades. So, why do patients need to be careful when using them?
“Overuse may cause unintended side effects,” Gardenhire said. “Common side effects include muscle tremors, palpitations, insomnia, nervousness, and nausea. However, the most concerning side effect due to overuse is tolerance.”
Tolerance is a side effect linked to overuse in which the airway responds by dilating. Still, due to continued use, the airway loses that response in what is referred to as downregulation. Downregulation occurs due to a reduction of beta receptors in the airway. Downregulation causes the desensitization of beta receptors and can happen in a matter of weeks with prolonged use of relief inhalers.
“This means that if a patient is overusing a relief inhaler at some time when they use the agent, it will not produce the intended action. In this case, the airway will not dilate, creating more issues in breathing,” Gardenhire said.
How can an RT help patients who are overusing relief inhalers?
RTs need to work with other health care practitioners to create an action plan. A plan will provide the patient with information on when to use the proper airway medication.
“This may mean they will need other medications to control symptoms in the airway,” Gardenhire said.
Relief inhalers, when used effectively, will work as they should. The overuse of these agents is the issue.
Communicate regularly with your health care practitioner. Using an action plan will help you reduce any overuse and manage your patients’ breathing issues more effectively.
Health care practitioners, RTs, and patients can use all the Aerosol Guides available from the AARC.
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