Medications to control airway secretions: Nursing pharmacology

There are certain medications that can be used to control airway secretions, which refers to the mucus secreted by the respiratory tract epithelium.

These medications are typically used when the airway secretions are either too much or too thick to be coughed out normally.

They can broadly be divided into 4 classes; nasal decongestants, expectorants, mucolytics, and antitussives.The most commonly used nasal decongestants include sympathomimetic medications like oxymetazoline and pseudoephedrine, and corticosteroids like fluticasone and mometasone; and can be administered orally or intranasally.

Nasal decongestants are usually used to treat a congested, or stuffy, nose, such as from allergic rhinitis. They act by constricting the blood vessels in the nasal mucosa, which ultimately reduces the local tissue edema and shrinks the congested mucosa; while corticosteroids also help decrease inflammation.Nasal decongestants can lead to side effects like anxiety, tremors, insomnia, hypertension, and increased blood glucose.

Prolonged use of decongestants, typically for more than 48 hours, may lead to rebound nasal congestion once the decongestant is stopped.

Additional side effects specific to corticosteroid nasal decongestants include a bad taste after administration, and dryness of the nasal mucosa following continuous use.Nasal decongestants should be used with caution in clients with hypertension, cardiac disease, hyperthyroidism, or diabetes mellitus, due to their adverse effects on blood pressure and blood glucose.On the other hand, commonly used expectorants include guaifenesin, usually given orally in the form of cough syrups; while common mucolytics include acetylcysteine and dornase alfa, which are usually given orally or by nebulizer.

Expectorants and mucolytics are used to relieve chest congestion due to infections like the common cold; chronic obstructive pulmonary disease, asthma, and cystic fibrosis.

Both classes of medications act by making the airway secretions thinner, and easier to cough out. Expectorants do that by stimulating the respiratory epithelium to increase the water content in the secretions.

Mucolytics, on the other hand, act by breaking down certain compounds in the airway secretions, making them less viscous.Expectorants and mucolytics commonly cause side effects like skin rash, and irritation and ulcers of the oropharyngeal mucosa, as well as irritation of the gastrointestinal mucosa, which can result in vomiting or diarrhea.Expectorants are contraindicated in chronic cough, while the mucolytic N-Acetylcysteine should be used with caution in asthma, as it can increase airway resistance and precipitate an exacerbation.Finally, antitussives can include opioids like codeine, and non-opioid medications like dextromethorphan, diphenhydramine, and benzonatate.

Antitussives can be given orally, and are only used when the cough is non-productive and irritating to the client, like in the case of a sore throat and post-viral cough.

They directly act on the cough control center in the brain and dampen the cough reflex. That means that the person doesn't feel like coughing anymore.Antitussives can cause side effects like dizziness, sedation, dry mouth, nausea, and constipation.

Additionally, opioid antitussives can cause respiratory depression and also have addictive potential, so they should only be used for short periods.Antitussives, in general, are contraindicated in chronic productive cough, as they may cause backing up of the secretions within the lungs.

Non-opioid antitussives are also contraindicated in children under the age of 2, and should be avoided in clients taking certain antidepressant medications like monoamine oxidase inhibitors, or MAOIs, and selective serotonin reuptake inhibitors, or SSRIs, as it can cause a potentially life-threatening condition called serotonin syndrome, which is caused by high levels of serotonin in the brain.

On the other hand, opioid antitussives shouldn't be taken along with central nervous system depressants like barbiturates and alcohol as their depressive effects on respiration can add up, resulting in death.

Finally, opioid antitussives are contraindicated in pregnancy and breastfeeding, since they can cause neonatal opioid withdrawal syndrome.Now, if your client is prescribed an intranasal decongestant, assess your client’s nasal passages for tears or lacerations.

Then, teach your client to gently blow their nose before self-administering to increase the effectiveness of the medication.

Let them know that prolonged use of an intranasal spray can cause tolerance and dependence; and stress the importance of using the medication as directed and only for the prescribed duration.

Advise them to report adverse effects like burning and stinging of the nasal passages, if their symptoms start to worsen, or if they experience any signs of systemic absorption such as hypertension and tachycardia.

On the other hand, if your client is prescribed an oral decongestant like pseudoephedrine, assess their vital signs, especially their blood pressure before administration.

Teach them to avoid taking the medication around bedtime, since it can interfere with sleep. Finally, for both intranasal and oral decongestants, be sure to evaluate for the desired therapeutic effect of decreased nasal congestion.

Okay, before administering an expectorant or mucolytic, be sure to assess your client’s baseline vital signs, respiratory status, and lung sounds.

If your client is prescribed an expectorant, let them know that expectorants should only be taken for a short duration of time, and advise them to notify their health care provider if their cough persists longer than one week.When administering mucolytics through a nebulizer, teach your client to avoid combining multiple medications in the nebulizer, and explain that small, frequent meals can be helpful if gastrointestinal discomfort is experienced.

If your client is prescribed the mucolytic, dornase alfa, let them know that the medication should be stored in the refrigerator and protected from light.

Finally, evaluate for the desired therapeutic effects of decreased chest congestion and improvement in respiratory symptoms.

With antitussives, assess baseline vital signs, respiratory status, and lung sounds both before and after administration.

Teach your client that increased hydration and the use of a humidifier can also be helpful in relieving their cough. Lastly, if the cough persists despite treatment, prompt the client to contact their healthcare provider.

Alright, as a quick recap… Medications used to control airway secretions include nasal decongestants, expectorants, mucolytics, and antitussives.

Nasal decongestants are usually used to treat congestion, such as from allergic rhinitis. Expectorants and mucolytics are used to relieve chest congestion due to infections like the common cold, chronic obstructive pulmonary disease, asthma, and cystic fibrosis.

Antitussives are used for a non-productive cough, like in the case of a sore throat and post-viral cough. Before administration, assess your client’s baseline status and provide education as needed.

After administering, evaluate for side effects and