NCLEX Review Guide: Respiratory Glucocorticoids

How Glucocorticoids Work in Respiratory Conditions

• Glucocorticoids are potent anti-inflammatory agents that suppress the immune response by inhibiting phospholipase A2, reducing production of inflammatory mediators like leukotrienes and prostaglandins.
• In respiratory conditions, they reduce airway inflammation, mucus production, and bronchial hyperresponsiveness, making breathing easier for patients with asthma and COPD.
• Available in multiple formulations: inhaled (first-line for asthma), oral, and IV for severe exacerbations requiring systemic treatment.

Inhaled Glucocorticoids

• Fluticasone (Flovent), Budesonide (Pulmicort), Beclomethasone (QVAR) are first-line maintenance therapy for persistent asthma and COPD.
• Administered via MDI, DPI, or nebulizer with proper technique essential for drug delivery to lower airways rather than oral cavity.

Systemic Glucocorticoids

• Prednisone, Prednisolone, Methylprednisolone used for severe asthma exacerbations, COPD flares, and when inhaled therapy is insufficient.
• Typically given as short courses (5-10 days) to minimize systemic side effects while providing rapid anti-inflammatory relief.

Inhaled Glucocorticoid Side Effects

• Oral thrush (candidiasis) is the most common local side effect, prevented by proper mouth rinsing and spacer device use.
• Hoarseness, throat irritation, and cough may occur due to local deposition in upper airways rather than intended lower airway targets.
• Growth suppression in children with high doses, requiring regular height monitoring and lowest effective dose usage.

Systemic Side Effects (Oral/IV)

• Hyperglycemia, hypertension, mood changes, and increased infection risk occur with systemic administration, requiring close monitoring.
• Long-term use leads to adrenal suppression, osteoporosis, weight gain, and cushingoid features necessitating gradual tapering to prevent withdrawal.
• Immunosuppression increases susceptibility to infections, particularly fungal and opportunistic pathogens in vulnerable patients.

Essential Patient Teaching

1. Demonstrate proper inhaler technique and have patient return demonstrate to ensure adequate drug delivery to lungs.
2. Emphasize importance of mouth rinsing after each inhaled dose to prevent oral thrush development.
3. Explain that inhaled glucocorticoids are preventive medications, not rescue inhalers, and must be used daily even when asymptomatic.
4. Teach recognition of thrush symptoms (white patches in mouth, sore throat) and when to contact healthcare provider.

Quick Check

I can explain why mouth rinsing prevents thrush
I understand the difference between controller and rescue medications
I can teach proper MDI technique
I know when to use systemic vs inhaled glucocorticoids