Reference — Aerosol Therapy & Pharmacology
Common Respiratory Medications
The inhaled drugs an RT administers and monitors, grouped by class — bronchodilators, controllers, combinations, mucoactive agents, and the specialty inhaled agents — with the mechanism and the bedside notes that actually change practice.
Written by Apex Respiratory Editorial Team
Educational use only. This material supports respiratory therapy education and exam review. It is not medical advice and is not a substitute for clinical judgment, institutional protocols, or physician orders. Always follow facility policies and current provider orders, and verify calculations independently before clinical use.
Overview
Drug names and doses change between formularies and editions; what stays constant is the class behavior. Knowing whether an agent is a rescue bronchodilator, a maintenance controller, or a mucoactive agent tells you what response to expect, when it is appropriate, and what to watch for. The table groups the common inhaled respiratory medications by class with the RT-relevant cautions.
Medications by Class
| Drug | Class | Action | Key RT Notes |
|---|---|---|---|
| Albuterol, levalbuterol | SABA (short-acting β₂ agonist) | Rapid bronchodilation via β₂-receptor smooth-muscle relaxation | Rescue agent for acute bronchospasm; watch for tachycardia, tremor, and hypokalemia. |
| Ipratropium | SAMA (short-acting antimuscarinic) | Bronchodilation by blocking acetylcholine-mediated tone | Added to a SABA in severe obstruction; dry mouth is the common side effect. |
| Salmeterol, formoterol | LABA (long-acting β₂ agonist) | Sustained bronchodilation for maintenance control | Maintenance only — never used as monotherapy in asthma (must pair with an ICS). |
| Tiotropium | LAMA (long-acting antimuscarinic) | Sustained bronchodilation via prolonged muscarinic blockade | Once-daily maintenance bronchodilator, a mainstay in COPD. |
| Fluticasone, budesonide | ICS (inhaled corticosteroid) | Anti-inflammatory controller — reduces airway inflammation over time | Controller, not rescue; have the patient rinse the mouth after use to prevent oral thrush. |
| Budesonide/formoterol, fluticasone/salmeterol | ICS + LABA combination | Combined anti-inflammatory control plus sustained bronchodilation | Single-inhaler maintenance; the ICS component keeps the LABA off asthma monotherapy. |
| N-acetylcysteine, dornase alfa, hypertonic saline | Mucoactive agents | Thin, break down, or hydrate secretions to aid clearance | Dornase alfa is specific to cystic fibrosis; N-acetylcysteine can trigger bronchospasm — pretreat with a bronchodilator. |
| Racemic epinephrine | Topical vasoconstrictor (inhaled) | Reduces airway-wall edema through mucosal vasoconstriction | Post-extubation stridor and croup; watch for rebound edema and monitor after dosing. |
| Inhaled prostacyclins, inhaled nitric oxide (iNO) | Selective pulmonary vasodilators | Dilate pulmonary vasculature to improve V/Q matching | Used for refractory hypoxemia and pulmonary hypertension per individual center protocols. |
| Inhaled antibiotics (e.g., tobramycin) | Inhaled antimicrobials | Deliver high local drug concentration to the airway | Chronic airway infection, notably in cystic fibrosis and bronchiectasis. |
Clinical Notes
- Delivery technique decides the dose that lands. A metered-dose inhaler with a spacer, a small-volume nebulizer, and a dry-powder inhaler each demand different coordination and inspiratory effort. A DPI needs a fast, deep breath the patient may not be able to generate when acutely short of breath — match the device to the patient’s ability.
- Assess the response, don’t assume it. After a bronchodilator, re-evaluate breath sounds, peak flow or FEV₁, and work of breathing. Improvement confirms the therapy; no change prompts a rethink.
- Watch for paradoxical bronchospasm. An inhaled agent meant to open the airway can occasionally tighten it. Worsening wheeze or distress immediately after a treatment means stop, reassess, and escalate — not redose.
- Rinse after every inhaled corticosteroid. Rinsing and spitting after an ICS removes the drug deposited in the mouth and prevents oropharyngeal candidiasis (thrush) and dysphonia.
- Never give a LABA as monotherapy in asthma. Long-acting β₂ agonists used alone in asthma are associated with worse outcomes; they must always be paired with an inhaled corticosteroid.
Related Resources
Sources
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021. Pharmacology and aerosol drug therapy chapters.
- Gardenhire DS. Rau's Respiratory Care Pharmacology. 10th ed. Elsevier; 2019.
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention (current annual report). GINA.