Reference — Aerosol Therapy & Pharmacology
Respiratory Medication Adverse Effects
The adverse effects and the bedside monitoring that go with the inhaled drug classes an RT administers — β₂-agonists, antimuscarinics, inhaled corticosteroids, mucolytics, inhaled nitric oxide, and racemic epinephrine — in one quick-reference table.
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
Every inhaled agent carries a predictable set of adverse effects, and for most classes the watch is the same at every bedside. This reference pairs each drug class with its common adverse effects and the specific monitoring the RT performs — the heart rate after a β₂-agonist, the mouth after a steroid, the methemoglobin level on inhaled nitric oxide. Most inhaled side effects are local and dose-related, and the monitoring is meant to catch the few that are not.
Adverse Effects by Class
| Drug class | Common adverse effects | RT monitoring |
|---|---|---|
| β₂-agonists (SABA / LABA) | Tremor, tachycardia, palpitations, hypokalemia, hyperglycemia | Heart rate, tremor, potassium with high or continuous dosing; reassess response |
| Antimuscarinics (SAMA / LAMA) | Dry mouth, urinary retention, blurred vision; caution in narrow-angle glaucoma | Symptoms; keep mask spray out of the eyes |
| Inhaled corticosteroids | Oral thrush (candidiasis), dysphonia, reflex cough; high-dose systemic effects | Inspect the mouth, rinse-and-spit, use a spacer |
| Mucolytic (N-acetylcysteine) | Bronchospasm, foul odor, nausea | Pretreat with a bronchodilator; watch for wheeze |
| Hypertonic saline | Bronchospasm, cough | Pretreat with a bronchodilator; monitor |
| Inhaled nitric oxide | Methemoglobinemia, NO₂ toxicity, rebound pulmonary hypertension on withdrawal | Methemoglobin and NO₂ levels; wean, do not stop abruptly |
| Racemic epinephrine | Tachycardia, rebound edema | Heart rate; monitor after dosing |
Clinical Notes
- Most inhaled side effects are local and dose-related. The majority of adverse effects stay in the airway and mouth and scale with dose, which is why technique and dosing matter as much as the drug itself.
- A spacer and rinse-and-spit cut ICS local effects. Using a spacer and rinsing the mouth after an inhaled corticosteroid reduce oropharyngeal deposition and prevent thrush and dysphonia.
- Pretreat with a bronchodilator before agents that can trigger bronchospasm. N-acetylcysteine and hypertonic saline can provoke bronchospasm; giving a bronchodilator first blunts that risk — then watch for wheeze.
- Always pair the adverse-effect watch with an assessment of the response. Monitoring for harm is only half the job; confirm the therapeutic effect at the same time so the agent is doing what it was given to do.
Related Resources
Sources
- Gardenhire DS. Rau's Respiratory Care Pharmacology. 10th ed. Elsevier; 2019.
- Kacmarek RM, Stoller JK, Heuer AJ. Egan's Fundamentals of Respiratory Care. 12th ed. Elsevier; 2021.