Budesonide

INTRODUCTION

Indications

Nebulization—Maintenance treatment and prophylactic therapy of asthma. Oral inhalation—Chronic control of persistent bronchial asthma. May decrease requirement for or eliminate use of systemic corticosteroids over time in patients with asthma. Intranasal—Management of allergic rhinitis. Oral—Treatment and maintenance of remission of mild to moderate Crohn's disease.

Action

Potent, locally acting anti-inflammatory and immune modifier. Therapeutic Effects: Decreases frequency/severity of asthma attacks. Improves asthma symptoms.

Adverse Reactions/Side Effects

CNS: headache. Derm: rash. EENT: otitis media, dysphonia, epistaxis, oropharyngeal fungal infections, pharyngitis, rhinitis, sinusitis. Resp: bronchospasm, cough. GI: abdominal pain, diarrhea, dyspepsia, gastroenteritis, nausea, vomiting. Endo: adrenal suppression (high-dose, long-term therapy only), decreased growth (children), weight gain. MS: back pain. Misc: flu-like syndrome.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Assess pulmonary function periodically by measuring lung volumes, breath sounds, respiratory rate, and other symptoms (wheezing, dyspnea, shortness of breath) (See Appendices I, J, K). Report changes in pulmonary function to help document the effects of drug therapy in treating asthma.

• Observe for paradoxical bronchospasm (cough, wheezing, dyspnea), especially at higher or excessive doses. If condition occurs, advise patient to withhold medication and notify physician immediately.

• Assess muscle strength periodically during longterm use. Although inhalation reduces the risk of systemic musculoskeletal damage, some degree of weakness and bone loss may still occur during prolonged, extensive use.

• Assess any back pain to rule out musculoskeletal pathology; that is, try to determine if pain is drug induced rather than caused by anatomic or biomechanical problems.

• Report signs of adrenal suppression, including hypotension, weight loss, weakness, nausea, vomiting, anorexia, lethargy, confusion, and restlessness.

• Assess growth rate in children receiving chronic therapy; report delayed or stunted growth to the physician.

• If treating inflammatory bowel diseases, monitor any changes in symptoms (decreased abdominal pain, decreased diarrhea, improved appetite) to help document whether drug therapy is successful.

Interventions

• Implement resistive exercises and weight-bearing activities to minimize muscle wasting and osteoporosis. Use caution to prevent musculoskeletal damage in patients with preexisting muscle and bone loss.

• Design and implement appropriate aerobic exercise and respiratory muscle training programs to maintain optimal cardiovascular and pulmonary function. Work with patient and family/caregivers to find forms of exercise (e.g., swimming) that can help improve respiratory function without triggering asthma attacks.

Patient/Client-Related Instruction

• Counsel patient on proper use of inhalation techniques (nebulizer, powder inhalers, nasal sprays); observe administration whenever possible to ensure proper technique.

• Advise patient to not exceed the recommended dose or frequency of inhalations. Contact physician immediately if bronchospasm is not relieved by medication or is accompanied by severe headache ...