Cromolyn

INTRODUCTION

Indications

Inhalation: Prophylaxis (long-term control) of bronchial asthma. Prevention of exercise-induced bronchospasm. Intranasal: Prevention and treatment of seasonal and perennial allergic rhinitis. PO: Mastocytosis. Treatment of food allergy. Treatment of inflammatory bowel disease.

Action

Prevents the release of histamine and slow-reacting substance of anaphylaxis (SRS-A) from sensitized mast cells. Therapeutic Effects: Decreased frequency and intensity of asthmatic episodes or allergic reactions.

Adverse Reactions/Side Effects

CNS: dizziness, headache. Derm: rash, urticaria, angioedema. EENT: intranasal: nasal irritation, nasal congestion, sneezing. Resp: inhalation: irritation of the throat and trachea, cough, wheezing, bronchospasm. GI: nausea, unpleasant taste. Misc: ALLERGIC REACTIONS, INCLUDING ANAPHYLAXIS OR WORSENING OF CONDITIONS BEING TREATED.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor signs of allergic reactions and anaphylaxis, including pulmonary symptoms (tightness in the throat and chest, wheezing, cough, dyspnea) or skin reactions (rash, pruritus, urticaria). Notify physician immediately if these reactions occur.

• Assess symptoms of bronchospasm, including wheezing, coughing, and tightness in the throat and chest. Perform pulmonary function tests to quantify suspected changes in ventilation and respiration (See Appendices I, J, K). Notify physician immediately if symptoms increase.

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

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician, and caution the patient and family/caregivers to guard against falls and trauma.

Interventions

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

Patient/Client-Related Instruction

• Advise patient to not exceed the recommended dose or frequency of inhalation or intranasal applications.

• Instruct patient and family/caregivers to report other troublesome side effects such as severe or prolonged headache, nausea, unpleasant taste, skin reactions (rash, itching, welts, swelling of the face), or nasal problems (rhinitis, sneezing, congestion).

Pharmacokinetics

Absorption: Oral: 0.5–2 %; Inhalation: Poorly absorbed systemically (total bioavailability is 8%); action is local. Small amounts may reach systemic circulation after inhalation.

Distribution: Because only small amounts are absorbed, distribution is not known.

Metabolism and Excretion: Small amounts absorbed are excreted unchanged in bile and urine.

Half-life: 80–90 min.