Flunisolide

INTRODUCTION

Indications

Maintenance treatment of asthma as prophylactic therapy. May decrease requirement for or eliminate use of systemic corticosteroids in patients with asthma.

Action

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

Adverse Reactions/Side Effects

CNS: headache, dizziness, irritability, nervousness. CV: palpitations. EENT: hoarseness, nasal congestion, pharyngitis, dysphonia, oropharyngeal fungal infections, rhinitis, sinusitis. Resp: bronchospasm, cough, wheezing. Derm: rash. GI: diarrhea, nausea, taste disturbances, vomiting, abdominal pain, anorexia, dry mouth. GU: menstrual disturbances. Endo: adrenal suppression (high-dose, long-term therapy only), decreased growth (children). 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 long-term use. Although inhalation reduces the risk of systemic musculoskeletal damage, some degree of weakness and bone loss may still occur during prolonged, extensive use.

• Report CNS problems such as headache, dizziness, irritability, and nervousness. Excessive or prolonged CNS symptoms may require a reduction in dose.

• 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.

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.

• Protect skin from breakdown, especially over bony prominences.

Patient/Client-Related Instruction

• Counsel patient on proper use of metered-dose inhaler; observe use of this device whenever possible to ensure proper technique.

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

• Caution patient not to use this drug to treat acute symptoms. A rapid-acting inhaled beta-adrenergic bronchodilator is typically used for relief of acute asthma attacks.

• Advise patient about the likelihood of upper respiratory tract infection ...