Respiratory Medications Reference
Clinical overview of medication classes used in respiratory care — mechanisms, uses, and key considerations for RTs administering, monitoring, and educating about respiratory pharmacotherapy.
The Respiratory Therapist's Role in Pharmacotherapy
Respiratory therapists occupy a unique position in the clinical pharmacology of pulmonary disease. Unlike most allied health professionals who assist with medication administration, RTs are often the primary clinicians administering, monitoring, and adjusting respiratory medications — particularly inhaled therapies — based on ongoing clinical assessment.
Protocol-based respiratory therapy allows RTs to initiate, modify, or discontinue treatments within defined parameters based on patient response, without requiring an order change for each adjustment. This clinical autonomy requires a thorough understanding of drug mechanisms, expected and adverse effects, and the clinical contexts in which each medication is appropriate.
In addition to administration, respiratory therapists are frequently responsible for patient and family education regarding inhaler technique, device selection, and medication adherence — skills that are as important as the pharmacology itself.
Medication Classes in Respiratory Care
Short-Acting Beta-2 Agonists (SABAs)
Albuterol (salbutamol), levalbuterol
Long-Acting Beta-2 Agonists (LABAs)
Salmeterol, formoterol, indacaterol
Short-Acting Anticholinergics (SAMAs)
Ipratropium bromide (Atrovent)
Long-Acting Anticholinergics (LAMAs)
Tiotropium (Spiriva), umeclidinium, aclidinium
Inhaled Corticosteroids (ICS)
Fluticasone, budesonide, beclomethasone, mometasone
Systemic Corticosteroids
Prednisone, methylprednisolone (Solu-Medrol), dexamethasone
Mucolytics
N-acetylcysteine (NAC), dornase alfa (Pulmozyme), hypertonic saline
Surfactants
Beractant (Survanta), calfactant (Infasurf), poractant alfa (Curosurf)
Aerosol Delivery Devices
The effectiveness of inhaled respiratory medications depends as much on delivery technique as on pharmacology. A correctly selected device, used incorrectly, can result in less than 10% of the dose reaching the lower airways. Understanding each device's requirements helps respiratory therapists optimize therapy and educate patients effectively.
Small Volume Nebulizer (SVN)
Converts liquid medication into an aerosol via compressed gas or vibrating mesh. Flow-independent — patients breathe normally during treatment. Suitable for acute and critically ill patients, mechanically ventilated patients (inline adapters), and those unable to coordinate MDI technique. Longer treatment time (5–10 minutes) is the main limitation.
Metered-Dose Inhaler (MDI)
Propellant-driven aerosol requiring coordination between actuation and inhalation. A spacer (valved holding chamber) significantly improves deposition and reduces oropharyngeal impaction, making it preferred for patients who struggle with coordination. Widely used in both inpatient and outpatient settings.
Dry Powder Inhaler (DPI)
Breath-actuated — requires an adequate inspiratory flow rate (typically ≥60 L/min) to disperse the powder. Not suitable for patients with severe airflow obstruction during acute exacerbations. No spacer required, but proper inhalation technique is critical.
Soft Mist Inhaler (SMI)
Produces a slow-moving aerosol that is less flow-dependent than DPIs, improving deposition in patients with limited inspiratory effort. Tiotropium Respimat is the most familiar example. Requires less coordination than a standard MDI.
Inline Ventilator Adapter
Both MDIs (with in-line spacer) and vibrating mesh nebulizers can be used in-line during mechanical ventilation. Placement in the inspiratory limb, ventilator settings optimization (flow, pattern), and humidification bypass may all affect drug delivery efficiency. Follow institutional protocols for mechanically ventilated aerosol delivery.
Monitoring Medication Response
Respiratory therapists assess patient response to respiratory medications as part of every treatment encounter. A structured post-treatment assessment should include:
- Breath sounds — clearing of wheeze, improvement in air entry, change in secretion character or volume
- Work of breathing — use of accessory muscles, respiratory rate, paradoxical breathing
- Pulse oximetry — SpO₂ response before and after treatment
- Heart rate — particularly relevant after SABA administration
- Patient-reported dyspnea — subjective symptom improvement
- Peak flow or spirometry when available and clinically indicated
Document pre- and post-treatment assessments and communicate significant changes — improvement or deterioration — to the clinical team promptly.
Following Facility Protocols
Respiratory medication references — including this one — provide general pharmacology information and clinical context. They do not replace facility-specific policies, formulary decisions, or physician orders. In practice:
- Formulary agents vary by institution — confirm which specific drugs are available before educating patients.
- Protocol-based care parameters (PRN frequency, dose adjustment criteria) are institution-specific.
- Some medications listed here may require specific training or certification to administer at certain facilities.
- Dosing information in clinical references may differ from your institution's approved doses — always follow the order.
Medication Quick-Reference in the RTB2 App
The RTB2 app includes a structured respiratory medication reference organized by drug class — available offline on shift for quick educational review and workflow reference.
