Fluticasone

INTRODUCTION

Indications

Maintenance and prophylactic treatment of asthma. May decrease requirement for or avoid use of systemic corticosteroids and delay pulmonary damage that occurs from chronic asthma.

Action

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

Adverse Reactions/Side Effects

CNS: headache, dizziness. EENT: dysphonia, hoarseness, oropharyngeal fungal infections, nasal stuffiness, rhinorrhea, sinusitis. Resp: bronchospasm, cough, upper respiratory tract infection, wheezing. GI: diarrhea. Endo: adrenal suppression (high-dose, long-term therapy only), decreased growth (in children), Cushing's syndrome. MS: muscle pain. Misc: CHURG-STRAUSS SYNDROME, fever.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Be alert for signs of allergic blood vessel reactions (Churg-Strauss syndrome). Early signs include allergic rhinitis, sinusitis, asthma, or hay fever–like reactions. Symptoms can increase to include fever, skin rash, joint pain, severe pain and numbness (peripheral neuropathy), shortness of breath, coughing up blood, bloody urine, chest pain, arrhythmias, and GI problems (diarrhea, nausea, vomiting, GI bleeding). Notify physician immediately for further evaluation of any signs listed above.

• 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.

• Assess any muscle 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.

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 or dry-powder inhaler; observe use of the device whenever possible to ensure proper technique.

• Advise patient not ...