31: Lower Resp Drugs
The nurse is providing education to a client with a new diagnosis of asthma. Which health education topic is most important for the nurse to share? 1) "Prolonged exposure to direct sunlight will trigger asthma." 2) "Exposure to cold temperatures can trigger asthma." 3) "Do not become fatigued. It will trigger asthma attacks." 4) "Do not consume foods high in sodium."
"Exposure to cold temperatures can trigger asthma." Explanation: Exposure to cold air can exacerbate asthma symptoms due to the bronchoconstriction of airways. Neither fatigue, consumption of dietary sodium, nor direct sunlight is a known trigger of an asthma attack.
The nurse has finished teaching a 15-year-old client how to use an inhaler to treat asthma. What statement by the client suggests an understanding of the teaching? 1) "I should take a deep breath, hold it while I administer the medication, and then exhale." 2) "I need to wait at least 30 minutes after the first inhalation before taking a second." 3) "I need to shake the inhaler well before taking the medication." 4) "I need to take three short, quick breaths to inhale the medication."
"I need to shake the inhaler well before taking the medication." Explanation: Just before each use, the client should shake the inhaler well. After shaking, proper technique involves exhaling before placing the inhaler in the mouth; taking a slow, deep breath while delivering the medication into the mouth; and holding the breath for approximately ten seconds before exhaling slowly. A subsequent dose can be administered within a few minutes of the first.
The nurse is evaluating a client's understanding of the adverse reactions related to the use of theophylline. Which of the following statements by the client demonstrates an understanding of theophylline? 1) "This medication may lower my blood pressure." 2) "My sleep pattern should improve while I am taking this medication." 3) "It common to experience palpitations and flushing." 4) "This medication may be used to treat peptic ulcers, too."
"It common to experience palpitations and flushing." Explanation: Adverse reactions to theophylline include restlessness, irritation, headache, nervousness, tremors, tachycardia, palpitations, and flushing. It may increase the blood pressure and is contraindicated in clients with peptic ulcer disease.
The nurse has provided health teaching for a 15-year-old client newly diagnosed with asthma. What statement made by the client indicates a good understanding of the teaching the nurse has done regarding inhalers? 1) "The aerosol canister should be shaken well before using." 2) "I should hold my breath when administering a puff." 3) "I should insert the inhaler about 1 inch into my mouth." 4) "I need to take 3 short, quick breaths when I administer the inhaler."
"The aerosol canister should be shaken well before using." Explanation: Inhalers should be shaken well, immediately before each use. It would not be appropriate to teach the client to hold his breath when administering a puff because this would inhibit inhalation. The client should hold the device around one inch from the open mouth, not inside it. There is no need to take three quick breaths.
A client who has been newly diagnosed with chronic obstructive pulmonary disease (COPD) calls the clinic and asks the nurse to explain what the newly prescribed medications are for. What would be the most appropriate response by the nurse? 1) "The medications that have been ordered for you are to help relieve the inflammation and to open your airways." 2) "The medications that have been ordered for you are what the physician thinks will help your breathing the most." 3) "The medications that have been ordered for you are designed to work together to reduce your oxygen requirements." 4) "The medications that have been ordered for you are to help you breathe with less resistance from your diaphragm."
"The medications that have been ordered for you are to help relieve the inflammation and to open your airways." Explanation: Drug treatment of asthma and COPD aims to relieve inflammation and promote bronchial dilation. Drugs affecting the lower airway do not normally affect the diaphragm. They do not reduce the body's oxygen demand. Stating that the physician thinks they are best is not a sufficient or helpful response.
When evaluating an asthmatic client's knowledge of self-care, the nurse recognizes that additional instructions are needed when the client makes which of the following statements? 1) "When I can do some, but not all of my usual activities, I am in the yellow zone." 2) "I need to inhale my medication and hold my breath for 10 seconds." 3) "When I am short of breath, I will increase the use of my fluticasone." 4) "I will wash my sheets weekly."
"When I am short of breath, I will increase the use of my fluticasone." Explanation: Fluticasone is an inhaled steroid and should not be used during acute asthmatic attacks. Washing linens weekly will decrease the incidence of dust mites. When clients can participate in some, but not all of usual activities, they are in the yellow zone. Once medication is inhaled, the client should hold his or her breath for 10 seconds so that medication can reach deep into the lungs.
When determining a client's personal best, the nurse would instruct the client to perform peak flow testing how many times? 1) 3 2) 1 3) 4 4) 2
3 Explanation: When determining a client's personal best, the nurse should instruct the client to perform the peak flow procedure three times. Compare the three readings. Record the highest reading on your action plan. Do not calculate an average. Once or twice is not enough to gauge the peak volume of inspiration and more than three times can cause fatigue of the client.
A client is prescribed albuterol, 2 puffs every 6 hours. After teaching the client about the drug and its administration, the nurse determines that the teaching was successful when the client states that they will allow how much time between each puff? 1) 10-30 seconds 2) 1 minute 3) 2 minutes 4) 3-5 minutes
3-5 minutes Explanation: The client should allow 3-5 minutes to elapse between each puff of the inhaled medication.
After reviewing information about drugs used to treat lower respiratory system conditions, a group of nursing students demonstrate understanding of the information when they identify which as an example of a short-acting beta-2 agonist (SABA)? 1) Arformoterol 2) Albuterol 3) Salmeterol 4) Formoterol
Albuterol Explanation: Albuterol is a SABA. Formoterol, salmeterol, and arformoterol are all long-acting beta-2 agonists.
Mr. Ashum is prescribed an albuterol inhaler as part of his treatment regimen for asthma. What is the mechanism of action for this medication? 1) Albuterol blocks the stimulation of the beta-2 receptors. 2) Albuterol decreases vital capacity. 3) Albuterol causes stimulation of the bronchial tissue. 4) Albuterol causes relaxation of the bronchial smooth muscles.
Albuterol causes relaxation of the bronchial smooth muscles Explanation: The main result of albuterol binding to beta-2 receptors in the lungs is relaxation of bronchial smooth muscles. This relaxation of bronchial smooth muscle relieves bronchospasm, reduces airway resistance, facilitates mucous drainage, and increases vital capacity.
A nurse cares for several clients who have asthma. Which client should the nurse monitor most closely because of a heightened risk for asthma-related death? 1) An Asian American client with a history of cigarette smoking 2) a 76-year-old client who takes theophylline 3) An African American client taking salmeterol 4) A 17-year-old client who experiences exercise-induced asthma
An African American client taking salmeterol Explanation: Salmeterol has a black box warning addressing a small but significant increase in the risk of life-threatening asthma episodes in patients using salmeterol. This is based on a study that showed African American clients had a greater risk of asthma-related deaths than did other groups. For this reason, an African American client taking salmeterol likely has a higher risk than the other listed clients.
A client with chronic bronchial asthma is prescribed montelukast. What will the nurse instruct the client to avoid taking? 1) Aspirin 2) Nifedipine 3) Penicillin 4) Sertraline
Aspirin Explanation: The nurse would instruct the client to avoid aspirin, which might cause an increased montelukast level and toxicity. The other options do not cause drug-drug interactions with montelukast.
A client with chronic bronchial asthma is prescribed montelukast. What will the nurse instruct the client to avoid taking? 1) Nifedipine 2) Aspirin 3) Sertraline 4) Penicillin
Aspirin Explanation: The nurse would instruct the client to avoid aspirin, which might cause an increased montelukast level and toxicity. The other options do not cause drug-drug interactions with montelukast.
A client is prescribed a leukotriene receptor antagonist. The nurse should evaluate the effectiveness of the medication therapy based on the long term management of symptoms associated with which respiratory condition? 1) Emphysema 2) Pneumonia 3) Chronic bronchitis 4) Asthma
Asthma Explanation: Leukotriene receptor antagonists block or antagonize receptors for the production of leukotrienes D4 and E4, thus blocking many of the signs and symptoms of asthma. This class of medication is not typically associated with the long term management of any of the other options.
A client has been admitted to the emergency department (ED) in status asthmaticus. The ED nurse should anticipate administering which medication? 1) high doses of montelukast 2) inhaled corticosteroids 3) beta2 agonists in high doses 4) intravenous theophylline
Beta2-adrenergic agonist Explanation: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.
What is the most common first-line therapy for relief of an acute asthma attack? 1) Inhaled steroid 2) Xanthine 3) Beta2-adrenergic agonist 4) Leukotriene modifier
Beta2-adrenergic agonist Explanation: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.
What is the most common first-line therapy for relief of an acute asthma attack? 1) Xanthine 2) Beta2-adrenergic agonist 3) Inhaled steroid 4) Leukotriene modifier
Beta2-adrenergic agonist Explanation: A client experiencing an acute asthma attack should be administered a beta2-adrenergic agonist. The client can receive an inhaled steroid, but it is not the first-line therapy. Leukotriene modifiers are used for maintenance in asthma, not during acute exacerbation. Xanthines are not the drug of choice in acute asthma attack.
A client is given theophylline to treat acute asthma symptoms. Which food should the client avoid? 1) Cranberry juice 2) Orange juice 3) Chocolate 4) Bananas
Chocolate Explanation: Chocolate contains caffeine and is also a xanthine; thus chocolate should be avoided when the client is taking theophylline. Restriction of bananas, orange juice, and cranberry juice is not required.
The nurse is providing education to a client who has been prescribed an antiasthmatic drug. The nurse should instruct the client to avoid excessive intake of what beverage? 1) Acai juice 2) Grapefruit juice 3) Green tea 4) Coffee
Coffee Explanation: Clients taking antiasthmatic drugs should generally avoid excessive intake of caffeine-containing fluids such as coffee, tea, and cola drinks. These beverages may increase bronchodilation but also may increase heart rate and cause palpitations, nervousness, and insomnia with bronchodilating drugs. None of the other options contain sufficient amounts of caffeine to cause such an affect.
A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer? 1) Triamcinolone 2) Cromolyn 3) Calfactant 4) Montelukast
Cromolyn Explanation: Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.
A group of students are reviewing the various drugs that affect inflammation. The students demonstrate understanding when they identify which agent as a mast cell stabilizer? 1) Triamcinolone 2) Cromolyn 3) Montelukast 4) Calfactant
Cromolyn Explanation: Cromolyn is a mast cell stabilizer. Montelukast is a leukotriene receptor antagonist. Calfactant is a lung surfactant. Triamcinolone is an inhaled steroid.
A client who has chronic bronchial asthma has had a mast cell stabilizer prescribed. What drug would the provider prescribe? 1) Aminophylline 2) Cromolyn 3) Ipratropium 4) Isoetharine
Cromolyn Explanation: Cromolyn is the only mast cell stabilizer used in the treatment of asthma. Aminophylline is a xanthine. Ipratropium is an anticholinergic drug. Isoetharine is a sympathomimetic drug.
A nurse is teaching a client diagnosed with asthma about the disease. Which should the nurse instruct the client to avoid because it may cause bronchoconstriction? 1) Direct sunlight 2) Food high in sodium 3) Fatigue 4) Extremely cold temperatures
Extremely cold temperatures Explanation: When lungs are exposed to causative stimuli, like cold air, bronchoconstriction can result. Fatigue, foods high in sodium, and direct sunlight do not cause bronchoconstriction.
The client has mild, persistent asthma. The nurse anticipates the healthcare provider prescribing which daily medications? 1) Albuterol 2) Fluticasone 3) Terbutaline 4) Levalbuterol
Fluticasone Explanation: Terbutaline, albuterol, and levalbuterol are all short-acting beta-2 agonists that are used for acute symptom relief. Fluticasone is a daily inhaled corticosteroid.
The nurse is caring for a client who is taking an adrenergic bronchodilator. In what disease process should adrenergic bronchodilators be used cautiously? 1) Liver failure 2) Heart failure 3) Respiratory failure 4) Renal failure
Heart failure Explanation: Adrenergic drugs cause cardiac stimulation and may be contraindicated in heart failure. Patients with liver failure, renal failure, or respiratory failure do not need to use adrenergic bronchodilators cautiously.
A nurse is providing health education to a client recently diagnosed with asthma and prescribed albuterol and ipratropium. Which of the client's statements suggests a need for clarification by the nurse? 1) "I'll try to make sure that I drink plenty of fluids each day." 2) "I'll keep taking my medications until I'm not experiencing any more symptoms." 3) "I'm a heavy coffee drinker, but I know that I now know I need to cut down on this." 4) "I'll make sure I don't take my inhalers more often than they've been prescribed."
I'll keep taking my medications until I'm not experiencing any more symptoms." Explanation: Antiasthma medications should normally be taken on a regular schedule, not solely based on immediate symptoms. They should not be discontinued in the absence of symptoms. Increasing fluid intake, limiting caffeine, and adhering to the administration schedule are correct actions.
The nurse is reviewing a client's morning blood work and notes a theophylline level of 22.2 mcg/mL (123.21 µmol/L). What action should the nurse take? 1) Withhold the scheduled dose of theophylline pending the next day's blood work results. 2) Administer the scheduled dose of theophylline with as needed (PRN) dose of a bronchodilator. 3) Inform the health care provider that an increase in the client's dose of theophylline may be necessary. 4) Inform the health care provider that the client has toxic theophylline levels.
Inform the health care provider that the client has toxic theophylline levels. Explanation: To determine theophylline dosage, prescribers should measure serum theophylline levels. Therapeutic range is 5 to 15 mcg/mL (27.75 to 83.25 µmol/L); toxic levels are 20 mcg/mL (111 µmol/L) or above. The health care provider must be informed of this elevated serum level.
A client is prescribed salmeterol. The nurse would expect this drug to be administered by which route? 1) Intravenous 2) Subcutaneous 3) Oral 4) Inhalation
Inhalation Explanation: Salmeterol is administered via inhalation.
The nurse is providing education to a client with asthma on the therapeutic action of inhaled corticosteroid agents. How will the nurse describe the action? 1) Inhaled corticosteroid agents reduce bronchodilation. 2) Inhaled corticosteroid agents will depress the central nervous system. 3) Inhaled corticosteroid agents reduce respiratory rate. 4) Inhaled corticosteroid agents reduce airway inflammation.
Inhaled corticosteroid agents reduce airway inflammation. Explanation: Inhaled corticosteroid agents suppress the release of inflammatory mediators, block the generations of cytokines, and decrease the recruitment of airway eosinophils. Inhaled corticosteroid agents do not depress the central nervous system or reduce bronchodilation or respiratory rate.
The nurse is caring for a client with chronic obstructive pulmonary disease. The plan of care will focus on what client problem? 1) Lack of patent airway 2) Activity intolerance 3) Risk for aspiration 4) Adverse effects of medication therapy
Lack of patent airway Explanation: Asthma, emphysema, chronic obstructive pulmonary disease (COPD), and respiratory distress syndrome (RDS) are pulmonary obstructive diseases. All but RDS involve obstruction of the major airways. RDS obstructs the alveoli. Pain, activity intolerance, and adverse effects of medication therapy are conditions identified to detect, manage, and minimize the unexpected outcomes the nurse should be especially aware of the potential for an obstructed airway in these clients.
When teaching a client about their prescribed asthma therapy, the nurse understands that which medications may increase the risk of asthma-related death? 1) Inhaled corticosteroids (ICSs) 2) Short-acting beta agonists (SABAs) 3) Long-acting beta-2 agonists 4) Mast cell stabilizers
Long-acting beta-2 agonists Explanation: Long-acting beta-2 agonists may increase the risk of asthma-related death. ICSs are contraindicated in clients with hypersensitivity to the corticosteroids, acute bronchospasm, status asthmaticus, or other acute episodes of asthma and can cause throat irritation, hoarseness, upper respiratory tract infection, and fungal infections of the mouth and throat. SABA bronchodilators are drugs used to relieve bronchospasm associated with respiratory disorders, such as bronchial asthma, chronic bronchitis, and emphysema but can cause tachycardia, palpations, arrhythmias, hypertension, nervousness, anxiety, and insomnia. The mast cell stabilizer is contraindicated in clients with known hypersensitivity to the drugs and during attacks of acute asthma, because they may worsen bronchospasm during the acute asthma attack. A mast cell stabilizer is used cautiously during pregnancy (pregnancy category B) and lactation and in clients with impaired renal or hepatic function.
The client uses his sympathomimetic inhaler frequently. The nurse evaluates the client for which of the following symptoms related to frequent use of the sympathomimetic inhaler? 1) Bradycardia 2) Hypotension 3) Nervousness 4) Fatigue
Nervousness Explanation: Frequent use of sympathomimetic inhalers can cause nervousness, hypertension, tachycardia, and anxiety.
A 36-year-old client is prescribed inhaled corticosteroid (ICS) for daily use. Which adverse effects should the nurse closely monitor for in this client? 1) Hypotension 2) Delayed growth 3) Suppression of the hypothalamic-pituitary-adrenal axis 4) Oropharyngeal Candida albicans infection
Oropharyngeal Candida albicans infection Explanation: Dysphonia and oropharyngeal Candida albicans infections are common adverse effects associated with daily use of ICS. Long-term use of ICS may delay growth in children, not adults. Suppression of the hypothalamic-pituitary-adrenal axis is a rare adverse effect, and hypotension is not an identified adverse effect of the drug.
A client, experiencing respiratory distress related bronchi constriction, will benefit from what therapeutic action provided by anticholinergic medication therapy? 1) Reduction of the inflammatory response 2) Enhancement of alveolar expansion 3) Relaxation of smooth muscle 4) Decrease in the production of leukotrienes D4 and E4
Relaxation of smooth muscle Explanation: Anticholinergics can be used as bronchodilators because of their effect on the vagus nerve, resulting in relaxation of smooth muscle in the bronchi, which leads to bronchodilation. None of the other options describe the bronchial dilation affected of the anticholinergic classification of medications.
The nurse is evaluating the education of a client that uses albuterol for an acute asthma attack. The nurse knows that the lesson has been effective when the client states that albuterol is which of the following types of medication? 1) SABA 2) LABA 3) Leukotriene modifier 4) Antiasthma
SABA Explanation: Albuterol is a short-acting beta-2 agonist (SABA). It is used to treat and prevent bronchospasm.
The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching? 1) Polydipsia 2) Diarrhea 3) Tachycardia 4) Hypotension
Tachycardia Explanation: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.
The nurse is providing education to a client who has been prescribed albuterol. What adverse reaction should the nurse discuss during teaching? 1) Tachycardia 2) Polydipsia 3) Hypotension 4) Diarrhea
Tachycardia Explanation: The symptoms of cardiac stimulation, including tachycardia, are noted with the administration of albuterol. The client will not experience polydipsia, hypotension, or diarrhea because of the effects of albuterol.
The client is 73 years of age and has a history of coronary artery disease and COPD. She is being started on formoterol (Foradil). The nurse would assess the client for which of the following conditions? Select all that apply. 1) Hypotension 2) Tachycardia 3) Bradycardia 4) Lethargy 5) Hypertension
Tachycardia Hypertension Explanation: Older adults taking adrenergic bronchodilators are at increased risk for adverse reactions related to the cardiovascular system, such as tachycardia (not bradycardia), arrhythmias, palpitations, and hypertension (not hypotension). Lethargy is not related to taking adrenergic bronchodilators.
What action by the client would indicate that the client understands how to use an inhaler? 1) The client exhales as soon as he or she compresses the inhaler. 2) The client holds his or her breath for several seconds after compressing the canister. 3) The client uses a spacer to administer a powdered medication. 4) The client inhales as soon as the inhaler enters his or her mouth.
The client holds his or her breath for several seconds after compressing the canister. Explanation: Holding the breath prevents exhalation of medication still remaining in the mouth. The client should inhale when the canister is compressed, not as soon as the inhaler enters his or her mouth. The client should only administer one dose of medication at a time, and the client should wait to exhale until after the breath has been held as long as possible. Spacers are not used with powdered medications.
The nurse is caring for a 38-year-old client with asthma who has been started on albuterol. What assessment finding should the nurse most likely attribute to adverse medication effects? 1) The client had diarrhea this morning. 2) The client's oral temperature is 37.8°C (100°F). 3) The client's heart rate is 99 beats/min. 4) The client reports excessive thirst.
The client's heart rate is 99 beats/min. Explanation: Adrenergic agents stimulate beta1-adrenergic receptors in the heart as well as beta2-adrenergic receptors in the lungs. Adrenergic agents do not cause polydipsia, fever, or diarrhea.
Why are inhaled steroids used to treat asthma and COPD? 1) They act locally to improve mobilization of edema 2) They act locally to increase histamine release 3) They act locally to decrease release of inflammatory mediators 4) They act locally to decrease histamine release
They act locally to decrease release of inflammatory mediators Explanation: When administered into the lungs by inhalation, steroids decrease the effectiveness of the inflammatory cells. This has two effects, which are decreased swelling associated with inflammation and promotion of beta-adrenergic receptor activity, that may promote smooth muscle relaxation and inhibit bronchoconstriction.
A 70-year-old client is being treated for chronic obstructive pulmonary disease (COPD) with theophylline. What will be a priority assessment by the nurse? 1) Use of nicotine 2) Intake of fatty foods 3) Activity level 4) Weight
Use of nicotine Explanation: Nutritional status, weight, and activity level would be important for a nurse to know about a COPD client. However, it would be most important for the nurse to know whether the client smokes or uses tobacco in other ways or smoking cessation methods that involve nicotine. Nicotine increases the metabolism of theophyllines; the dosage may need to be increased to produce a therapeutic effect.
A client is being assessed by the home care nurse for the appropriate use of a metered-dose inhaler. Instructions concerning which intervention will assist a client in the proper use of the device? 1) Using a spacer 2) Pushing fluids 3) Exhaling immediately after administration 4) Administrating corticosteroid first
Using a spacer Explanation: The client should be instructed to use a spacer to increase compliance and accuracy of administration. An asthma spacer is an add-on device used to increase the ease of administering aerosolized medication from a metered-dose inhaler (MDI). The corticosteroid should be administered after the bronchodilator. The increase in fluids will not affect the administration of the inhaler. The client should hold the breath for several seconds after administration of the inhaler.
When educating a group of students on the mechanism of action of various antiasthma drugs, the nurse identifies which drugs as inhibiting the formation of leukotriene? 1) Budesonide 2) Zafirlukast 3) Montelukast 4) Zileuton
Zileuton Explanation: Zileuton acts by inhibiting the formation of leukotriene. Montelukast is a leukotriene receptor antagonist. Budesonide is a corticosteroid drug that decreases the inflammatory process and increases the sensitivity of the beta-2 receptors. Zafirlukast acts as a leukotriene receptor antagonist.
What is considered a possible trigger for an asthma attack? Select all that apply. 1) warm weather 2) allergens 3) pollutants 4) exercise 4) cigarette smoke
cigarette smoke exercise allergens pollutants Explanation: Precipitants may include allergens (e.g., pollens, molds), airway irritants and pollutants (e.g., chemical fumes, cigarette smoke, automobile exhaust), cold air, and exercise.
A client has been prescribed medication therapy for the treatment of newly diagnosed asthma. During teaching, the nurse should alert the client to potential exacerbation of what concurrent medical condition? 1) dermatitis 2) cataracts 3) urinary retention 4) gastroesophageal reflux disease
gastroesophageal reflux disease Explanation: Asthma may aggravate gastroesophageal reflux disease because antiasthma medications that dilate the airways also relax muscle tone in the gastroesophageal sphincter and may increase acid reflux. The relationship between asthma medications and the other options is not supported by research data.
The nurse is providing education to the parents of a child who has been newly diagnosed with asthma. During teaching, the nurse should explain that asthma attacks occur when mast cells release substances that cause what reaction? 1) smooth muscle dilation. 2) inflammation. 3) decreased capillary permeability. 4) Decreased fluid leakage.
inflammation. Explanation: When lung tissues are exposed to causative stimuli, mast cells release substances that cause bronchoconstriction and inflammation, increased capillary permeability and fluid leakage, and changes in the mucus-secreting properties of the airway epithelium.