New, more specific asthma meds are on the horizon

In the coming years, you’ll have exciting new treatment options to care for asthma patients in your emergency department (ED). Here are two trends to watch for:

• More specific medications.

Promising asthma medications on the distant horizon specifically will target some of the exact cells and mediators responsible for inflammation and bronchospasm, predicts Rita K. Cydulka, MD, MS, associate professor at Case Western Reserve University School of Medicine in Cleveland.

Although these medications still are in the experimental phases, they will have a dramatic impact on your practice, she says. Use of the drugs will mean that patients will be able to manage their asthma better, and therefore, fewer patients would wind up in EDs, she explains. "There would be fewer exacerbations, because the mediators wouldn’t have a chance to be released or to act. Treatment also would be quicker, because of the binding of mediators," Cydulka says.

In the meantime, follow updated recommendations from the Bethesda, MD-based National Asthma Education and Prevention Program’s Expert Panel, Cydulka urges. (For more information on this topic, see "Updated asthma guidelines are here: Are you giving the right medications?" ED Nursing, September 2002, p. 141.) "All personnel who care for asthma should take steps to make patient compliance with the guidelines both affordable and easy," she says.

• Increased use of existing interventions.

Two key medications are approved, but not yet commonly used in the ED, according to Lee M. Trexler, RN, research nurse for the department of emergency medicine at MetroHealth Medical Center in Cleveland. Levalbuterol has fewer side effects than albuterol and works just as well in opening the patient’s airway, she says. "Patients don’t get tachycardia, even with multiple stacked doses." A second medication, fluticasone propionate and salmeterol inhalation powder, is also approved but not yet used in most EDs, Trexler says.

She says she hopes that in the near future, one key intervention will become common practice in the ED: collecting pre-treatment peak flows, or forced expiratory volume at 1 second (FEV1). "I can’t stress enough the importance of this," she says.

The FEV1 is more accurate and a better indicator of asthma severity because it is a measure of the lower airway, Trexler says. Pulmonary function tests should be done before the first aerosol treatment if the patient condition allows this to be done, she says. "This measurement gives important objective data," she says.


For more information on asthma management, contact:

Rita K. Cydulka, MD, MS, Associate Professor, Case Western Reserve University School of Medicine, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109. Telephone: (216) 778-2864. Fax: (216) 778-5349. E-mail:

Lee M. Trexler, RN, Research Nurse, Department of Emergency Medicine, MetroHealth Medical Center, 2500 MetroHealth Drive, Cleveland, OH 44109. Telephone: (216) 778-5344. Fax: (216) 778-8373. E-mail: