Are you up-to-date on new asthma treatments?
New medications are available for treatment of asthma. Here are several that emergency department nurses need to be aware of:
• Controversial therapies.
Controversial therapies include use of anticholerics, magnesium, and heliox, says Rita Cydulka, MD, residency director for the department of emergency medicine at Case Western Reserve University in Cleveland.
"The use of noninvasive positive pressure ventilation in the treatment of severe asthmatics is also controversial," says Cydulka. "Inhaled corticosteroids in ED treatment is controversial, as is the usefulness of inhaled controcorticosteroids at discharge, although the use for maintenance is very clear-cut."
"The effectiveness of these treatments hasn’t been determined," she says. "Some of the literature has showed that magnesium sulfate is effective for severe exacerbation, but not very effective for mild or moderate exacerbation," she says.
Likewise, heliox appears to be effective with severe exacerbation, but so far no role has been found for moderate or mild exacerbation, Cydulka says.
"There have been a few studies on inhaled corticosteriods, but there is not enough literature out on that yet," she adds. "Leukotriene modifiers are in the process of being addressed, but their role in an exacerbation has not been delineated yet at all."
Sustained-release theophylline is a mild-to-moderate bronchodilator used principally as adjuvant to inhaled corticosteroids for prevention of nocturnal asthma symptoms, says Cydulka. "However, the guidelines do not recommend use of methylxanthines," she notes.
"Antibiotics are also still not recommended unless there is an infection noted. And aggressive hydration is not recommended unless indicated," Cydulka adds.
• Long-acting inhaled ß2 agonists.
Long-acting inhaled ß2-agonists is adjunctive therapy to inhaled corticosteroids, especially for night-time symptoms, says Karen Huss, RN, DNSc, CANP, FAAN, associate professor at the Johns Hopkins University School of Nursing in Baltimore, and member of the National Asthma Education Program Nurses’ Committee, part of the Bethesda, MD-based National Heart, Lung, and Blood Institute.
Duration of action is 12 hours, Huss says. "It is not to be used for acute symptoms or acute exacerbations, because it takes at least 30 minutes to work," she explains.
• Leukotriene modifiers.
Leukotriene receptor antagonist for age 12 and older, is used BID, says Huss.
"Leukotriene modifiers may be useful as daily long-term control medications for patients with mild persistent asthma," she says. "Their role in helping asthma in more severe cases is not yet established."
• Zileuton lipoxygenase inhibitor.
Zileuton lipoxygenase inhibitor is used QID for ages 12 and older, says Huss.
• Montelukast leukotriene receptor agonist.
Montelukast leukotriene receptor agonist are used for ages 6 and older with once-a-day dosage, Huss says.