The acute asthmatic patient in the ED: to admit or discharge

The American Journal of Emergency Medicine
B Brenner, M S Kohn

Abstract

Treating asthma in the emergency department (ED) always involves the potentially difficult decision as to whether to discharge the patient, to continue treatment, or to admit to the hospital. The following are useful guidelines. (1) The duration of the bronchospasm, frequency of visits, history of previous endotracheal intubation, pulse rate, and accessory muscle use are findings affecting successful discharge from the ED. (2) Patients with peak expiratory flow rate (PEFR) of < 20% and who do not respond to inhalant therapy, with PEFR values persisting at < 40% of predicted, will require 4 or more days to resolve and should be admitted to the hospital. (3) Patients with a PEFR between 40% and 70% of predicted after initial inhalant therapy may well be responsive to steroids in the ED, but an ED will adequately need to care for the patient for 5 to 12 hours while waiting for the onset of action of glucocorticoids. Discharged with glucocorticoids, this group has a 6% relapse rate within 10 days of the ED visit. (4) Patients with a PEFR of > or = 70% have a 14% relapse rate after discharge without glucocorticoids. Other reasons to consider admission are pneumonia, barotrauma, lability, prominent psychiatric difficulties, poor acce...Continue Reading

References

Apr 1, 1979·British Journal of Diseases of the Chest·N J CookeI W Grant
Jul 1, 1975·The Journal of Allergy and Clinical Immunology·E R McFadden
Sep 11, 1992·The American Journal of Medicine·W C BaileyJ M Richards
Aug 20, 1992·The New England Journal of Medicine·A B Bergman
Jun 1, 1990·Annals of Internal Medicine·L M Stein, R P Cole
Jun 1, 1990·Annals of Internal Medicine·P H MayoH W Harris
May 1, 1983·The American Journal of Medicine·C H FantaE R McFadden
Jun 1, 1983·The American Journal of Medicine·B E BrennerR R Simon
Aug 1, 1983·The American Journal of Medicine·S B FielM E Francis
Sep 1, 1993·The American Journal of Medicine·J M KallenbachS Zwi
May 1, 1993·The American Review of Respiratory Disease·E R McFadden

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Citations

Feb 11, 2014·Herz·S Brenner, G Güder
Jan 12, 2000·Pediatric Clinics of North America·S R Smith, R C Strunk
Nov 22, 2013·The Journal of Asthma : Official Journal of the Association for the Care of Asthma·Javier Navarro-EstevaAntonio Esquinas Rodríguez
Sep 3, 1999·Occupational and Environmental Medicine·P Frost, J H Andersen
Jul 15, 2005·Nephron. Clinical Practice·Mark S MacGregorJ Michael Boulton-Jones
Sep 6, 2006·The Journal of Asthma : Official Journal of the Association for the Care of Asthma·Akerke BaibergenovaAmiram Gafni
Jun 21, 2001·Critical Care Medicine·B E BrennerUNKNOWN MARC Investigators

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