Discharge considerations for adult asthmatic patients treated in emergency departments

OBJECTIVE:To review the medical literature on outcome of treatment of acute asthma in the emergency department and issue recommendations regarding patient admission or discharge.DATA SOURCES:A MEDLINE search was done for articles in the English language on acute asthma and treatment in the emergency department for the years 1975 to 1993. In addition, references in pertinent review articles were reviewed.STUDY SELECTION:Studies addressing treatment of acute asthma in emergency departments were selected by consensus.DATA SYNTHESIS:Three major areas have been shown to affect outcome and the decision to admit or discharge a patient following treatment in the emergency department: first, the severity of the attack and the response to therapy; second, historical risk factors; and third, care following discharge from the emergency department. This paper reviews the literature on outcome of acute asthma attacks and issues recommendations regarding objective airflow measurements and co-existing risk factors to be assessed before discharging patients. The role of anti-inflammatory therapy in emergency department treatment and in postdischarge treatment of these patients is also reviewed.CONCLUSION:Evaluation for discharge following treatment of acute asthma should integrate objective measures of airflow obstruction with historical high risk factors. The use of systemic corticosteroids in the emergency department and following discharge, with careful follow-up, may help control the attack and reduce relapse of asthma.