{ "schemaVersion": 2, "eyebrow": "Emergency Medicine", "title": "Asthma Exacerbation Discharge Criteria", "summary": "Discharge after an asthma exacerbation requires sustained clinical improvement after treatment, objective airflow assessment when feasible, no ongoing respiratory distress, relapse-risk assessment, controller prescribing, inhaler technique review, and prompt outpatient follow-up rather than reliance on transient symptom relief alone.", "seoDescription": "Physician criteria for safe discharge after asthma exacerbation: objective airflow assessment, relapse risk, medications, education, and follow-up.", "clinicalQuestion": "Which patients can be safely discharged after treatment for an acute asthma exacerbation, and what must be completed before discharge?", "specialty": "Emergency Medicine", "audience": "U.S. physicians and medical trainees", "tags": [ "acute asthma", "asthma exacerbation", "emergency department discharge", "peak expiratory flow", "asthma relapse", "discharge planning" ], "keyTakeaways": [ "Do not base discharge on symptom improvement alone: document pulse oximetry and objective airflow response with PEF or spirometry when feasible. [11][19]", "A PEF below 60% of predicted or personal best warrants emergency-department management rather than routine outpatient treatment; PEF and FEV1 are not interchangeable. [11]", "Before discharge, identify relapse risk: prior acute-care use, longer symptom duration, inhaled corticosteroid use at ED presentation, and female sex have been associated with relapse within 4 weeks. [1]", "Discharge planning should include the indicated controller medication, inhaler technique assessment, and primary care follow-up within 3 to 5 days. [14][16]", "History of intubation or mechanical ventilation, recent systemic corticosteroid use or withdrawal, recurrent ED visits, and asthma hospitalization identify patients at increased risk for near-fatal or fatal asthma and should lower the threshold for admission or prolonged observation. [4][7][20]" ], "sections": [ { "id": "discharge-decision", "eyebrow": "Disposition", "heading": "When discharge is reasonable after ED treatment", "intro": "Use sustained response, objective assessment, and future-risk assessment together.", "paragraphs": [ "Consider discharge only after the patient has improved clinically after initial therapy, has no persistent clinical evidence of respiratory distress, and has an objective airflow assessment when it can be obtained. PEF monitoring remains guideline-supported in emergency care despite inconsistent evidence for its ability to predict admission; it should supplement rather than replace serial clinical assessment. [19]", "A PEF less than 60% of predicted or personal best should be managed in the emergency department. For patients considered for discharge, compare the post-treatment value with the patient’s personal best or predicted value when available, and document the direction and magnitude of response rather than a single isolated measurement. PEF must not be interpreted interchangeably with FEV1. [11]", "Measure oxygen saturation by pulse oximetry in every acute asthma presentation. In a non-severe exacerbation, PEF and pulse oximetry are generally the only investigations required; broaden testing only when the presentation or treatment response suggests an alternative diagnosis or complication. [11]" ], "bullets": [ "Document pre- and post-treatment respiratory status, pulse oximetry, and PEF when feasible. [11][19]", "Do not discharge a patient with persistent respiratory distress after treatment, regardless of temporary subjective relief. [6]", "Use an extended observation or admission decision when risk factors for severe or fatal asthma outweigh a reassuring short-term response. [4][7][20]" ], "subsections": [], "table": { "caption": "Disposition elements after acute asthma treatment. [4][7][11][19][20]", "columns": [ "Finding after initial treatment", "Disposition implication", "Immediate next action" ], "rows": [ [ "PEF <60% of predicted or personal best", "Continue ED-level management rather than routine outpatient disposition. [11]", "Repeat treatment and reassess airflow and respiratory status. [11]" ], [ "No clinical respiratory distress and improved objective airflow when measurable", "May support discharge if relapse risk and discharge readiness are acceptable. [6][19]", "Complete medication, education, and follow-up plan before departure. [14][16]" ], [ "History of intubation or mechanical ventilation, recurrent ED visits or hospitalization, recent systemic corticosteroid use or withdrawal", "High-risk phenotype; lower threshold for prolonged observation or admission. [4][7][20]", "Reassess trajectory and ability to obtain rapid follow-up before choosing discharge. [4][7]" ], [ "Alternative acute condition requiring inpatient care, such as pneumonia, heart failure, or pneumothorax", "Asthma response does not determine disposition. [6]", "Evaluate and treat the alternate diagnosis and admit when indicated. [6]" ] ] } }, { "id": "objective-reassessment", "eyebrow": "Testing", "heading": "How to use PEF and spirometry in the discharge decision", "intro": "Obtain objective measures early enough to trend after bronchodilator treatment.", "paragraphs": [ "When spirometry is unavailable, use serial PEF to quantify bronchodilator response. A rise of 60 L/min and/or 20% after 400 micrograms of salbutamol or equivalent is considered a positive bronchodilator response, but this response is neither diagnostic of asthma nor sufficient by itself to establish safe discharge. [11]", "Spirometry is preferred for demonstrating airflow obstruction and reversibility when it is feasible and safe, because PEF has limited sensitivity and cannot be substituted directly for FEV1. A favorable PEF response should therefore be interpreted alongside work of breathing, oxygen saturation, medication requirements, and prior severe-exacerbation history. [11]", "Do not delay disposition solely to obtain nonessential laboratory or imaging studies in an otherwise non-severe exacerbation. Conversely, absence of an adequate objective response or discordance between reported improvement and persistent distress should prompt continued treatment and reassessment rather than discharge based on patient-reported symptom relief. [11][19]" ], "bullets": [ "Use the patient’s documented personal-best PEF when available; otherwise use predicted PEF for interpretation. [11]", "Record PEF as a percentage of personal best or predicted value, not only as an absolute L/min value. [11]", "Treat PEF as one component of reassessment; guidelines and studies have reported variable performance for predicting admission. [19]" ], "subsections": [], "table": { "caption": "Objective testing actions in acute asthma disposition. [11][19]", "columns": [ "Test or measure", "Actionable interpretation", "Pitfall" ], "rows": [ [ "Pulse oximetry", "Measure in all patients presenting with an acute asthma attack. [11]", "A normal value does not negate persistent respiratory distress or poor airflow response. [11][19]" ], [ "PEF", "PEF <60% of predicted or personal best requires ED management. [11]", "Do not use PEF interchangeably with FEV1. [11]" ], [ "Post-bronchodilator PEF", "An increase of at least 60 L/min and/or 20% after 400 micrograms salbutamol or equivalent indicates bronchodilator response. [11]", "Bronchodilator reversibility neither confirms nor excludes asthma. [11]" ], [ "Spirometry", "Preferred when feasible to demonstrate obstruction and reversibility. [11]", "Do not require it in every non-severe exacerbation. [11]" ] ] } }, { "id": "relapse-risk", "eyebrow": "Risk Stratification", "heading": "Who should not be discharged after a brief improvement", "intro": "Past severe events and unstable disease trajectory matter as much as current examination.", "paragraphs": [ "Patients discharged after ED treatment have a meaningful short-term relapse burden, with relapses evaluated within 4 weeks in adult studies. Female sex, prior healthcare use, longer symptom duration, and inhaled corticosteroid use at ED presentation were recurrently associated with relapse in multivariable observational studies. Use these factors to intensify discharge safeguards or select observation or admission when the post-treatment response is borderline. [1]", "A history of clinically severe asthma, intubation or mechanical ventilation, prior asthma hospitalization or ED visits, frequent short-acting beta2-agonist use, current systemic corticosteroid use, or recent systemic corticosteroid withdrawal identifies increased risk for future severe exacerbation, admission, near-fatal asthma, or asthma death. A patient with these features requires a more conservative disposition decision even if PEF improves transiently. [4][7][20]", "Medication history can also reveal unstable disease. In a study of patients admitted for exacerbation, death was associated with greater short-acting beta-agonist and oral corticosteroid use and more asthma-associated healthcare utilization; failure to prescribe inhaled corticosteroids at hospital discharge has also been associated with asthma mortality risk in prior studies. [4]" ], "bullets": [ "Ask specifically about previous intubation, mechanical ventilation, ICU care, ED visits, hospitalizations, and systemic corticosteroid bursts or recent discontinuation. [4][7][20]", "Clarify symptom duration before the index visit and current controller use; both affect relapse-risk assessment. [1]", "If reliable medication access, device use, or near-term follow-up cannot be established in a high-risk patient, do not treat an initially improved examination as sufficient discharge readiness. [1][4][7]" ], "subsections": [], "table": { "caption": "Features that should lower the threshold for observation or admission. [1][4][7][20]", "columns": [ "Risk feature", "Clinical consequence", "Disposition effect" ], "rows": [ [ "Prior intubation or mechanical ventilation", "Associated with near-fatal and fatal asthma risk. [4][20]", "Use a conservative threshold for prolonged monitoring or admission. [4][20]" ], [ "Prior asthma ED visits or hospitalization", "Associated with future exacerbation, admission, and death risk. [4][7]", "Do not rely on a single improved reassessment to determine safety. [4][7]" ], [ "Current or recently discontinued systemic corticosteroids", "Associated with future severe outcomes. [7]", "Reassess severity trajectory and relapse prevention plan before discharge. [7]" ], [ "Longer symptom duration, ICS use at ED presentation, female sex", "Associated with relapse after ED discharge in adult observational studies. [1]", "Strengthen follow-up and consider observation when other discharge criteria are marginal. [1]" ] ] } }, { "id": "discharge-package", "eyebrow": "Transitions of Care", "heading": "Required discharge actions before the patient leaves", "intro": "A safe discharge is a medication-and-follow-up intervention, not merely a disposition order.", "paragraphs": [ "Prescribe the indicated asthma controller medication at discharge rather than deferring controller decisions to a later visit. Pediatric acute-asthma discharge guidance specifically includes prescribing the appropriate controller according to asthma classification, and failure to prescribe inhaled corticosteroids at discharge has been associated with mortality risk in prior asthma outcome studies. [16][4]", "Confirm that the patient can demonstrate acceptable inhaler technique before discharge. This is particularly important when the outpatient plan depends on inhaled rescue or controller therapy; a current ED-discharge trial requires demonstration of acceptable metered-dose inhaler technique before enrollment in a post-ED rescue-inhaler intervention. [18]", "Arrange follow-up with the patient’s primary care clinician within 3 to 5 days after an acute asthma exacerbation. Do not substitute an unspecified recommendation to follow up for an actual timeframe and appointment pathway. For children hospitalized with asthma who require pulmonary involvement, one quality-improvement protocol targeted pulmonary follow-up within 45 days after discharge and required inpatient pulmonary consultation before discharge for PICU admissions. [14][5][15]" ], "bullets": [ "Provide the indicated controller prescription before discharge. [16]", "Observe and correct metered-dose inhaler technique before the patient leaves. [18]", "Set primary care follow-up within 3 to 5 days after the exacerbation. [14]", "For pediatric PICU asthma admissions, arrange pulmonary consultation before discharge and establish pulmonary follow-up when indicated. [5][15]" ], "subsections": [], "table": { "caption": "Minimum operational discharge checklist for acute asthma. [14][16][18]", "columns": [ "Discharge element", "What to complete", "Why it changes disposition safety" ], "rows": [ [ "Controller therapy", "Prescribe the controller medication indicated by asthma classification. [16]", "Addresses ongoing asthma management after the acute episode. [16]" ], [ "Inhaler technique", "Have the patient demonstrate acceptable metered-dose inhaler use and correct errors. [18]", "An inhaled outpatient regimen cannot be assumed effective without usable technique. [18]" ], [ "Follow-up", "Arrange primary care follow-up within 3 to 5 days. [14]", "Creates an early reassessment point after a relapse-prone period. [1][14]" ], [ "High-risk pediatric follow-up", "For PICU asthma admission, obtain pulmonary consultation before discharge; schedule pulmonary follow-up when indicated. [5][15]", "Supports posthospital management in a severe-exacerbation population. [5][15]" ] ] } }, { "id": "special-populations", "eyebrow": "Exceptions", "heading": "Pediatric and diagnostic exceptions to routine discharge", "intro": "Disposition must reflect the setting and competing diagnoses, not asthma metrics alone.", "paragraphs": [ "In children, most mild or moderate exacerbations respond to first-line inhaled short-acting beta2-agonist therapy, but response alone does not eliminate the need for discharge planning, controller review, and follow-up. Pediatric guidance emphasizes severity assessment, treatment response, discharge planning, and controller prescribing. [21][10][16]", "For any age, pursue an alternate cause of acute dyspnea when the clinical course is atypical or the expected treatment response does not occur. Pneumonia, acute congestive heart failure, and pneumothorax are examples of conditions that independently warrant admission and should not be managed under an asthma discharge pathway. [6]", "Avoid using bronchodilator reversibility to settle diagnostic uncertainty during the acute visit. Its presence is not diagnostic of asthma, and its absence does not exclude asthma; arrange subsequent diagnostic reassessment when the underlying diagnosis remains uncertain after stabilization. [11]" ], "bullets": [ "Do not discharge under an asthma pathway when pneumonia, heart failure, pneumothorax, or another acute disorder explains the presentation or requires inpatient treatment. [6]", "Do not use absent PEF improvement alone to exclude asthma, and do not use a positive response alone to establish asthma as the diagnosis. [11]", "For pediatric patients admitted to the PICU with asthma, include pulmonary consultation before discharge. [5]" ], "subsections": [], "table": { "caption": "Situations in which standard asthma discharge criteria are insufficient. [5][6][11]", "columns": [ "Situation", "Why routine discharge criteria fail", "Next step" ], "rows": [ [ "Suspected pneumonia, heart failure, or pneumothorax", "A competing acute diagnosis may require hospital-level treatment independent of airflow response. [6]", "Evaluate and manage the alternate diagnosis; determine disposition on that condition’s severity. [6]" ], [ "Uncertain asthma diagnosis", "Bronchodilator reversibility neither confirms nor excludes asthma. [11]", "Stabilize the acute episode and arrange diagnostic reassessment rather than making a definitive diagnosis from PEF response. [11]" ], [ "Pediatric PICU admission for asthma", "Severity history warrants structured specialty transition. [5]", "Obtain pediatric pulmonary consultation before discharge. [5]" ] ] } } ], "faq": [ { "question": "Can a patient be discharged after a normal oxygen saturation if PEF remains low?", "answer": "No. Pulse oximetry should be measured in all acute attacks, but a PEF below 60% of predicted or personal best warrants ED management; oxygen saturation alone should not override persistent airflow limitation or respiratory distress. [11][19]" }, { "question": "Should every patient receive chest imaging or laboratory testing before asthma discharge?", "answer": "No. In non-severe exacerbations, PEF and pulse oximetry are generally sufficient. Obtain additional evaluation when the presentation, examination, or poor response raises concern for an alternate diagnosis such as pneumonia, heart failure, or pneumothorax. [11][6]" } ], "references": [ { "number": 1, "title": "Factors associated with relapse in adult patients discharged from the emergency department following acute asthma: a systematic review", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/bmjresp/4/1/e000169.full.pdf", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com" }, { "number": 2, "title": "Part 10: Pediatric Advanced Life Support | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.i-291", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 3, "title": "Part 12: Cardiac Arrest in Special Situations", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/circulationaha.110.971069", "authors": "www.ahajournals.org", "host": "www.ahajournals.org" }, { "number": 4, "title": "Independent risk factors for death in patients admitted for asthma exacerbation in Taiwan | npj Primary Care Respiratory Medicine", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41533-020-0164-4", "authors": "www.nature.com", "host": "www.nature.com" }, { "number": 5, "title": "Ensuring Timely Pulmonary Follow-up after an... : Pediatric Quality & Safety", "detail": "journals.lww.com", "url": "https://journals.lww.com/pqs/fulltext/2025/05000/ensuring_timely_pulmonary_follow_up_after_an.7.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 6, "title": "Spirometric Criteria for Hospital Admission of Patients with Acute Exacerbation of COPD* - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0012369216309254", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 7, "title": "Asthma emergency care: National guidelines summary - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0147956301029296", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 8, "title": "Rates and Correlates of Relapse Following ED Discharge for Acute Asthma - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0012369215302439", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 9, "title": "Prediction of Relapse within Eight Weeks after an Acute Asthma Exacerbation in Adults - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0895435697002461", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com" }, { "number": 10, "title": "Managing the paediatric patient with an acute asthma exacerbation", "detail": "academic.oup.com", "url": "https://academic.oup.com/pch/article/17/5/251/2638870", "authors": "academic.oup.com", "host": "academic.oup.com" }, { "number": 11, "title": "Guidelines for diagnosis and management of... : Lung India", "detail": "journals.lww.com", "url": "https://journals.lww.com/lungindia/_layouts/15/oaks.journals/downloadpdf.aspx?an=01408641-201532001-00002", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 12, "title": "Oscillometry Measures the Response to Acute... : Annals of the American Thoracic Society", "detail": "journals.lww.com", "url": "https://journals.lww.com/01735135-202512000-00018", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 13, "title": "Status asthmaticus and the use of ketamine... : Annals of Medicine & Surgery", "detail": "journals.lww.com", "url": "https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2025/02000/status_asthmaticus_and_the_use_of_ketamine.30.aspx", "authors": "journals.lww.com", "host": "journals.lww.com" }, { "number": 14, "title": "A Controlled Trial of Two Emergency Department–Based Follow-up ...", "detail": "publications.aap.org", "url": "https://publications.aap.org/pediatrics/article/117/Supplement_2/S127/68899/Emergency-Department-Allies-A-Controlled-Trial-of", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 15, "title": "Ensuring Timely Pulmonary Follow-up after an Inpatient Asthma Hospitalization: A Quality Improvement Initiative - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pubmed/40371048", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov" }, { "number": 16, "title": "Acute Asthma Exacerbation - AAP Publications", "detail": "publications.aap.org", "url": "https://publications.aap.org/books/chapter-pdf/1484808/ch104.pdf", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 17, "title": "Discharging Asthma Patients on 3-Hour β-Agonist Treatments", "detail": "publications.aap.org", "url": "https://publications.aap.org/hospitalpediatrics/article/8/12/733/26564/Discharging-Asthma-Patients-on-3-Hour-Agonist", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 18, "title": "Study Details | NCT07166939 | 45th Multicenter Airway Research Collaboration | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT07166939", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov" }, { "number": 19, "title": "Use of Peak Expiratory Flow Rate Monitoring for the Management of ...", "detail": "www.acep.org", "url": "https://www.acep.org/by-medical-focus/thoracic-respiratory/use-of-peak-expiratory-flow-rate-monitoring-for-the-management-of-asthma-in-adults-in-the-emergency-department", "authors": "www.acep.org", "host": "www.acep.org" }, { "number": 20, "title": "104: Acute Asthma Exacerbation - AAP Publications", "detail": "publications.aap.org", "url": "https://publications.aap.org/aapbooks/book/676/chapter/8137721/Acute-Asthma-Exacerbation", "authors": "publications.aap.org", "host": "publications.aap.org" }, { "number": 21, "title": "Interventions for escalation of therapy for acute exacerbations of ...", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012977.pub2", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com" }, { "number": 22, "title": "Non‐invasive positive pressure ventilation for acute asthma in children", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012067.pub2/references", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com" }, { "number": 23, "title": "Combined inhaled anticholinergics and short‐acting beta2‐agonists ...", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000060.pub2/full", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com" }, { "number": 24, "title": "Prevention of Acute Exacerbations of COPD - Online Supplement", "detail": "journal.chestnet.org", "url": "https://journal.chestnet.org/cms/10.1378/chest.14-1676/attachment/e9d82dc8-ccfc-441a-a5d9-0e8542d28fc5/mmc1.pdf", "authors": "journal.chestnet.org", "host": "journal.chestnet.org" } ], "editorialNote": "Prepared from cited clinical literature using Astra's research workflow. Verify recommendations against current guidance and patient-specific factors.", "citations": [ { "number": 1, "title": "Factors associated with relapse in adult patients discharged from the emergency department following acute asthma: a systematic review", "detail": "bmjopenrespres.bmj.com", "url": "https://bmjopenrespres.bmj.com/content/bmjresp/4/1/e000169.full.pdf", "authors": "bmjopenrespres.bmj.com", "host": "bmjopenrespres.bmj.com", "snippet": "# Factors associated with relapse in adult patients discharged from the emergency department following acute asthma: a systematic review. Factors associated with relapse in adult patients discharged from the emergency department following acute asthma: a systematic review. A significant proportion o", "score": 0.8095324 }, { "number": 2, "title": "Part 10: Pediatric Advanced Life Support | Circulation", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/10.1161/circ.102.suppl_1.i-291", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "Magnesium bolus or infusion fails to improve expiratory flow in acute asthma exacerbations. Chest. 1993;104:831–834. Go to Citation. Crossref · PubMed · Google", "score": 0.32943538 }, { "number": 3, "title": "Part 12: Cardiac Arrest in Special Situations", "detail": "www.ahajournals.org", "url": "https://www.ahajournals.org/doi/pdf/10.1161/circulationaha.110.971069", "authors": "www.ahajournals.org", "host": "www.ahajournals.org", "snippet": "The use of ipratropium bromide for the management of acute asthma exacerbation in adults and children: a systematic review. J Asthma. 2001", "score": 0.26112875 }, { "number": 4, "title": "Independent risk factors for death in patients admitted for asthma exacerbation in Taiwan | npj Primary Care Respiratory Medicine", "detail": "www.nature.com", "url": "https://www.nature.com/articles/s41533-020-0164-4", "authors": "www.nature.com", "host": "www.nature.com", "snippet": "Compared with the control group, we found that asthmatic patients who died after admission for asthma exacerbation were significantly associated with a higher percentage of SABA use (92.9% vs. 70.8%, p < 0.001) and OCS use (67.4% vs. 50.0%, p < 0.001) and a lower percentage of having no anti-asthmat", "score": 0.5482629 }, { "number": 5, "title": "Ensuring Timely Pulmonary Follow-up after an... : Pediatric Quality & Safety", "detail": "journals.lww.com", "url": "https://journals.lww.com/pqs/fulltext/2025/05000/ensuring_timely_pulmonary_follow_up_after_an.7.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "##### Standardized Care and Guideline Development\n\nThe Department of Pediatric Pulmonology thoroughly reviewed the existing literature9,11–13 on managing asthma and recommendations for outpatient follow-up after admission for asthma exacerbations. The team developed a standardized guideline (Fig. 2)", "score": 0.7339103 }, { "number": 6, "title": "Spirometric Criteria for Hospital Admission of Patients with Acute Exacerbation of COPD* - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/pii/S0012369216309254", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "Title: Spirometric Criteria for Hospital Admission of Patients with Acute Exacerbation of COPD* - ScienceDirect\n# Spirometric Criteria for Hospital Admission of Patients with Acute Exacerbation of COPD\\*. Recent studies have demonstrated that there is a high relapse rate for patients discharged from", "score": 0.60386235 }, { "number": 7, "title": "Asthma emergency care: National guidelines summary - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0147956301029296", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Subacute lack of asthma control as a predictor of subsequent acute asthma exacerbation in a managed care population\n\n### Predicting asthma control and exacerbations: Chronic asthma as a complex dynamic model\n\n### A Study of Admission Criteria and Early Management of Adult Patients with Acute Ast", "score": 0.586926 }, { "number": 8, "title": "Rates and Correlates of Relapse Following ED Discharge for Acute Asthma - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0012369215302439", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Chest\n\n### Prediction of relapse within eight weeks after an acute asthma exacerbation in adults\n\n### J Clin Epidemiol\n\n### Factors associated with relapse after emergency department treatment for acute asthma\n\n### Ann Emerg Med\n\n### MARC Investigators Differences between men and women in report", "score": 0.50315 }, { "number": 9, "title": "Prediction of Relapse within Eight Weeks after an Acute Asthma Exacerbation in Adults - ScienceDirect", "detail": "www.sciencedirect.com", "url": "https://www.sciencedirect.com/science/article/abs/pii/S0895435697002461", "authors": "www.sciencedirect.com", "host": "www.sciencedirect.com", "snippet": "### Am J Med\n\n### Efficacy of short-term corticosteroid therapy in outpatient treatment of acute bronchial asthma\n\n### Am J Med\n\n### Comparison of peak expiratory flow and FEV admission criteria for acute bronchial asthma\n\n### Ann Emerg Med\n\n### Outcomes of emergency room visits for asthmaI. Patient", "score": 0.4708102 }, { "number": 10, "title": "Managing the paediatric patient with an acute asthma exacerbation", "detail": "academic.oup.com", "url": "https://academic.oup.com/pch/article/17/5/251/2638870", "authors": "academic.oup.com", "host": "academic.oup.com", "snippet": "Guidance includes the assessment of asthma severity, treatment considerations, proper discharge planning, follow-up, and prescription for", "score": 0.5030035 }, { "number": 11, "title": "Guidelines for diagnosis and management of... : Lung India", "detail": "journals.lww.com", "url": "https://journals.lww.com/lungindia/_layouts/15/oaks.journals/downloadpdf.aspx?an=01408641-201532001-00002", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "When spirometry is not available, response to bronchodilator can be assessed using peak expiratory flow (PEF) measurements. An increase in baseline peak expiratory flow by 60 L/min (and/or 20%) following inhalation of 400 μg of salbutamol or equivalent is considered a positive bronchodilator respons", "score": 0.4594405 }, { "number": 12, "title": "Oscillometry Measures the Response to Acute... : Annals of the American Thoracic Society", "detail": "journals.lww.com", "url": "https://journals.lww.com/01735135-202512000-00018", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "Crossmark: Check for updates\n\n# Oscillometry Measures the Response to Acute Asthma Therapy in the Pediatric Emergency Department\n\n# Abstract\n\n## Rationale:\n\nOscillometry is a feasible and safe method to measure pulmonary function in children with asthma exacerbations in the emergency department (ED)", "score": 0.3492669 }, { "number": 13, "title": "Status asthmaticus and the use of ketamine... : Annals of Medicine & Surgery", "detail": "journals.lww.com", "url": "https://journals.lww.com/annals-of-medicine-and-surgery/fulltext/2025/02000/status_asthmaticus_and_the_use_of_ketamine.30.aspx", "authors": "journals.lww.com", "host": "journals.lww.com", "snippet": "| Daengsuwan et al, 2017 | Nebulized MgSO4 vs. IV MgSO4 | 28 children with severe acute asthma (15 nebulized, 13 intravenous) | No statistically significant differences in clinical outcomes for length of stay. Both forms were effective, with clinical improvement noted at 60 minutes and continuing ov", "score": 0.25112435 }, { "number": 14, "title": "A Controlled Trial of Two Emergency Department–Based Follow-up ...", "detail": "publications.aap.org", "url": "https://publications.aap.org/pediatrics/article/117/Supplement_2/S127/68899/Emergency-Department-Allies-A-Controlled-Trial-of", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "NAEPP guidelines recommend follow-up with a PCP within 3 to 5 days of an acute asthma exacerbation, numerous studies have demonstrated low", "score": 0.6892434 }, { "number": 15, "title": "Ensuring Timely Pulmonary Follow-up after an Inpatient Asthma Hospitalization: A Quality Improvement Initiative - PubMed", "detail": "www.ncbi.nlm.nih.gov", "url": "http://www.ncbi.nlm.nih.gov/pubmed/40371048", "authors": "www.ncbi.nlm.nih.gov", "host": "www.ncbi.nlm.nih.gov", "snippet": "Title: Ensuring Timely Pulmonary Follow-up after an Inpatient Asthma Hospitalization: A Quality Improvement Initiative - PubMed\nAn official website of the United States government. **The .gov means it’s official.**. The **https://** ensures that you are connecting to the. official website and that a", "score": 0.61112726 }, { "number": 16, "title": "Acute Asthma Exacerbation - AAP Publications", "detail": "publications.aap.org", "url": "https://publications.aap.org/books/chapter-pdf/1484808/ch104.pdf", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "A discharge checklist for AAE is shown in Table 104-4. At discharge, prescribe the appropriate controller medication, as determined by classifica- tion of", "score": 0.5356092 }, { "number": 17, "title": "Discharging Asthma Patients on 3-Hour β-Agonist Treatments", "detail": "publications.aap.org", "url": "https://publications.aap.org/hospitalpediatrics/article/8/12/733/26564/Discharging-Asthma-Patients-on-3-Hour-Agonist", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "Our aim was to reduce the median length of stay (LOS) for children hospitalized with asthma exacerbations by 4 hours by changing the discharge", "score": 0.39768162 }, { "number": 18, "title": "Study Details | NCT07166939 | 45th Multicenter Airway Research Collaboration | ClinicalTrials.gov", "detail": "clinicaltrials.gov", "url": "https://clinicaltrials.gov/study/NCT07166939", "authors": "clinicaltrials.gov", "host": "clinicaltrials.gov", "snippet": "Eligibility Criteria\n\nDescription\n\nINCLUSION CRITERIA:\n\n acute asthma\n age 18.0 to 54.9 years\n English and/or Spanish speaking\n decision by ED attending to discharge patient to home on short course of systemic corticosteroids\n (intervention group only) Willingness to use Airsupra as their ", "score": 0.38498205 }, { "number": 19, "title": "Use of Peak Expiratory Flow Rate Monitoring for the Management of ...", "detail": "www.acep.org", "url": "https://www.acep.org/by-medical-focus/thoracic-respiratory/use-of-peak-expiratory-flow-rate-monitoring-for-the-management-of-asthma-in-adults-in-the-emergency-department", "authors": "www.acep.org", "host": "www.acep.org", "snippet": "32. Atta JA, Nunes MP, Fonseca-Guedes CH, et al. Patient and physician evaluation of the severity of acute asthma exacerbations. Braz J Med Biol Res. 2004;37:1321-1330.\n33. Banerji A, Clark S, Afilalo M, et al. Prospective multicenter study of acute asthma in younger versus older adults presenting t", "score": 0.37545508 }, { "number": 20, "title": "104: Acute Asthma Exacerbation - AAP Publications", "detail": "publications.aap.org", "url": "https://publications.aap.org/aapbooks/book/676/chapter/8137721/Acute-Asthma-Exacerbation", "authors": "publications.aap.org", "host": "publications.aap.org", "snippet": "In a patient with a known history of asthma, focus the initial history on recent asthma symptoms, medication use, and any risk factors for death (Box 104-1).", "score": 0.3355473 }, { "number": 21, "title": "Interventions for escalation of therapy for acute exacerbations of ...", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012977.pub2", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "Most children with asthma have mild or moderate exacerbations and respond well to first‐line therapy (inhaled short‐acting beta‐agonists and", "score": 0.21231405 }, { "number": 22, "title": "Non‐invasive positive pressure ventilation for acute asthma in children", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012067.pub2/references", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "Noninvasive positive airway pressure in the pediatric emergency department for the treatment of acute asthma exacerbations. https://clinicaltrials.gov/ct2/show/", "score": 0.20793796 }, { "number": 23, "title": "Combined inhaled anticholinergics and short‐acting beta2‐agonists ...", "detail": "www.cochranelibrary.com", "url": "https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000060.pub2/full", "authors": "www.cochranelibrary.com", "host": "www.cochranelibrary.com", "snippet": "Guidelines advocate the use of inhaled short acting beta2‐agonists (SABAs) in children experiencing an asthma exacerbation. Anticholinergic", "score": 0.18413617 }, { "number": 24, "title": "Prevention of Acute Exacerbations of COPD - Online Supplement", "detail": "journal.chestnet.org", "url": "https://journal.chestnet.org/cms/10.1378/chest.14-1676/attachment/e9d82dc8-ccfc-441a-a5d9-0e8542d28fc5/mmc1.pdf", "authors": "journal.chestnet.org", "host": "journal.chestnet.org", "snippet": "Exacerbation in follow up (f/u): required treatment with systemic corticosteroids &/or antibiotics. discharge. Pulmonary rehab = 24 exercise sessions (18-36)", "score": 0.63098115 } ], "publishedAt": "2026-09-15T18:08:31.176884+00:00", "updatedAt": "2026-09-15T18:08:31.176884+00:00", "readingMinutes": 6, "slug": "asthma-exacerbation-discharge-criteria" }