From the Guidelines
Telemetry monitoring is not routinely indicated for most patients with uncomplicated asthma exacerbations. According to the National Asthma Education and Prevention Program Expert Panel report 3 guidelines for the management of asthma exacerbations 1, the primary focus should be on immediate care, close observation for deterioration, frequent treatment, and repeated measurement of lung function. Standard monitoring for asthma exacerbations should include pulse oximetry, vital signs (heart rate, respiratory rate, blood pressure), and clinical assessment of respiratory status.
The guidelines emphasize the importance of recognizing the signs and symptoms of severe and life-threatening exacerbations, and being familiar with the risk factors for asthma-related death 1. However, telemetry should be reserved for specific high-risk situations, such as patients with known cardiac disease, significant arrhythmias, electrolyte abnormalities, QTc prolongation, or those receiving high doses of beta-agonists that could potentially cause cardiac side effects.
Some situations where telemetry monitoring may be appropriate include:
- Patients with significant tachycardia (heart rate >140 bpm)
- Those with a history of coronary artery disease
- Elderly patients
- Patients showing signs of hemodynamic instability during treatment In these cases, clinicians should maintain a low threshold for initiating cardiac monitoring to ensure timely detection and management of potential cardiac complications. The goal is to balance the need for monitoring with the potential risks and costs, while prioritizing patient outcomes and quality of life.
From the Research
Asthma Exacerbation Telemetry
- Asthma exacerbations can be classified as mild, moderate, severe, or life threatening, based on symptoms and physical examination parameters, as well as lung function and oxygen saturation 2
- The goals of treatment for asthma exacerbations in the ambulatory and emergency department settings are correction of severe hypoxemia, rapid reversal of airflow obstruction, and reduction of the risk of relapse 2
- Administration of systemic corticosteroids within one hour of emergency department presentation decreases the need for hospitalization, with the most pronounced effect in patients with severe exacerbations 2
Treatment Options
- Metered-dose inhalers with a spacer device are at least equivalent to nebulized beta2 agonist therapy in children and adults 2, 3, 4
- Multiple doses of inhaled anticholinergic medication combined with beta2 agonists improve lung function and decrease hospitalization in school-age children with severe asthma exacerbations 2
- Intravenous magnesium sulfate has been shown to significantly increase lung function and decrease the necessity of hospitalization in children 2
Home Monitoring
- Home monitoring of asthma exacerbations using an AI-aided stethoscope can provide reliable information on asthma exacerbations and make remote monitoring of patients easier 5
- The best single-parameter discriminators of exacerbations were wheezes intensity for young children, rhonchi intensity for older children, and survey answers for adults 5
- A combination of several parameters can provide the greatest efficacy in exacerbation detection 5
Management Strategies
- Current management strategies for asthma exacerbations include prevention of exacerbations, treatment of acute exacerbations, and novel treatments that target type 2 airway inflammation 6
- The presence of exacerbations is an important defining characteristic of asthma severity, and the mechanisms that underlie these exacerbations are complex and multifactorial 6