What is the appropriate discharge plan for a 38-year-old male patient who was admitted for a severe asthma attack, is now asymptomatic and stable with equal bilateral air entry and no wheezing?

From the Guidelines

The patient should be discharged with a short course of oral corticosteroids, such as prednisone 40mg daily for 5 days, to prevent relapse, as recommended by the National Asthma Education and Prevention Program Expert Panel report 3 guidelines for the management of asthma exacerbations 1. The discharge plan should also include continuation of his regular inhaled medications, typically including a combination inhaled corticosteroid and long-acting beta-agonist, plus a rescue short-acting beta-agonist as needed for breakthrough symptoms.

• A written asthma action plan should be provided, detailing when to increase medications or seek medical attention based on symptoms or peak flow measurements.
• A follow-up appointment with his primary care provider or pulmonologist should be scheduled within 1-2 weeks, as suggested by the expert panel report 3 (epr-3): guidelines for the diagnosis and management of asthma-summary report 2007 1.
• Before discharge, his inhaler technique should be reviewed, and he should demonstrate proper use, to ensure adherence to the treatment plan.
• Potential triggers for this attack should be identified and discussed, with strategies for avoidance, to prevent future exacerbations. This comprehensive approach addresses both the immediate recovery from the acute attack and long-term management to prevent future exacerbations by maintaining control of airway inflammation and bronchospasm. The patient's FEV1 or PEF results being 70% or more of predicted value or personal best, and symptoms being minimal or absent, indicate that he can be safely discharged 1. It is essential to consider the patient's individual needs and circumstances when developing the discharge plan, and to provide clear instructions and education to ensure a smooth transition to outpatient care.

From the Research

Discharge Plan

The patient, a 38-year-old male, was admitted for a severe asthma attack but is now asymptomatic and stable with equal bilateral air entry and no wheezing. The discharge plan should focus on preventing future exacerbations and ensuring the patient's asthma is well-controlled.

Medication

• The patient should be prescribed a combination inhaler containing a short-acting beta-agonist (SABA) and an inhaled corticosteroid (ICS) for rescue use, as studies have shown that this combination can reduce the risk of severe asthma exacerbations 2, 3.
• The use of a fixed-dose combination of albuterol and budesonide as rescue medication has been shown to be effective in reducing the risk of severe asthma exacerbation 3.
• Regular use of inhaled corticosteroids is recommended for patients with mild persistent asthma, and adding a long-acting beta-agonist (LABA) to ICS may be unnecessary in most patients with mild asthma 4.

Follow-up

• The patient should be scheduled for a follow-up appointment with their primary care physician or an asthma specialist to monitor their asthma control and adjust their treatment plan as needed.
• The patient should be educated on how to use their inhalers correctly and how to recognize the signs and symptoms of an asthma exacerbation.

Lifestyle Modifications

• The patient should be advised to avoid triggers that can exacerbate their asthma, such as tobacco smoke, dust, and pollen.
• The patient should be encouraged to maintain a healthy lifestyle, including regular exercise and a balanced diet.

Key Points

• The patient's discharge plan should focus on preventing future exacerbations and ensuring their asthma is well-controlled.
• A combination inhaler containing a SABA and an ICS should be prescribed for rescue use.
• Regular follow-up appointments and patient education are crucial for effective asthma management.
• Lifestyle modifications, such as avoiding triggers and maintaining a healthy lifestyle, can help prevent asthma exacerbations 5, 6, 2, 4, 3.