What are the discharge criteria for an asthma patient?

Discharge Criteria for Asthma Patients

Asthma patients should be discharged from hospital only when their symptoms have stabilized or returned to normal function, with peak expiratory flow (PEF) >75% of predicted or best value, diurnal variability <25%, and no nocturnal symptoms. 1

Clinical Stability Requirements

• Patient should have been on discharge medication for at least 24 hours before leaving the hospital 1
• Inhaler technique must be checked and documented prior to discharge 1
• PEF should be >75% of predicted or personal best value 1
• PEF diurnal variability should be <25% 1
• No significant nocturnal symptoms should be present 1
• Respiratory rate and other vital signs should have normalized (respiration <25 breaths/min, pulse <110 beats/min) 1

Medication Preparation

• Nebulizers should be replaced by standard inhaler devices 24-48 hours before discharge unless the patient requires a nebulizer at home 1
• Treatment with inhaled steroids must be started at least 48 hours before discharge 1
• Patient should be prepared to leave with:
  • Prednisolone tablets (30-60 mg daily) for 1-3 weeks according to a written action plan 1, 2
  • Inhaled steroids at a higher dosage than before admission 1, 2
  • Inhaled β-agonists for use as needed 1, 2
  • Oral theophylline, long-acting β-agonists, or inhaled ipratropium if required 1, 2

Self-Management Tools

• Patient must have their own PEF meter and be taught how to use it 1
• A written self-management plan must be provided, including when to increase treatment, when to call their doctor, and when to return to the hospital 1, 2
• Instructions for parents should be provided if the patient is a child 1

Follow-up Arrangements

• Follow-up with primary care physician should be arranged within 1 week of discharge 1, 2
• Hospital follow-up with a respiratory physician should be scheduled within 4 weeks 1, 2
• If discharge criteria are not met, the patient should be seen by a respiratory physician while still in hospital 1

Special Considerations

• Patients with complicating diseases require more careful assessment before discharge 3
• If the patient is on oral xanthines, blood theophylline concentrations should be monitored before discharge 1
• The circumstances of admission should be investigated to identify and address any avoidable precipitating factors 1

Common Pitfalls to Avoid

• Discharging patients too early can lead to relapse and readmission 4, 5
• Failing to provide a written self-management plan significantly increases risk of relapse 1, 2
• Inadequate corticosteroid dosing at discharge can lead to symptom recurrence 1
• Not checking inhaler technique before discharge can result in medication delivery issues 1
• Overlooking follow-up arrangements can lead to gaps in care continuity 1, 2

Alternative Approaches

Some studies suggest that early discharge may be safe in selected patients who respond promptly to intensive treatment, even with incomplete resolution of symptoms and PEF <70% predicted, provided they are compliant with medication and have no complicating factors 3. However, this approach carries higher risk and should be considered only in exceptional circumstances when hospital resources are severely limited.