What medications should be prescribed to patients with asthma on discharge?

Medications for Asthma Patients on Discharge

Patients with asthma should be discharged with inhaled short-acting beta-agonists (SABAs), systemic corticosteroids, and inhaled corticosteroids (ICS) to prevent relapse and improve outcomes. 1

Essential Medications for Discharge

Short-Acting Beta-Agonists (SABAs)

• All patients should continue treatment with inhaled SABAs (such as albuterol) for as-needed symptom relief 1
• Dosing should be adjusted based on symptom severity, typically 2-4 puffs every 4-6 hours as needed 1
• Ensure proper inhaler technique is checked and documented before discharge 2

Systemic Corticosteroids

• Prescribe oral corticosteroids (prednisolone 30-60 mg daily) to continue for 3-10 days after discharge 1
• For adults, typical regimen is 40-60 mg in single or divided doses 1
• For children, prescribe 1-2 mg/kg/day (maximum 60 mg/day) for 3-10 days 1
• For patients at high risk of non-adherence, consider intramuscular depot corticosteroid injections 1

Inhaled Corticosteroids (ICS)

• All patients with persistent asthma should be initiated on or continue ICS therapy before discharge 1, 3
• For patients already on ICS, continue therapy while taking systemic corticosteroids 1
• For patients not already on ICS, initiate therapy before discharge to improve long-term control 3
• Standard daily dose should be 200-250 μg of fluticasone propionate or equivalent 4
• Low-dose ICS is effective across all symptom frequency groups, including those with symptoms on fewer than 2 days per week 5

Medication Selection Based on Severity

Mild-to-Moderate Asthma

• SABA: Albuterol MDI, 4-8 puffs every 1-4 hours as needed 1
• Oral corticosteroid: Prednisolone 40-60 mg daily for 5-10 days 1
• ICS: Low-dose (e.g., fluticasone 100-250 μg twice daily) 4, 6

Severe Asthma

• SABA: Albuterol MDI, 4-8 puffs every 1-4 hours as needed 1
• Oral corticosteroid: Prednisolone 40-80 mg daily for 5-10 days 1
• ICS: Consider moderate-dose ICS or ICS/LABA combination 7
• For patients with life-threatening exacerbations, consider adding ipratropium bromide 1

Important Considerations

Medication Timing and Preparation

• Patient should have been on discharge medications for at least 24 hours before leaving the hospital 2
• Nebulizers should be replaced by standard inhaler devices 24-48 hours before discharge unless the patient requires a nebulizer at home 2
• Ensure PEF is >75% of predicted or personal best with diurnal variability <25% before discharge 2

Patient Education

• Provide written instructions on medication use, including dosing schedule and duration 1
• Check and document proper inhaler technique before discharge 2
• Provide a written asthma action plan that includes when to increase treatment, when to call their doctor, and when to return to the hospital 2

Follow-up Planning

• Schedule follow-up with primary care provider within 1 week of discharge 2
• Schedule follow-up with respiratory specialist within 4 weeks 2
• Assess need for additional corticosteroid treatment at follow-up visit 1

Common Pitfalls to Avoid

• Failing to initiate ICS before discharge in patients with persistent asthma leads to poor outcomes 3, 8
• Inadequate duration or dosing of systemic corticosteroids increases risk of relapse 1
• Adolescents are less likely to use ICS after discharge (51% vs 68% for children), requiring special attention 8
• Not checking inhaler technique before discharge can result in medication delivery issues 2
• Overlooking the need for a written action plan significantly increases risk of relapse 2