What are the recommended take-home medications for a patient with an acute exacerbation of bronchial asthma?

Take-Home Medications for Acute Asthma Exacerbation

All patients discharged after an acute asthma exacerbation must receive oral prednisolone 30-60 mg daily for 1-3 weeks, inhaled corticosteroids at a higher dose than before admission, and an inhaled short-acting beta-agonist for as-needed use. 1

Essential Discharge Medications

Oral Corticosteroids (Mandatory)

• Prednisolone 30-60 mg daily for 5-10 days without tapering is the cornerstone of discharge therapy 2
• The British Thoracic Society guidelines specify prednisolone tablets should continue for 1-3 weeks (or longer in patients with chronic asthma) according to a written action plan 1
• No tapering is required for courses less than 1 week 3
• For patients at high risk of non-adherence, consider intramuscular depot corticosteroid injection as an alternative 2

Inhaled Corticosteroids (Mandatory)

• Prescribe inhaled steroids at a higher dosage than before admission 1
• Treatment with inhaled steroids must be started at least 48 hours before discharge 1
• All patients should continue taking inhaled steroids until the first hospital visit 1
• Prednisolone may be stopped before this visit but must never be stopped if asthma is worsening 1

Short-Acting Beta-Agonists (Mandatory)

• Inhaled or nebulized β-agonists for use "as necessary" 1
• Nebulizers should be replaced by standard inhaler devices 24-48 hours before discharge unless the patient requires a nebulizer at home 1
• Verify inhaler technique before discharge and document performance, as improper technique is a common cause of treatment failure 1, 2

Additional Controller Medications (As Needed)

• Oral theophylline, long-acting β-agonists, or inhaled ipratropium if required 1
• For patients requiring these medications, blood theophylline concentrations should be monitored 1

Critical Discharge Equipment and Education

Peak Flow Meter (Mandatory)

• All patients must have a peak expiratory flow meter prescribed on discharge 1
• Teach patients how to use it and how to act on the results 1
• Patients should know at what PEF values to increase treatment, call their doctor, or readmit themselves to hospital 1

Written Asthma Action Plan (Mandatory)

• All patients must have a written self management plan 1, 2
• The plan should specify when to step up treatment based on symptoms and PEF measurements 1
• Include instructions on monitoring symptoms and PEF on a chart 1

Follow-Up Arrangements

Primary Care Follow-Up

• Surgery review within 48 hours for patients treated at home 1
• See general practitioner within 1 week of hospital discharge 1
• Modify treatment at review according to guidelines for chronic persistent asthma 1

Specialist Follow-Up

• Hospital follow-up by a respiratory physician with outpatient appointment within 1 month 1
• For patients requiring frequent courses of systemic corticosteroids (>2 bursts per year), refer to an asthma specialist for consideration of step-up in long-term controller therapy or biologic agents 2

Common Pitfalls to Avoid

• Never discharge patients until symptoms have stabilized or returned to normal function, recognized by PEF >75% predicted or best, diurnal variability <25%, and no nocturnal symptoms 1
• Do not delay corticosteroid administration 2
• Avoid unnecessarily high steroid doses - hydrocortisone 50 mg IV four times daily is as effective as 200 or 500 mg 4
• Do not taper short courses of oral steroids 2
• Do not prescribe antibiotics routinely - give antibiotics only if bacterial infection is present 1
• Never prescribe sedatives - any sedation is contraindicated 1
• Ensure adequate medication supply to last until the next consultation opportunity 1

Discharge Readiness Criteria

Before discharge, confirm:

• Patient has been on discharge medication for 24 hours 1
• Inhaler technique has been checked and recorded 1
• PEF >75% of predicted or best (if recorded) 1
• PEF diurnal variability <25% 1
• Patient or caregiver understands treatment prescribed and use of delivery devices 1
• Patient has adequate support to cope at home 1