What are the criteria for hospital admission for acute asthma exacerbation?

From the Guidelines

Admission criteria for asthma should be based on the presence of life-threatening features, severe respiratory distress, or a peak expiratory flow (PEF) below 40% of predicted or personal best, as indicated by the most recent guidelines 1. The criteria for hospital admission for asthma include:

• Any life-threatening features, such as inability to speak or severe respiratory distress
• Any features of acute severe asthma present after initial treatment, especially PEF <40% of predicted or personal best 1
• Severe symptoms, such as dyspnea at rest, interference with conversation, or use of accessory muscles
• Poor response to initial bronchodilator therapy, with minimal or no relief from frequent inhaled short-acting beta-agonists (SABA)
• Significantly decreased PEF, with values below 40% of predicted or personal best, or a PEF <25% of predicted or personal best, indicating a life-threatening exacerbation 1
• Altered mental status, respiratory fatigue, or impending respiratory failure
• High-risk factors, such as previous ICU admissions, recent hospitalization, or multiple ED visits for asthma
• Treatment-resistant asthma, where symptoms persist despite administration of consecutive nebulized albuterol treatments with ipratropium bromide and systemic corticosteroids
• Social factors, such as inability to follow up, lack of home support, or difficulty accessing medications, which may lower the threshold for admission. According to the expert panel report 3 (EPR-3) guidelines for the diagnosis and management of asthma, patients with a PEF below 50% of predicted or personal best require immediate medical care, and those with a PEF below 40% usually require hospitalization 1.

From the Research

Criteria for Admission for Asthma

The criteria for admission for asthma are not explicitly stated in the provided studies. However, the studies suggest that the duration of symptoms, severity of asthma, and response to treatment are important factors in determining the need for hospital admission.

• Duration of symptoms: A study published in 2002 found that patients with a longer duration of symptoms of acute asthma are more likely to require admission to hospital 2.
• Severity of asthma: The same study found that patients with moderate or severe asthma are more likely to require hospital admission or transfer for further treatment than patients with a shorter duration of symptoms 2.
• Response to treatment: A study published in 2012 found that patients who responded well to treatment in the emergency department had improved ventilation and increased exhaled nitric oxide levels 3.

Factors Associated with Hospital Admission

The studies also identified several factors associated with hospital admission, including:

• Duration of symptoms: Patients with a duration of symptoms more than 6 hours were more likely to require hospital admission 2.
• Peak expiratory flow (PEF) rate: Patients with lower PEF rates were more likely to require hospital admission 3.
• Exhaled nitric oxide levels: Patients with higher exhaled nitric oxide levels were more likely to have improved ventilation and response to treatment 3.
• Asthma control: Patients with poor asthma control were more likely to require hospital admission 4.
• Use of rescue medication: Patients who required more frequent use of rescue medication were more likely to require hospital admission 5.