Monitoring

Patients with severe asthma exacerbations may have labile airway obstruction for several days after the onset of the acute exacerbation. Medication on discharge should reflect this, including considering longer courses of oral corticosteroids. The role of high-dose inhaled corticosteroid (ICS) on discharge, either as a substitute for or in addition to oral corticosteroids, is unclear. There is some evidence that high-dose ICS may be equivalent to oral corticosteroids in mild asthma.[94][143] [ Cochrane Clinical Answers logo ] ​​ 

If the patient received treatment in primary care, an acute care facility, the emergency department, or in hospital, then a follow-up visit should be scheduled within 2-7 days of discharge. After a self-managed exacerbation, the patient should have a semi-urgent review in primary care within 1-2 weeks, ideally before stopping any oral corticosteroids.[7]​ The follow-up review should assess:[7]​​

  • Whether or not the exacerbation has resolved

  • Whether or not oral corticosteroids can be stopped

  • The patient's level of symptom control

  • The patient's risk factors

  • The potential cause of the exacerbation

  • The patient's written asthma action plan

  • The patient's inhaler technique and adherence to treatment

  • Whether or not a step up in treatment is needed.

Discharge plans assigned to individual caseworkers (responsible for liaison between hospital staff and patients/parents) may help to prevent hospital re-admissions for acute asthma exacerbations in children.[144] [ Cochrane Clinical Answers logo ] Refer children to a paediatric respiratory specialist if they have frequent exacerbations despite optimal treatment or if they have a life-threatening episode.[57]​ Adopting an integrated and standardised care model after discharge may improve health outcomes.[145] Worsening of symptoms should prompt clinical re-assessment and re-hospitalisation if required. Peak flow monitoring may play a role for children and parents who are compliant but have poor symptom perception.

Referral to a paediatric respiratory specialist should be considered for those with frequent exacerbations and should be undertaken after life-threatening episodes.[57]​​

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