Asthma

Table 9. Criteria Supporting Hospital Admission for Acute Exacerbation of Asthma Patients at high risk for death from asthma: > With an asthma history that includes 1 or more of the following: ▶ Previous severe asthma exacerbations (with intubation or admission to an ICU) ▶ 2 or more hospitalizations for asthma in past year ▶ 3 or more emergency room visits for asthma in the past year ▶ Hospitalization or emergency room visit for asthma in past month ▶ Using ≥ 2 canisters of SABA per month ▶ Difficulty perceiving asthma symptoms or severity of exacerbations ▶ Lack of a written asthma action plan, sensitivity to Alternaria > With a social history that includes: low socioeconomic status, inner-city residence, illicit drug use, major psychosocial problems Constellation of risk factors that are severe, including: signs/symptoms, initial PEFR or FEV1 , and poor response to treatment: > Dyspnea at rest — interferes with conversation > Accessory muscle use, chest retraction > PEFR < 40% predicted or personal best > Partial relief from frequent inhaled SABA > Symptoms for ≥ 3 days after oral corticosteroids begun Consider admission to ICU when there is a constellation of life-threatening risk factors: > Patient too dyspneic to speak, perspiring > PEFR < 25% of personal best or predicted > Minimal or no relief from frequent inhaled SABA > Imminent or actual respiratory arrest: ▶ Drowsy or confused ▶ Paradoxical thoracoabdominal movement ▶ Absence of pulsus paradoxus suggestive of respiratory muscle fatigue ▶ Bradycardia ▶ Absence of wheeze Abbreviations bid, twice daily; d, day(s); EIB, exercise induced bronchospasm; FEV1 , forced expiratory volume in 1 second; FVC, forced vital capacity; h, hour(s); ICS, inhaled corticosteroids; ICU, intensive care unit; inh, inhalation; IU, international unit; kg, kilogram; LABA, long-acting β2 -agonists; LTRA, leukotriene receptor antago- nists; Max, maximum; mcg, microgram; min, minutes; mg, milligram; mL, milliliter; NA, not applicable; PCO2 -agonists; SaO2 , saturation of oxygen; SC, subcutaneous; SOL, solution; tid, three times daily; wk, week; yrs, years , partial pressure of carbon dioxide; PEFR, peak expiratory flow rate; prn, as needed; q, every; qd, every day; qhs, nightly at bedtime; qid, four times daily; qod, every other day; SABA, short-acting β2 Disclaimer This Guideline attempts to define principles of practice that should produce high-quality patient care. It focuses on the needs of primary care practice, but also is applicable to providers at all levels. This Guideline should not be considered exclusive of other methods of care reasonably directed at obtaining the same results. The ultimate judgment concerning the propriety of any course of conduct must be made by the clinician aſter consideration of each individual patient situation. Neither IGC, the medical associations, nor the authors endorse any product or service associated with the distributor of this clinical reference tool. 5740 Executive Drive Suite 220 Baltimore, MD 21228 TEL: 410-869-3332 • FAX: 410-744-2150 Additional copies: orders@GuidelineCentral.com Copyright © 2010 All rights reserved 9 > With any of the following comorbidities: cardiovascular disease, other chronic lung disease, chronic psychiatric problems

• Cover