Patients Suitable for Discharge from the ED

Patients considered for discharge should meet all of the following criteria [2]:

  • No life-threatening features at any point (including pre-hospital)
  • No features of severe asthma after initial treatment
  • PEFR >75% best or predicted and stable one hour after initial treatment
  • PEFR >50% best or predicted and stable two hours after initial treatment

Regardless of the PEFR, when any of the following features are present, admission may be appropriate:

  • Still have significant symptoms
  • Concern over compliance
  • Lives alone
  • Psychosocial problems
  • Physical disability or learning difficulties
  • History of severe asthma
  • Presentation at night
  • Pregnancy
  • Exacerbation despite adequate dose steroids pre-presentation

A decision to discharge a patient with any of the features above should only be made by a senior doctor after discussion with the patient.

Caution should be exercised in discharging patients that present late in the evening or early hours of the morning since the airways are naturally at their narrowest at around 04:00.