Referral criteria from primary care - acute asthma

Criteria for admission include:

• any features of a life-threatening or near-fatal asthma attack
• any features of a severe attack that persist after initial treatment
• patients whose peak flow is greater than 75% best or predicted one hour after initial treatment may be discharged from ED unless they meet any of the following criteria, when admission may be appropriate:
  • still have significant symptoms
  • concerns about adherence
  • living alone/socially isolated
  • psychological problems
  • physical disability or learning difficulties
  • previous near-fatal asthma attack
  • asthma attack despite adequate-dose steroid tablets prior to presentation
  • presentation at night
  • pregnancy

A lower threshold for admission is appropriate in patients:

• seen in the afternoon or evening rather than earlier in the day
• with recent onset of nocturnal symptoms or worsening of symptoms
• who have had previous severe attacks, especially if the onset was rapid
• in whom there is concern over their assessment of severity of symptoms
• in whom there is concern over the social circumstances or relatives' ability to respond appropriately (1)

Reference:

1. British Thoracic Society (BTS)/Scottish Intercollegiate Guidelines Network (SIGN) 2019. British Guideline on the Management of Asthma. A national clinical guideline