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Specialist referral (asthma)

Last reviewed dd mmm yyyy. Last edited dd mmm yyyy

Authoring team

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

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