Early discharge of patients hospitalized with acute asthma: a controlled study

There is no consensus on the optimal length of stay and timing of release f rom hospital in patients admitted with acute asthma. We hypothesize that it might be safe to discharge patients from hospital once they have responded clinically to intensive anti-asthma treatment. In a non-randomized prospective controlled study, we compared two discharge protocols in consecutive patients admitted for acute severe exacerbations of bronchial asthma. Patients in group A were discharged after remission of signs and symptoms and those in group B after improvement but before compl ete remission of signs and symptoms. Peak expiratory flow rates (PEFR) were monitored but were not used as discharge criteria for either group. Patien ts with complicating disease and who were likely to be non-compliant were e xcluded. The length of hospital stay (LOS) and best PEFR at discharge were significa ntly lower in group B (87 admissions) than group A (80 admissions). The mea n (+/-SD) LOS was 1.8(+/-1) days vs. 3.5(+/-1.4) days and best PEFR was 58( +/-17)% predicted versus 71(+/-15)% predicted respectively (P<0.001 for bot h variables). No patient in either group relapsed within 4 weeks of dischar ge from hospital. We concluded that the release of asthmatics who respond promptly to intensi ve treatment and are compliant with medication despite incomplete resolutio n of symptoms, signs and PEFR at the time of discharge from hospital may no t be associated with increased risk of early relapse.