When should you hospitalize for asthma?

Asthma is a chronic lung disease that inflames and narrows the airways. Asthma causes recurring periods of wheezing, chest tightness, shortness of breath, and coughing. Asthma attacks vary in severity. Some can be mild and easily managed with medications at home, while others require immediate emergency care and hospitalization.

Table of Contents

When is hospitalization necessary for asthma?

Hospitalization is necessary when asthma symptoms are unresponsive to initial treatment at home or in the emergency department. Signs that indicate the need for hospitalization include:

Severe shortness of breath that is not relieved with initial bronchodilator treatment
Inability to speak full sentences due to shortness of breath
Chest retractions – sucking in of skin between ribs during breaths

Cyanosis – blue coloring of lips and fingernails
Decreased level of consciousness
Measurement of peak flow or FEV1
Oxygen saturation level
Exhaustion from work of breathing

Hospitalization provides more intensive monitoring and treatment than is available at home. Patients who need hospital care are often admitted to intensive care for close observation and treatment. Hospitalization allows for:

Administration of oxygen and breathing treatments via mask or breathing tube if needed
Intravenous corticosteroids to rapidly reduce inflammation
Intravenous magnesium, which acts as a bronchodilator

High-flow humidified oxygen
Monitoring of oxygen saturation, respiratory rate, and effort of breathing
Close observation for respiratory failure

What are the usual causes for hospitalization?

The most common reasons for hospitalization for asthma include:

Severe asthma exacerbation: A flare-up of symptoms that does not respond adequately to initial treatments at home. Continuous wheezing, coughing, chest tightness and breathing difficulties can indicate a severe exacerbation needing hospital care.
Respiratory infection: Viral or bacterial lung infections such as pneumonia, bronchitis, sinusitis, or the flu can trigger an asthma attack. The added inflammation and airway restriction make symptoms more difficult to control.

Allergic reaction: Anaphylaxis or severe allergic reaction involving asthma symptoms requires hospitalization monitoring even after epinephrine is given.
Low peak flow: When peak expiratory flow rate is less than 40% of the patient’s personal best measurement, hospitalization is recommended.
Side effect of medication: Rarely, asthma medications such as leukotriene inhibitors can induce bronchospasm and make asthma worse. Hospitalization allows for discontinuing the medication and managing symptoms.

What treatments are given in the hospital?

Treatments given in the hospital for asthma exacerbations include:

Supplemental oxygen: Oxygen administered via nasal cannula, face mask, or breathing tube if intubation is required.
Inhaled short-acting bronchodilators: Albuterol breathing treatments every 20 minutes up to 3 hours via nebulizer. May also include anticholinergic inhalers like ipratropium.

Systemic corticosteroids: Intravenous corticosteroids (methylprednisolone, hydrocortisone) help relieve airway inflammation. Oral corticosteroids may also be used.
IV magnesium sulfate: Can help relax airway spasms and improve breathing function.
IV fluids: Intravenous hydration is important, as difficulty breathing often leads to fluid loss.

Antibiotics: May be prescribed if there is suspicion of a lung infection triggering symptoms.
Sedatives: Used occasionally for severe exacerbations requiring mechanical ventilation.
Methylxanthines: IV theophylline is sometimes used for severe asthma unresponsive to other treatments.

What are the discharge criteria from the hospital?

The decision to discharge a patient hospitalized for asthma is based on several criteria:

Respiratory symptoms – wheezing, coughing, shortness of breath – have significantly improved or resolved.
Objective measure of lung function has substantially improved – Peak flow or FEV1 >70% of personal best or predicted.

Oxygen saturation levels remain normal without supplemental oxygen for 24 hours.
The patient can participate in normal physical activity without asthma symptoms.
The patient understands correct use of all discharge medications – inhalers, oral steroids.

Follow up care is arranged with the primary care provider within 24-48 hours of discharge.
Any triggers of the asthma exacerbation have been identified and strategies implemented to help prevent future episodes.
The patient has a written asthma action plan outlining medications and self-management steps for home use.

These criteria ensure the patient’s condition is stable enough to return home safely without hospital-level monitoring and treatment.

What education is provided at hospital discharge?

Comprehensive asthma education is essential prior to hospital discharge to prevent recurrent exacerbations. Education should include:

Review of proper inhaler and medication use. Observe and coach on inhaler technique.

Avoidance of known asthma triggers – allergens, smoke, respiratory infections.
Use and interpretation of a peak flow meter for self-monitoring.
Early signs of asthma worsening and what steps to take.

Instructions on accessing an asthma action plan.
When to seek emergency care – what symptoms indicate the need for immediate treatment.
Importance of adherence to discharge plan and following up with regular provider.

Smoking cessation resources if needed.

Providing this education helps empower patients to manage their asthma properly at home and know when to seek assistance when symptoms worsen.

What medications are prescribed at discharge?

Medications prescribed at hospital discharge often include:

Inhaled corticosteroids: Preventive anti-inflammatory medication used daily. Examples include budesonide, fluticasone, beclomethasone.
Long-acting beta agonists: Bronchodilators that provide sustained symptom relief for 12 or 24 hours. Salmeterol, formoterol are examples.
Leukotriene modifiers: Reduces airway inflammation and improves lung function. Montelukast, zafirlukast, zileuton.

Short-acting beta agonists: Bronchodilators to provide quick symptom relief. Albuterol, levalbuterol.
Oral corticosteroids: Oral prednisone for 3-10 days help transition from IV steroids and reduce inflammation.

These medications help prevent recurrence of asthma exacerbations after hospital discharge. Using inhaled corticosteroids regularly is crucial for controlling the underlying disease process.

What follow up is needed after discharge?

Close outpatient follow up after hospitalization for asthma is necessary. Recommended follow up includes:

See primary care provider within 24-48 hours of discharge for reevaluation.
Have lung function measured by spirometry at follow up visits.

See asthma specialty care provider such as pulmonologist within 1-2 weeks of discharge.
Ongoing follow up every 1-6 weeks in the first 6 months after hospitalization to optimize treatment.
A phone or virtual visit 24-72 hours after discharge to ensure stability.

Home health nurse may arrange 1-2 home visits to reinforce education.

Diligent follow up helps identify ongoing issues requiring treatment adjustments. Lung function testing guides treatment modifications. Coordination amongst the care team provides comprehensive post-discharge care.

What preventive steps help avoid hospitalization?

Several preventive measures can help reduce the risk of asthma attacks progressing to require hospitalization:

Taking inhaled corticosteroids and bronchodilators properly every day as prescribed.
Monitoring lung function with a peak flow meter at home.
Having and following a written asthma action plan for self management.

Avoiding triggers for asthma symptoms whenever possible.
Getting an annual influenza vaccine to reduce respiratory infections.
Seeking regular asthma care to review and adjust medications as needed.

Refilling medications before they run out to prevent lapses in treatment.
Carrying a rescue inhaler at all times and using it at the first sign of symptoms.

Implementing these preventive measures empowers patients to gain better control of asthma and reduce the risk for severe attacks leading to hospitalization.

Key Takeaways

Hospitalization for asthma is necessary when symptoms are uncontrolled with initial treatments or oxygen levels, lung function, or level of consciousness are significantly impaired.
Common reasons for hospitalization include severe asthma exacerbations, respiratory infections, allergic reactions, and issues with medications.
Treatments given in the hospital include supplemental oxygen, frequent inhaled bronchodilators, IV corticosteroids, IV magnesium, and possibly antibiotics or sedatives.

Discharge readiness is based on symptom improvement, stable oxygen levels, lung function, ability to be active, understanding of discharge plan, and follow up arrangements.
Comprehensive asthma education on triggers, medications, monitoring, and emergency care is provided at discharge.
Medications at discharge often add an inhaled corticosteroid for prevention and may modify other asthma treatments.

Follow up within 24-48 hours and 1-2 weeks optimizes post-hospital care and prevents readmission.
Adherence to preventive measures like medication compliance, trigger avoidance, and monitoring can prevent hospitalizations.

Conclusion

Hospitalization for asthma represents a serious progression of the disease requiring intensive treatments not feasible at home. Certain signs like exhaustion, severely impaired breathing function, or low oxygen levels indicate hospital-level care is necessary. Hospitalization aims to stabilize oxygenation, maximize bronchodilation, reduce inflammation, and closely monitor the patient’s response to treatment. Prior to discharge, individuals must demonstrate improved breathing capacity along with readiness to manage asthma care at home. They also need education on medication use, trigger avoidance, symptom monitoring, and emergency preparedness. Diligent follow up after hospitalization is crucial to prevent relapse and readmission. With proper self-management guided by the healthcare team, many hospitalizations can be avoided through control of asthma symptoms and early intervention when exacerbations occur.