Identifying the acutely ill patient with asthma

We studied 77 patients suffering acute asthma to identify those who needed hospitalization. Patients randomly received various doses of subcutaneous epinephrine. Peak expiratory flow rate (PEFR) was measured initially and at ten and 20 minutes after epinephrine administration. If adequate response was not noted from three doses of epinephrine, aminophylline and later hydrocortisone were given. Patients were admitted to the hospital if they did not improve or required emergency room treatment for four hours. Thirty-five percent (13/37) of the patients with an initial PEFR of less than or equal to 100 liters/min required hospital admission, whereas only 8% (3/40) with an initial PEFR of greater than 100 liters/min required hospitalization (P less than .01). Analysis of patients in the group at high risk also revealed significant differences between hospitalized and nonhospitalized patients in PEFR. Asthmatics with significant airway obstruction (initial PEFR, less than or equal to 100 liters/min) who do not show prompt improvement after optimal epinephrine therapy should be closely observed and considered candidates for hospital admission.