Emergency management of asthma in children

We studies the records of 242 consecutive visits paid by 85 children for emergency treatment of asthma, using a standard format that included history, physical signs, peak expiratory flow rates, and responses to treatments. The decision for admission was made in 23% of the episodes. It was based on the degree of airway obstruction, as reflected in physical signs and depression of PEFR, remaining after treatment. The risk of hospital admission was directly related to duration of symptoms prior to the visit, to the extent of signs of airway obstruction on arrival, and to response to the first epinephrine injection. In 39 instances, children were sent home only to return within two days because symptoms recurred. Review of data from their initial visits did not allow us to predict most of these returns. These data may serve as an aid to composing criteria useful for managing episodes of asthma in children. They support the utility of pulmonary function data in discriminating between episodes that can and those that cannot be managed safely as outpatients.