Discharge Checklist
Ideally, a proforma should be used as an aide-memoire to ensure that the following issues are checked prior to discharge.
Steroids
Patients that had an initial PERF of <50% best (or predicted) should be prescribed prednisolone (40-50 mg) for 5 days if discharged.
If the patient has a steroid inhaler they should be advised to use it twice a day. A new inhaler should be prescribed if they have lost it, it is nearly empty, or they have not previously used one.
2-agonist inhaler
A check should be made to confirm that the patient has an adequate supply of a 2 agonist inhaler on their person. If not, or if the inhaler is well used, a repeat inhaler should be prescribed.
The patient’s inhaler technique should be checked before discharge and if technique is poor, a spacer should be dispensed.
GP/asthma nurse follow up
The patient should be told to see the GP after 48 hours or return to the ED sooner if they feel their symptoms are getting worse.
A discharge letter should be e-mailed or faxed to the GP practice and, ideally, a GP appointment made for the patient before they leave the ED.
Lifestyle advice
Smoking is associated with increased incidence of relapse following an acute episode, and long term is strongly associated with declining lung function.
Patients should be advised to discuss strategies to help them stop when they see their GP.
Obese patients should be encouraged to lose weight since in asthmatics this is associated with better symptom control.