Children responding well to conventional therapy may be discharged after 2 to 4 h of treatment. A short ED observation period is recommended for patients with an incomplete response but acceptable PEFR. Detailed discharge instructions should outline medication administration, inhaler use, and follow-up ( T.a.b!eJ...2..0.-.§). No child should be discharged without an MDI and spacer ( Fig, 120:2.), and prescriptions for oral glucocorticoids are generally recommended unless the attack was extremely mild (resolved with minimal treatment) or exercise-induced. Studies suggest that a tapered dose is not generally needed for "burst dose" (3- to 10-day) therapy,35 since the side effect of adrenal suppression with prolonged use is unlikely to occur. Of the two most common forms of methylprednisolone, Pediapred is reported to taste better than Prelone; however, its lower concentration requires that three times the volume of Prelone be given for the same dose.
TABLE 120-8 Discharge Treatment Dosage Guidelines
FIG. 120-2. Steps for using your inhaler. (From the Expert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program, National Heart, Lung, and Blood Institute, 1997.)
A courtesy call to the private pediatrician of the child who has been treated for asthma in the ED should be made, as it facilitates continuity of care for the child and ensures follow-up. All children should be referred to their pediatrician for follow-up within 24 h.
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