Guidelines for ED Observation of Asthma


  • Acceptable vital signs
  • Intermediate response to therapy — improving but still wheezing
  • Peak flow 40-70% of predicted (if reliable)
  • Fair to good air exchange
  • Alert and oriented
  • Patients should receive at least two nebulized bronchodilator treatments and steroids prior to transfer to Observation Unit


  • Unstable vital signs or clinical condition
  • Poor response to therapy
  • Elevated partial pressure of carbon dioxide (if done)
  • Pulse oximetry <90 on room air after initial treatment
  • Peak Flow <40% predicted value after initial treatment (if reliable)
  • Persistent use of accessory muscles, respiratory rate >40 after initial treatment
  • Pneumonia
  • Lethargy
  • Toxic theophylline level
  • New electrocardiogram changes


  • Nebulized bronchodilator therapy
  • Systemic steroids
  • Chest X-ray
  • Pulse oximetry, arterial blood gases
  • Frequent reassessment
  • Oxygen
  • Telemetry Monitor System monitoring as needed


Home —

  • Acceptable vital signs
  • Resolution of bronchospasm or return to baseline status
  • Peak flow >70% predicted
  • Pulse oximetry >94% on room air

Hospital —

  • Progressive deterioration in status
  • Failure to resolve bronchospasm within 18 hours
  • Co-existent pneumonia
  • Carbon dioxide Retention
  • Persistent peak flow <70% of predicted (if reliable)
  • Unstable vital signs
  • Pulse oximetry <90% on room air

Estimated Time in Unit: <18 hours


Source: William Beaumont Hospital, Royal Oak, MI.