Discharge Instructions for Asthma Patients Treated for Pneumonia

Medication Recommendations at Discharge

The British Thoracic Society recommends prescribing prednisolone tablets (30 mg daily) for one to three weeks according to a written action plan 1, 2
Increase inhaled steroids to a higher dosage than before admission, as suggested by the British Thoracic Society 1, 2
Continue inhaled β-agonists for use "as necessary", following the guidelines of the British Thoracic Society 1, 2
Consider oral theophylline, long-acting β-agonists, or inhaled ipratropium if required based on severity of asthma, as recommended by the British Thoracic Society 1, 2
Antibiotics should be prescribed only if bacterial infection is present and continued until completion of the course, according to the British Thoracic Society 1, 3

Provide a peak expiratory flow meter and teach the patient how to use it properly, as recommended by the British Thoracic Society 1, 2
Develop a written self-management plan that includes when to increase treatment based on PEF values, when to call their doctor, and when to return to the hospital, following the guidelines of the British Thoracic Society 1, 2, 4
Ensure the patient has been on discharge medication for at least 24 hours before leaving the hospital, as suggested by the British Thoracic Society 4
Verify and document proper inhaler technique, according to the British Thoracic Society 1, 5
Replace nebulizers with standard inhaler devices 24-48 hours before discharge unless the patient requires a nebuliser at home, as recommended by the British Thoracic Society 1, 5

Schedule follow-up with primary care physician within one week of discharge, as recommended by the British Thoracic Society 4
Arrange follow-up appointment with a respiratory physician within 4 weeks, following the guidelines of the British Thoracic Society 4, 5
Monitor blood theophylline concentrations if the patient is on oral xanthines, as suggested by the British Thoracic Society 5

Return to the emergency department if experiencing worsening shortness of breath, increased wheezing, or decreased effectiveness of rescue inhalers, as recommended by the British Thoracic Society 1, 3

Review potential triggers that may have contributed to the pneumonia or asthma exacerbation, including environmental factors and medication compliance, as suggested by the British Thoracic Society 1, 2
Assess if there was an avoidable precipitating cause, and evaluate if the patient was complying with regular treatment, following the guidelines of the British Thoracic Society 1, 2

Never stop prednisolone abruptly or reduce the dose if asthma symptoms are worsening, as recommended by the British Thoracic Society 1, 2
Ensure inhaled steroid treatment is started at least 48 hours before discharge, according to the British Thoracic Society 1, 5
Avoid sedatives as they are contraindicated in asthma, as suggested by the British Thoracic Society 1, 3