A simple algorithm to rapidly determine asthma severity classification (SC) in the emergency department (ED)

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RATIONALE: In order to discharge asthmatic patients from the ED on appropriate medications, a simple, reliable, reproducible tool was developed to quickly assess the SC. The American Academy of Allergy, Asthma and Immunology (AAAAI) and the American College of Emergency Physicians (ACEP) guidelines recommends that every asthmatic patient have their SC determined, and persistent asthmatics are discharged with controller medications (CM).

METHODS: The detailed NHLBI guidelines served as the model. Multiple permutations and combinations of the guidelines were trialed in four ED's until the algorithm most consistent with the guidelines and our needs was developed.

RESULTS: We produced a simple and reliable method for determining SC which helped physicians appropriately prescribing CM's upon ED discharge. It consisted of six, brief, yes/no questions asked in an algorithmic fashion relating to a patient's frequency of coughing, wheezing, or difficulty breathing during the day and night. (Administration time was approximately 1 minute). Responses to the series of questions determined the patient SC. The ED SC was validated by a telephone call 1-week later.

CONCLUSIONS: The ED plays an important role in prescribing CM since it is frequently the only source of physician contact. A simple algorithm that rapidly determines asthma SC is recommended so that CM can be appropriately prescribed at discharge from the ED. This tool can also be replicated and applied in other ED settings.

This study is supported by the Robert Wood Johnson Foundation with direction and technical assistance provided by the AAAAI.