Acute asthma is the most common medical emergency in children and is responsible for increasing hospitalization and death rates in several countries. It is, therefore, becoming increasingly important to optimize the assessment and treatment of patients with acute asthma. In the Emergency Room setting, the most critical issue facing the attending physician is deciding when outpatient therapy of acute asthma is adequate, or when hospitalization is indicated. Traditionally, this decision is reached on the basis of patient history, findings on physical examination, laboratory measurements, and response to therapy. The literature relevant to this issue is confusing with respect to the relative importance of the various components of patient assessment.
Thus, although Lulla and Newcomb found that a history of asthma symptoms of greater than 24 hours in duration reduced the likelihood of successful treatment and discharge from the ER, this observation was not confirmed by subsequent investigators. No individual clinical measurement has been shown to predict the outcome of acute asthma reliably, and thus, a variety of multifactorial scoring systems have been devised. Fischl et al developed an index primarily based on clinical assessment, which they claimed could reliably predict the outcome of adult patients treated in the ER for acute asthma. However, subsequent prospective studies failed to confirm the predictive accuracy of this index.