Asthma: acute exacerbation: individual clinical signs and symptoms did not predict relapse.

Clinical bottom line (level 1b)

  1. No individual clinical signs or symptoms could help predict which patients with acute asthma require admission or who were likely to relapse.
Fisch et al: New England Journal of Medicine 1981; 305 (14): 783-789
Expires November 2002

The study

Inception cohort study with objective outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: emergency department, university hospital, USA

205 patients (aged mean 30 years, 67% female) with severe airway obstruction

Excluded if
  • <15 or >45 years old
  • COPD or other lung diseases


    • All patients had terbutaline, epinephrine, oxygen, and iv aminophylline if required. Patients stayed for 12 hours in the emergency department before discharge.

    Multivariate regression analysis was performed on risk factors.

    100% followed for 10 days
    Outcomes studied:
    • clinical signs and symptoms tested:
      • pulse 120 or more
      • respiratory rate 30 or more
      • pulsus paradoxus 18 or more
      • PEFR 120 or less
      • moderate-severe dyspnoea
      • moderate-severe accessory muscle use
      • moderate-severe wheezing

    The evidence


    • No feature was found to be independently predictive of admission or relapse.

    Comments

    1. See CAT asthma_Fisch_81b for clinical prediction rule derived from the information gathered.
    2. No patients received steroids - this has been shown to reduce subsequent relapses in patients.

    Citation

    1. Fisch MA, Pitchenik A, Gardner LB: An index predicting relapse and need for hospitalization in patients with acute bronchial asthma. New England Journal of Medicine 1981; 305 (14): 783-789
    Search Terms: acute asthma in Cochrane
    Contributor: Chris Ball and Clare Wotton, November 2000
    Reviewer: Mitsuhiro Kamei

    Clinical Question.
    Patient acute asthma
    Intervention or Exposure clinical signs or symptoms
    Outcome requiring admission