A 29 y/o female with NIDDM and poorly controlled chronic asthma present s with 3days of sob and wheezing typical of her prior asthma exacerbations. After two nebulizer treatments and dose of corticosteroids her PEFR is measured at 55% of predicted. Should she be admitted?
PEFR is not going to make this decision for you.
PEFR monitoring has not been shown to reliably predict need for admissions among patients who, or relapse from outpatient treatment.
Using specific PEFR cut offs for admission have led to increased admission rates without improving outcome measures.
Severely diminished PEFR (e.g. <100ml/min) post treatment have been shown to require inpatient treatment, but these are not patients in which the admission decision is otherwise in question.
ACEP recommends PEFR to assess treatment progress in particular patients per clinician judgment in the ED setting, but not as a requirement for evaluating all asthma patients or as admission criteria.
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