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April 25, 1980

Treatment of Asthma-Reply

Author Affiliations

The Memorial Hospital Worcester, Mass

JAMA. 1980;243(16):1630. doi:10.1001/jama.1980.03300420014010

In Reply.—  Dr Salberg is correct in noting that no rigid criteria were used in determining suitability for discharge or admission, although none of our discharged patients were sent home with PEFs of less than 200 L/min. While some studies have used PEF data and response to initial treatment as the basis for prompt decision making regarding admission (235:1337, 1976), and others have attempted to grade asthma based on physical examination,1 we relied on the individual judgment of our investigator-physician with regard to patient discharge or admission.Patients showing satisfactory improvement, both subjectively (improved sense of well-being and less shortness of breath) and objectively (increased respiratory excursion, decreased inspiratory-expiratory ratio, increased peak expiratory flow, and decreased wheezing), were discharged. In general, emergency room treatment was limited to 12 hours, so that patients not well enough to go home at that time were routinely admitted. Patients showing marked refractoriness to