Administration of Bronchodilators Based on Astma score

The administration of bronchodilators for acute asthma is based on serial assessments of the patient’s respiratory status. In daily practice, this may result in variability and/or delay in the decision-making process to wean or intensify bronchodilator administration. We aim to improve the quality of care by standardizing inpatient asthma care and reduce the length of stay. We developed an asthma score that does not require auscultation of the lungs. This innovative asthma score was adapted from the physical findings in pediatric asthma scores validated previously. We recently demonstrated that this childhood asthma score (CAS) could accurately predict the bronchodilator nebulization requirement compared to the routine clinical judgment of the attending physician to administer bronchodilators. Subsequently, we conducted a study to implement a nurse-driven clinical pathway based on our innovative asthma score. This pathway included standardized respiratory assessments and a protocol for the nursing staff to administer bronchodilators without a specific order from the physician. Length of stay was significantly reduced compared to the historical standard practice. Patient safety was not compromised.
The results of our previous study encourage us to further evaluate and adapt the pathway for patients who need supplemental oxygen. In this randomised study, length of stay and safety for patients who need supplemental oxygen treated according to the current pathway will be compared to a pathway with adjusted treatment thresholds.

A clinical pathway with adjusted treatment thresholds for patients who need supplemental oxygen will reduce the number of unnecessary bronchodilator administrations.

Length of hospital admission will be determined by obtaining date and time of admission and discharge from the electronic record form
Asthma scores are calculated by a validated Excel software algorithm and automatically registered in an Excel database.
All relevant data for the secondary outcomes will be obtained from the electronic record form one week after discharge to be able to register readmissions for acute asthma

The intervention comprises adjusted treatment thresholds for patients with acute asthma who need supplemental oxygen.