患者在出院前应收到书面的哮喘管理计划和宣教。 书面的哮喘行动计划已经证明有较好的改善哮喘结局的作用。[114]Wolf FM, Guevara JP, Grum CM, et al. Educational interventions for asthma in children. Cochrane Database Syst Rev. 2002;(4):CD000326.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000326/fullhttp://www.ncbi.nlm.nih.gov/pubmed/12535395?tool=bestpractice.com[115]Ducharme FM, Zemek RL, Chalut D, et al. Written action plan in pediatric emergency room improves asthma prescribing, adherence, and control. Am J Respir Crit Care Med. 2011;183:195-203.http://www.atsjournals.org/doi/full/10.1164/rccm.201001-0115OChttp://www.ncbi.nlm.nih.gov/pubmed/20802165?tool=bestpractice.com 基于症状的计划优于呼气峰流速为基础的计划。[116]Cano-Garcinuno A, Diaz-Vazquez C, Carvajal-Uruena I, et al. Group education on asthma for children and caregivers: a randomized, controlled trial addressing effects on morbidity and quality of life. J Investig Allergol Clin Immunol. 2007;17:216-226.http://www.ncbi.nlm.nih.gov/pubmed/17694693?tool=bestpractice.com[117]Zemek RL, Bhogal SK, Ducharme FM. Systematic review of randomized controlled trials examining written action plans in children: what is the plan? Arch Pediatr Adolesc Med. 2008;162:157-163.http://jamanetwork.com/journals/jamapediatrics/fullarticle/379087http://www.ncbi.nlm.nih.gov/pubmed/18250241?tool=bestpractice.com 书面管理计划应包括针对目前发作的合理的减药计划，同时对于未来的发作应提供合理的处理建议，包括气管舒张剂的使用以及何时应再就诊。需要考虑是正规吸入糖皮质激素还是改换为预防性治疗方案。文化问题也应该考虑在内。[118]Chang AB, Taylor B, Masters IB, et al. Indigenous healthcare worker involvement for indigenous adults and children with asthma. Cochrane Database Syst Rev. 2010;(5):CD006344.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD006344.pub3/fullhttp://www.ncbi.nlm.nih.gov/pubmed/20464742?tool=bestpractice.com 一项研究表明，父母导师可降低少数儿童哮喘发作的机率。[119]Flores G, Bridon C, Torres S, et al. Improving asthma outcomes in minority children: a randomized, controlled trial of parent mentors. Pediatrics. 2009;124:1522-1532.http://www.ncbi.nlm.nih.gov/pubmed/19948624?tool=bestpractice.com
宣教是哮喘管理的一个重要组成部分。 尽管对急诊就诊的患儿和其照顾者的宣教可降低将来急诊的再就诊率、住院率和非计划的随访率，但这种程度的改善在荟萃分析中并未得到印证。[120]Boyd M, Lasserson TJ, McKean MC, et al. Interventions for educating children who are at risk of asthma-related emergency department attendance. Cochrane Database Syst Rev. 2009;(2):CD001290.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD001290.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/19370563?tool=bestpractice.com[121]Bravata DM, Gienger AL, Holty JE, et al. Quality improvement strategies for children with asthma: a systematic review. Arch Pediatr Adolesc Med. 2009;163:572-581.http://jamanetwork.com/journals/jamapediatrics/fullarticle/381649http://www.ncbi.nlm.nih.gov/pubmed/19487615?tool=bestpractice.com[122]Coffman JM, Cabana MD, Halpin HA, et al. Effects of asthma education on children's use of acute care services: a meta-analysis. Pediatrics. 2008;121:575-586.http://www.ncbi.nlm.nih.gov/pubmed/18310208?tool=bestpractice.com 宣教内容应包括：潜在病理生理的探讨、对缓解和预防性药物作用的解释、坚持治疗的重要性以及患者或父母用药方式的评估。[123]Lavorini F, Magnan A, Dubus JC, et al. Effect of incorrect use of dry powder inhalers on management of patients with asthma and COPD. Respir Med. 2008;102:593-604.http://www.ncbi.nlm.nih.gov/pubmed/18083019?tool=bestpractice.com 尚无能力单独掌握恰当吸入器使用技术的幼童应使用储雾罐。
[Figure caption and citation for the preceding image starts]: 儿童演示利用大容量的储雾罐使用定量吸入气雾剂来自 Anne Chang 教授的个人资料 [Citation ends]. 应鼓励那些有严重哮喘发作史的患儿在将来加重过程中尽早就诊。 药剂师等其他医疗工作者参与宣教可能有益。[124]Benavides S, Rodriguez JC, Maniscalco-Feichtl M. Pharmacist involvement in improving asthma outcomes in various healthcare settings: 1997 to present. Ann Pharmacother. 2009;43:85-97.http://www.ncbi.nlm.nih.gov/pubmed/19109213?tool=bestpractice.com
父母给予的口服糖皮质激素的起始剂量对于一些患者可能适合，但仍需要临床研究进一步证实。 然而到目前为止，无论学龄期儿童[52]Vuillermin P, South M, Robertson C. Parent-initiated oral corticosteroid therapy for intermittent wheezing illnesses in children. Cochrane Database Syst Rev. 2006;(3):CD005311.http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD005311.pub2/fullhttp://www.ncbi.nlm.nih.gov/pubmed/16856091?tool=bestpractice.com[125]Vuillermin PJ, Robertson CF, Carlin JB, et al. Parent initiated prednisolone for acute asthma in children of school age: randomised controlled crossover trial. BMJ. 2010;340:c843.http://www.bmj.com/content/340/bmj.c843http://www.ncbi.nlm.nih.gov/pubmed/20194353?tool=bestpractice.com 还是学龄前儿童（包括频繁的病毒诱导的喘息发作），没有研究能证实该方法有益。[126]Oommen A, Lambert PC, Grigg J. Efficacy of a short course of parent-initiated oral prednisolone for viral wheeze in children aged 1-5 years: randomised controlled trial. Lancet. 2003;362:1433-1438.http://www.ncbi.nlm.nih.gov/pubmed/14602435?tool=bestpractice.com
在出院前应安排好出院后 1 周内的内科复查，而且可以考虑转诊至儿童呼吸道专科医师处。一些国际指南建议采用更短的内科复查时间范围（例如，英国胸科协会和苏格兰校际指南网络 [BTS/SIGN] 指南规定在 48 小时内接受家庭医师随访）。[29]British Thoracic Society/Scottish Intercollegiate Guidelines Network. SIGN 153: British guideline on the management of asthma. A national clinical guideline. September 2016 [internet publication].http://www.sign.ac.uk/sign-153-british-guideline-on-the-management-of-asthma.html
