Article Text

Written action plans for asthma: an evidence-based review of the key components
  1. P G Gibson,
  2. H Powell
  1. Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, NSW, Australia
  1. Correspondence to:
    Dr P G Gibson
    Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, Locked Bag #1, Hunter Region Mail Centre, NSW 2310 Australia; mdpggmail.newcastle.edu.au

Abstract

Background: Written action plans for asthma facilitate the early detection and treatment of an asthma exacerbation. Several versions of action plans have been published but the key components have not been determined. A study was undertaken to determine the impact of individual components of written action plans on asthma health outcomes.

Methods: Randomised controlled trials (n = 26) that evaluated asthma action plans as part of asthma self-management education were identified. Action plans were classified as being individualised and complete if they specified when and how to increase treatment (n = 17), and as incomplete (n = 4) or non-specific (n = 5) if they did not include these instructions.

Results: For individualised complete written action plans the use of 2–4 action points and the use of both inhaled (ICS) and oral (OCS) corticosteroid consistently improved asthma outcomes. Action points based on personal best peak expiratory flow (PEF) consistently improved health outcomes while those based on percentage predicted PEF did not. The efficacy of incomplete action plans was inconclusive because of insufficient data. Non-specific action plans led to improvements in knowledge and symptoms.

Conclusion: Individualised written action plans based on personal best PEF, using 2–4 action points, and recommending both ICS and OCS for treatment of exacerbations consistently improve asthma health outcomes. Other variations appear less beneficial or require further study. These observations provide a guide to the types of variations possible with written action plans, and strongly support the use of individualised complete written action plans.

  • asthma
  • asthma action plan
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    • [View PDF] - 14 Figures
      Figure S1 A comparison of the effects of personal best PEF vs % predicted action points on hospitalisations for asthma
      Figure S2 A comparison of the effects of personal best PEF vs % predicted action points on ER visits for asthma
      Figure S3 A comparison of the effects of personal best PEF vs % predicted action points on days off work for asthma
      Figure S4 A comparison of the effects of personal best PEF vs % predicted action points on PEF (mean) for asthma
      Figure S5 A comparison of the number of action points in written action plans on the outcome of hospitalisations
      Figure S6 A comparison of the number of action points in written action plans on the outcome of ER visits
      Figure S7 A comparison of the number of action points in written action plans on the outcome of PEF (mean)
      Figure S8 A comparison of action plan presentations (traffic light vs other) on the outcome hospitalisations
      Figure S9 A comparison of action plan presentations (traffic light vs other) on the outcome ER visits
      Figure S10 A comparison of action plan presentations (traffic light vs other) on the outcome unscheduled Dr visits
      Figure S11 The efficacy of action plan treatments using ICS and OCS based plans on hospitalisations
      Figure S12 The efficacy of action plan treatments using ICS and OCS based plans on ER Visits
      Figure S13 The efficacy of action plan treatments using ICS and OCS based plans on FEV1 (mean)
      Figure S14 The efficacy of action plan treatments using ICS and OCS based plans on PEF (mean)
    • [View PDF] - Table S1 Outcome comparisons for action points based on % predicted or personal
    • [View PDF] - Table S2 Outcome comparisons for number of action points
    • [View PDF] - Table S3 Outcome comparisons for �traffic light� configuration of action plans
    • [View PDF] - Table S4 Outcome comparisons for corticosteroids

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