An evidence-based, point-of-care tool to guide completion of asthma action plans in practice

Abstract

Asthma action plans (AAPs) reduce healthcare utilisation, improve quality of life and are recommended across guidelines. However, fewer than 25% of patients receive an AAP, partly due to prescribers' inability to complete “yellow zone” instructions (how to intensify therapy for acute loss of control). We sought to review best evidence to develop a practical, evidence-based tool to facilitate yellow zone guidance in adults.We reviewed recent asthma guidelines and adult studies addressing acute loss of asthma control (January 2010 to March 2016). We developed evidence-based rules for yellow zone therapy and operational guidelines to maximise adherence and minimise errors.We reviewed three guidelines and 11 manuscripts (2486 abstracts screened). Recommendations were comparable but some areas lacked guidance. For 15/43 asthma regimens, the commonly recommended four- to five-fold yellow zone inhaled corticosteroid dose increase was problematic due to regulatory dose limits. We identified evidence-based alternatives for 8/15 regimens. Operational guidance included increasing to a maximum of four inhalations while maintaining baseline inhaler frequency and device in the yellow zone.We developed a practical implementation tool to facilitate AAP delivery at the point of care, addressing existing gaps and uncertainties. Our tool should be implemented as part of a multifaceted approach to augment AAP usage.

Realising the potential of mHealth to improve asthma and allergy care: how to shape the future

“…KOURI et al [6] did not use ICT tools but should benefit from them. Although the authors overestimate the prevalence of uncontrolled asthma, their paper is of great clinical relevance.…”

“…mHealth may be of importance although patients may not be very interested in identifying loss of control, as found by SIMPSON et al [5] in this issue. KOURI et al [6] reviewed the best evidence from recent asthma guidelines [40][41][42] and adult studies addressing acute loss of asthma control ( January 2010 to March 2016). Recommendations were comparable across guidelines but some areas lacked guidance.…”

“…Two papers published in this issue of the European Respiratory Journal (ERJ) refer to the potential use of mHealth in asthma. One paper focusses on the patient and the healthcare professional's experience [5], and the second proposes a non-ICT developed algorithm to manage asthma [6]. This algorithm will be difficult to implement without an ICT solution.…”

Tactics of primary care physician in the management of patients with asthma in accordance with the latest changes in international and national guidelines

“…Для лучшего понимания эти ситуации имеют соответствующее цветовое обозначение (цвета светофора): зеленый, желтый и красный. Эффективность этой рекомендации подтверждается в систематических обзорах, метаанализах [31][32][33][34]. Использование пациентами плана действия по лечению астмы улучшает качество жизни, уменьшает симптомы и количество госпитализаций и вызовов скорой помощи.…”

Asthma control and action plans

“…Thus, in sharp contrast to AAPs, asthma control is a retrospective assessment and is healthcare provider oriented. KOURI et al [1] appear to represent the relatively recent Canadian approach, which unfortunately includes the control concept within the AAP. Consequently, there is a substantial difference in the advice that may be given to caregivers as to how to respond to an acute exacerbation using the AAP yellow-zone instructions.…”