Asthma control and action plans

Abstract

KOURI et al. [1] in Canada have developed a tool to guide completion of asthma action plans (AAPs). In their rationale, they suggest that "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)". The authors "reviewed recent asthma guidelines and adult studies addressing acute loss of asthma control" and "developed evidence-based rules for yellow zone therapy and operational guidelines to maximise adherence and minimise errors". There is a substantial inherent flaw in this study, both in its rationale and methodology. The authors suggested that completing yellow-zone instructions equates with advice regarding how to intensify therapy for acute loss of control.

Home Management of Childhood Asthma Exacerbations

“…This AAP is a non-generic plan and is customized to a patient's specific situation. However, like other Canadian AAPs, the ICAN AAP combines instructions for the management of acute exacerbations with advice for the general management of asthma, which can be confusing [18]. Adding the concept of asthma control to the Canadian AAP and thus placing the responsibility of assessing control on caregivers may cause considerable confusion in caregivers during acute exacerbations [12].…”

“…Similar precise actions are recommended by the British Thoracic Society (where a public health system similar to Canada exists) and by Australian Guidelines [19,20]. In contrast, the Canadian AAPs focus on ''control'' issues and may not achieve the intended purpose of an action plan, which is to provide guidance for treating acute transient exacerbations [12,18]. A review of caregiver's understanding and their use of AAP for home management combined with clear AAP instructions [21] is crucial to ensure adequate knowledge and skill for home management.…”