Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?

Abstract

Rationale: Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.Objectives: To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.Methods: A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians.Measurements and Main Results: Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P , 0.0001], nocturnal symptoms [P , 0.0001], b-agonist use [P , 0.0001]). There was also a significant reduction in emergency visits for the intervention (P , 0.0001) and control (P , 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P , 0.0001) and pediatric caregivers (P , 0.0001).Conclusions: Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialtybased medical care and education for asthma.Clinical trial registered with www.clinicaltrials.gov (NCT 00149461).

Physician Perspectives on the Burden and Management of Asthma in Six Countries: The Global Asthma Physician Survey (GAPS)

“…In terms of management, the low use of written management plans reported in this study, despite their recommendation in guidelines, is consistent with previous findings [32]. This may reflect the debate about the extent of the benefits of written management plans [35] since these benefits were first presented in 2004 [36]. The proportion of physicians employing written plans in Germany recorded in our study (37%) is lower than published data from the German Disease Management Programme (DMP) evaluation would suggest [37].…”

The effectiveness of newly developed written asthma action plan in improvement of asthma outcome in children

“…[5][6][7][8] Only one study in 2005 by Agrawal et al showed that adding WAAP can improve asthma outcome when compared with controlled group. 4 Noticeably both Agrawal et al and our study, all of the children applied the peak flow-based asthma action plan but other studies partially applied symptom-based asthma action plan.…”

Predicting and reducing risk of exacerbations in children with asthma in the primary care setting: current perspectives

“…A now rather old Cochrane review (published in 2006) concluded that symptom-based WAPs were more effective in reducing exacerbations compared to peak flow-based WAP;32 a trial published in 2004 demonstrated that peak flow monitoring was not effective in preventing attacks in children33 and peak flow monitoring is not routinely recommended for pediatric asthma management. A recent randomized control trial undertaken in “subspecialty” practice in the US recruited adults and children and found no benefit of a WAP over no written instructions;34 it seems that the benefit from a WAP arises from more than simply having a handheld document to refer to when symptoms increase.…”