Written action plans for asthma: an evidence-based review of the key components

Gibson, Peter G.; Powell, Heather

doi:10.1136/thorax.2003.011858

Cited by 378 publications

(343 citation statements)

References 42 publications

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“…Provision of written asthma action plans may not be considered a high priority by GPs, 16 despite being generally welcomed by patients. 12 Despite evidence that including instructions on the use of inhaled and oral steroids in asthma action plans improves morbidity, 17 only a quarter had an emergency supply of steroid tablets. There is a need to explore further this limited use.…”

Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Do practices comply with key recommendations of the British Asthma Guideline? If not, why not?

Wiener-Ogilvie

Pinnock

Huby

et al. 2007

Primary Care Respiratory Journal

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Aims: Amongst general practices in the NHS Borders region of Scotland, we aimed to determine compliance with the three key recommendations of the British Guideline for the Management of Asthma and to understand the nature of barriers and facilitators to their implementation.Methods: Using piloted audit tools, a researcher extracted data from computerised and/or paper patient medical records to assess compliance with recommendations for objective diagnosis and stepwise management. Provision of asthma action plans was assessed by patient survey. Clinicians' attitude to guidelines was assessed by postal survey.Results: Fifteen of the 24 practices in the NHS Borders region participated. Audited compliance with the three key recommendations varied markedly amongst and within practices. Whilst 367/547 (67%) of patients were treated appropriately with add-on therapy, only 58/254 (23%) of patients reported having been given an asthma action plan. Barriers to implementation identified by the clinicians' survey (response rate 64/84 -76%) were theoretical (doubt about the evidence base and relevance to primary care, lack of knowledge and skills, misconceptions) as well as practical (lack of time and resources) and were exacerbated by poor teamwork. Facilitators were good teamwork and appropriate organisation of work within the practice.Conclusions: Implementation of key recommendations was variable, particularly in the more complex intervention of issuing asthma action plans. An intervention to enhance compliance with these guideline recommendations will need to address both theoretical and practical barriers within the context of improved teamwork.

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Section: Interpretation Of Findings In Relation To Previously Publishmentioning

confidence: 99%

Do practices comply with key recommendations of the British Asthma Guideline? If not, why not?

Wiener-Ogilvie

Pinnock

Huby

et al. 2007

Primary Care Respiratory Journal

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“…Such diaries are web-based (personalized) diaries that provide patients a space to produce personal health information and share similar attributes with self-management action plans (for example, helping patients develop goal setting with an individual treatment plan), but may also offer other functions (such as an e-consult). 7 Although webbased diaries have existed a long time, developments in web technologies (primarily the development of blogging platforms 8 ) have made them easier to use, broadening the scope of the target group for whom they may be beneficial.…”

Section: Introductionmentioning

confidence: 99%

Use of Online Self-Management Diaries in Asthma and COPD: A Qualitative Study of Subjects' and Professionals' Perceptions and Behaviors

et al. 2015

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BACKGROUND: Online self-management diaries are used to support patients' self-management skills and facilitate associated behavioral changes. Although web-based diaries are well-known as a potential self-management tool, reasons that patients use (or do not use) self-management diaries, as well as perceptions and behaviors related to diary use, remain largely unknown. METHODS: Semistructured interviews (n ‫؍‬ 30) were conducted with health-care professionals and subjects to understand perceptions and behaviors related to self-management diary use for asthma and COPD in 2 hospitals in Rotterdam, The Netherlands. RESULTS: Subjects in this study used self-management diaries to improve their knowledge of the disease, cope more consciously with their disease, feel in control, and discuss outcomes from the self-management diaries with their health-care professionals. Two subjects reported that they used the self-management diary to cope more effectively with their disease and recognized an exacerbation and acted by adjusting their medications. Both health-care professionals and subjects experienced practical barriers in integrating self-management diaries into their regular practices. Subjects' reasons for nonuse were related to the intervention, the disease, and subject-provider contact. CONCLUSIONS: Health-care professionals should help patients use self-management diaries by collaboratively developing an individual treatment plan and by showing patients how to use the diaries to recognize and act on an exacerbation. Together with the suggestions made for improving the self-management diaries, this will aid in the integration of self-management diaries into regular health-care practice and enhance patients' self-management of their disease.

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“…If symptoms persist for more than a few minutes, an additional inhalation should be taken. These instructions should be discussed with patients and, where possible, it is recommended that a personalized written action plan is also provided, as advocated with other asthma management approaches (76). As discussed earlier, budesonide/formoterol 80/4.5 and 160/4.5 lg pMDIs are approved for use in some countries, including the USA, as fixed-dose therapy for asthma.…”

Section: Practical Considerations For Physicians Using Budesonide/ Fomentioning

confidence: 99%

Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthma

Humbert

Andersson

Buhl³

2008

Allergy

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The Global Initiative for Asthma (GINA) guidelines aim at improving asthma control and preventing future risk. For patients with moderate to severe asthma an inhaled corticosteroid (ICS) or an ICS/long‐acting β2‐agonist (LABA) combination with a short‐acting β2‐agonist (SABA) as reliever is recommended. Despite the availability of effective maintenance therapies, a large proportion of patients still fail to achieve guideline‐defined asthma control, and overuse of SABA reliever medication at the expense of ICS is commonly observed. New simplified treatment approaches may offer a solution and assist physicians to achieve overall asthma control. One such treatment approach, which is recommended in the GINA guidelines, is budesonide/formoterol for both maintenance and reliever therapy. This treatment strategy significantly reduces the rate of severe asthma exacerbations compared with ICS/LABA plus SABA and achieves equivalent daily symptom control compared with higher doses of ICS/LABA plus separate SABA for relief. These benefits are achieved at a lower overall steroid load, and budesonide/formoterol maintenance and reliever therapy is well tolerated in patients with moderate to severe asthma. This review discusses current asthma management in patients with moderate to severe disease and examines the evidence for alternative asthma management approaches.

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Written action plans for asthma: an evidence-based review of the key components

Cited by 378 publications

References 42 publications

Do practices comply with key recommendations of the British Asthma Guideline? If not, why not?

Do practices comply with key recommendations of the British Asthma Guideline? If not, why not?

Use of Online Self-Management Diaries in Asthma and COPD: A Qualitative Study of Subjects' and Professionals' Perceptions and Behaviors

Budesonide/formoterol for maintenance and reliever therapy in the management of moderate to severe asthma

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