Do Written Asthma Action Plans Improve Outcomes?
John M. Kelso, MD
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4851179/pdf/ped.2016.0634.pdfI'd be interested in seeing some allergists/pulmos comment on this. From a patient perspective, my opinion is that all asthma patients should be given an asthma action plan.
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PUBLIC RELEASE: 13-MAY-2016
Is a written asthma action plan for children necessary?
MARY ANN LIEBERT, INC./GENETIC ENGINEERING NEWS
http://www.eurekalert.org/pub_releases/2016-05/mali-iaw051316.phpJohn M. Kelso, MD, Scripps Clinic (San Diego, CA), states that an asthma action plan is essentially the same for all children--use albuterol for symptoms and call if it is not helping--and can be conveyed orally to parents and caregivers in the home and school settings.
My dd has been managed by many docs over the years & I can say with certainty that the plans have not been the same. For instance, she currently has 3 different inhalers with very specific use instructions (1 is an additional controller to be added in yellow zone) ... she has a pill ... she has related GERD instructions ... she has pretreat before exercise instruction ... symptom severity explanation and instructions ... little things like rinsing the mouth after meds & the doc and I used shared decision making to add food allergy instructions in the asthma plan comment section to address the risk of anaphylaxis being mistaken for asthma. My plan is unique & customized to my dd ... there is no way that I would not want this written out in a formal plan. My dh & other caregivers are not usually with me at appointments to receive asthma education ... having a written plan lets me bring them up to speed very quickly.
When dd was 1st diagnosed and was not yet managed by a pulmo, I was not given a plan ... yet I basically wrote one out for myself in my sloppy handwriting after listening to the doc ... the asthma education given to me at that time, I do not think, was so good & we had lots of urgent care / ER visits.
For school, our asthma plan has doc approval that dd is able & allowed to self-carry and self-admin her asthma meds ... I'd have to verify, but I believe that state law comes into play regarding this issue requiring a doc's signature.
Oh my gosh, this issue is so complicated ... I hope that docs don't stop giving their patients asthma action plans.
ETA - So many things to consider ...
Patients are given so many papers at doc appointments. Were they just handed the plan ... or was it stressed that they should put it somewhere like the fridge where it can be seen every day, put a copy in your purse, etc ... was it stressed that this plan was important? There are so many plan formats ... some might work better than others ... I think, this would have to be studied in depth before making the suggestion to ditch asthma plans altogether. You know I have a thing for forms ... it would be my pleasure to help design better asthma plans that would better meet patient needs ... just sayin.
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"A Low-Literacy Asthma Action Plan to Improve Provider Asthma Counseling: A Randomized Study"
H. Shonna Yin, Ruchi S. Gupta, Suzy Tomopoulos, Alan L. Mendelsohn, Maureen Egan, Linda van Schaick, Michael S. Wolf, Dayana C. Sanchez, Christopher Warren, Karen Encalada, Benard P. Dreyer
http://pediatrics.aappublications.org/content/early/2015/11/30/peds.2015-0468Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P < .001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1–123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P < .001; OR = 6.7; 95% CI, 2.9–15.8), address need for daily medications when sick (93.4% vs 34.5%, P < .001; OR = 27.1; 95% CI, 8.6–85.4), use explicit symptoms (eg, “ribs show when breathing,” 54.1% vs 3.4%, P < .001; OR = 33.0; 95% CI, 7.4–147.5).
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Re: Standard Protocol for "Asthma Action Plans"&
Re: Standard Protocol for "Asthma Action Plans"---
The ‘vicious cycle’ of personalised asthma action plan implementation in primary care: a qualitative study of patients and health professionals’ views
http://bmcfampract.biomedcentral.com/articles/10.1186/s12875-015-0352-4Professionals infrequently review/update PAAPs with patients; patients with out-dated PAAPs do not value or use these; professionals observing patients’ lack of interest in PAAPs do not discuss these. Patients observing this do not refer to their plans and perceive them to be of little value in asthma self-management.
Breaking this vicious cycle to create a healthcare context more conducive to PAAP implementation requires a whole systems approach with multi-faceted interventions addressing patient, professional and organisational barriers.
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http://www.cdc.gov/asthma/actionplan.htmlAll people with asthma should have an asthma action plan. An asthma action plan (also called a management plan) is a written plan that you develop with your doctor to help control your asthma.