Rapid Responses to:
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Rapid Responses: Rapid Responses published:
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Action plans for asthma
- S K Agarwal (27 April 2002)
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Problems with generalising the findings
- Clare E Creswell, Hannah E. Steele (4 May 2002)
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Patient Education and Action Plans for Asthma
- S K Agarwal (6 May 2002)
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Action plans lead to better explanation
- Liesl M Osman, J Graham Douglas (9 May 2002)
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S K Agarwal, Head, Department of Chest Diseases, Institute of Medical Sciences, BHU, Varanasi,India
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Despite of the fact that action plans for asthma are a critical component of guidelines for asthma management its use is declining despite strong advocacy for their use and evidence of clinical benefit. Action plans for asthma are considered useful or desirable by many patients with the disease and treating physicians should thus include its use while treating a case of asthma. |
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Clare E Creswell, Stage 4 medical student The Medical School, Newcastle-Upon Tyne, NE2 4HH, Hannah E. Steele
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Dear Editor, Douglass et al’s qualitative study is the first of its kind to investigate the patients’ perspective on the use of action plans in the management of asthma (1). They concluded that most patients with action plans found them useful but modified them according to their perceptions of the disease. We felt, however, that the results must not be applied to asthma sufferers as a whole because their method of patient selection was limited to those presenting to Accident and Emergency. The patient sample was also very small with only 29 patients owning an action plan. Of these 29, 16 patients found their action plans useful, while the other 13 did not use or were not confident in the use of their plans. With these points in mind, we therefore question the strength of the conclusion that ‘most patients found their action plans useful’ (1). In addition, the authors go on to suggest that their results support the idea that asthma education alone in the absence of an action plan is insufficient to improve patient outcomes. However, this contradicts their finding that patients without formal action plans formulated their own ‘plan of action’. While the authors measure asthma severity of subjects at presentation, they do not correlate this information with possession of an action plan or the patient’s views of their plan. This would have been useful information given the spectrum of results in terms of ownership and use of plans. Personally we found the most striking revelation of this study was that over half of patients did not have an action plan given to them by their doctor, despite them being a ‘critical component of guidelines for asthma management’ (2,3). This is an issue which needs to be addressed given that action plans are known to improve patient outcomes and mortality. Yours faithfully Clare Creswell and Hannah Steele Stage 4 Medical Students The Medical School University of Newcastle-upon-Tyne Newcastle-upon-Tyne, NE2 4HH 1 – Douglass, J. et al, ‘A qualitative study of action plans for asthma’, British Medical Journal, 324, 1003 – 1005, 2002 2 – National Asthma Council Australia, ‘Asthma management handbook 2002.’ South Melbourne: NACA, 2002 3 – British Thoracic Society, British Guidelines on Asthma Management. Thorax, 1997; 52 (suppl1):1 – 21S |
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S K Agarwal, Head, Department of Chest Diseases, Institute of Medical Sciences, BHU, Varanasi,India
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Action plans constitute an important part of asthma therapy and is the concept of self-management of the disease, so that the patient initiates changes in therapy, according to the degree of symptoms, â2- agonists use or PEF. It’s very important that if asthma symptoms, or inhaled â2-agonist usage increases or the PEF falls, the amount of anti- inflammatory therapy should be increased according to a predetermined (preferably written) action plan. As an example, if PEF falls to 70% of the expected value, the patient should double the dose of inhaled steroids. If PEF falls to 50% of expected value, a short course of oral steroids is needed. This should be prednisolone/prednisone 30-40 mg orally each morning and given until the PEF comes back to normal, than either continued for 2 further days or tailed off by 5 mg daily. If the PEF falls to 30% of the expected value than urgent medical attention should be sought. It’s very essential for each and every treating physician to provide written action plan to the patient as this reduces asthma admissions and improve overall control of asthma and quality of life. |
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Liesl M Osman, Senior Research Fellow CHEST CLINIC • ABERDEEN ROYAL INFIRMARY • FORESTERHILL ABERDEEN AB25 2ZN, J Graham Douglas
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EDITOR - Douglass et al1 have found that action plans are not as negatively regarded by patients with asthma as has been suggested2. Our results support Douglass’s conclusion. We have recently completed a randomised evaluation of the benefit of a providing an asthma self management plan to adult patients who have been admitted to hospital with acute asthma. Among 280 patients, a postal survey one month after discharge showed that patients who received an action plan were significantly more likely to be satisfied with the explanation of their asthma which they had in hospital.
No patients in the action plan group in our study told us they had an explanation which they didn’t understand, or no explanation, compared to 28 patients in the control group. Providing an action plan entails that health professionals check their patient’s understanding of their treatment regimen. Was your asthma explained while you were in hospital?
Received plan Did not receive plan
N (%) N (%)
Asthma explained clearly 103 (76%) 51 (35%)
Asthma explained enough 5 ( 4%) 38 (26%)
Explained, didn't understand 0 9 ( 6%)
Asthma not explained 0 19 (13%)
No reply to questionnaire 27 (20%) 28 (19%)
Total 135 (100%) 145 (100%)
Chi square 70.6 p<0.001
Although last year Jones et al2 reported that patients in focus groups thought that action plans would not be useful, it would appear from Douglass’ study and our data that patients who have real experience of mutual development of an action plan are likely to find this helpful in increasing their understanding of how to manage their asthma. Liesl M Osman J Graham Douglas Chest Clinic, Aberdeen Royal Infirmary 1. Douglass J, Aroni R, Goemann D. A qualitative study of action plans for asthma. BMJ 2002;324:1003-5. 2. Jones A, Pill R, Adams S. Qualitative study of views of health professionals and patients on guided self management plans for asthma. BMJ 2000;321:1507-10. Conflicting interests: None |
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