Current situation
The ultimate goal for the management of asthma is to help patients lead a normal life, free from symptoms and with no limitations on activities.
The British Thoracic Society guidelines indicate the importance of management plans in asthma control.
A combination of education, review by health practitioners, and a written self-management plan improve outcomes.
Patients with asthma should be trained to manage their own treatment by using personal asthma action plans (PAAPs).
What is the evidence?
A written PAAP aids detection of deteriorating control and suggests appropriate drug treatment. They must be devised on an individual basis, formulated according to personal best peak expiratory flow, symptoms, or both (Thorax 2004: 59: 94).
A systematic review has concluded that symptom-based action plans are superior to peak flow action plans for preventing acute care visits for children with asthma (Coch-rane Database Syst Rev 2006; 3: CD005306).
Mobile telephones have been used to report symptoms and obtain feedback on the appropriate action (J Telemed Telecare 2005; 11: 43).
A recent trial showed that children receiving an individualised written home-management plan had fewer acute asthma events, fewer lost school days, lower symptom score and less nocturnal awakening than those who did not receive one (Acta Paediatr 2005; 94: 1,742).
Implications for practice
Asthma reviews should be an opportunity for patients to be given a written action plan.
Further advances in monitoring may come through technology. Using portable digital assistants can prompt assessment such as peak flow and administration of routine therapy as well as storing and supplying management plans (BMJ 2006; 332: 767)
There may be a role for telephone consultations to imp-rove the control of asthma in primary care. Using telephone consultations in one study lead to a surprisingly high satisfaction — 88 per cent of patients expressed a strong preference for telephone consultations (BJGP 2005; 55: 918).
Written action plans for patients should include peak expiratory flow based on personal best values and not predicted values.
The plans should cover two to four levels of intervention in terms of symptoms or lung function, and advice as to when to use oral corticosteroids.
Useful websites
www.gpiag.org — General Practice Airways Group
www.brit-thoracic.org.uk — British Thoracic Society
www.asthma.org.uk — National Asthma Campaign
Dr Louise Newson is a GP in the West Midlands and author of ‘Hot Topics for MRCGP and General Practitioners’, Pas Test 2006
Key points
Many patients with asthma are still not adequately controlled.
PAAPs can improve health outcomes.
Patients should be central to their management.
Action plans are also beneficial for children.
