A Randomized Trial Comparing Peak Expiratory Flow and Symptom Self-management Plans for Patients with Asthma Attending a Primary Care Clinic

Turner, Mark; Taylor, David; Bennett, Rebecca J.; FitzGerald, J. Mark

doi:10.1164/ajrccm.157.2.9703060

Cited by 148 publications

(91 citation statements)

References 38 publications

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“…The higher proportion of patients possessing a peak flow meter compared with those having a written AMP probably results from free peak flow meters being given out by the hospital specialists. There may also be a perception that the technology of peak flow measurement somehow enhances a patient's ability to manage their asthma better than spending the time to teach patients the importance of their symptoms (Turner et al, 1998) and to develop a written AMP. The AMP is based on measures of severity using either the peak flow rate or a symptom score.…”

Section: Discussionmentioning

confidence: 99%

Outcomes measurement for asthma following acute presentation to an emergency department

Masters¹,

Hall²,

Phillips³

et al. 2001

Aust. Health Review

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The Asthma Management Plan (AMP) This study was designed to evaluate the impact of these two instruments on asthma outcomes one month after presentation to the emergency department. The AMP and CP were both found to have had positive influences on asthma management. However, the study illustrates that there continue to be problems with asthma management, which would be improved by a more consistent use of these instruments.

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Section: Discussionmentioning

confidence: 99%

Outcomes measurement for asthma following acute presentation to an emergency department

Masters¹,

Hall²,

Phillips³

et al. 2001

Aust. Health Review

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show abstract

“…This view is supported by the observation that patients enrolled in a number of the studies were previously taking inhaled corticosteroids and that with regular assessment as a result of the use of a management plan, their inhaled corticosteroid dose was appropriately increased, with a resulting improvement in asthma control [1,7,12].…”

Section: Which Components Of the Plan Contribute To Its Efficacy?mentioning

confidence: 95%

“…Thus, self-management plans can be considered to provide practical guidelines in which the recommendations for acute se- vere and chronic persistent asthma can be brought together within the framework of one system. The basic structure of this standardised prototype plan has been used in most studies which have assessed the efficacy of this form of care [1,[6][7][8][9][10][11][12][13].…”

Section: Standard Prototype Planmentioning

confidence: 99%

“…For example, in the situation of severe asthma requiring oral steroids and medical review, values ranging from 50 to 70% of personal best or predicted peak flow have been recommended [1,[6][7][8][9][10]12,13]. While the use of personal best, rather than predicted peak flow levels is now recognised as preferable for reference values, the absolute percentage levels to be used at each stage remain uncertain [14].…”

Section: Peak Flow Levelsmentioning

confidence: 99%

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The use of the self-management plan system of care in adult asthma

Holt¹,

Masoli

Beasley

2004

Primary Care Respiratory Journal

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KEYWORDS Asthma self-management plans;Asthma action plans; Asthma managementSummary The development of self-management plans arose as clinicians tried to design better methods by which they could deliver asthma care and reduce the significant mortality and morbidity associated with this disease. The basic principles that resulted have been widely endorsed, and self-management plans are now recommended in the long-term management of adult asthma. Self-management plans essentially focus on the early recognition of unstable or deteriorating asthma, by monitoring peak flow or symptoms. Through the use of written guidelines, patients are then able to determine when it is necessary to adjust therapy or obtain medical assistance.There is now convincing evidence that the use of self-management plans by patients with asthma leads to a marked reduction in morbidity and a reduced requirement for acute medical treatment including hospital admissions. Recent research has also clarified many of the different issues concerning their structure and implementation. In some respects the skill in the use of the asthma self-management plan system of care is the ability to modify the standard plans to meet the particular needs of the individual asthmatic patient, including their preferences.

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“…Unfortunately, the individual effects of each of these three components of a comprehensive asthma care program are difficult to separate. The available trials (2)(3)(4)(5)(6)(7)(8)(9) are too small and the results are too inconsistent, with potential biases in patient selection and withdrawals, and problems with data collection and analyses, for any firm conclusions to be made as to the contribution of written self-management plans.…”

mentioning

confidence: 99%

Do Written Self‐Management Plans Improve Asthma Control? The Evidence Is Not Conclusive

Bai

2003

Canadian Respiratory Journal

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T hree components of asthma care have been promulgated by national asthma guidelines: patient education, regular review and written self-management plans. Unfortunately, the individual effects of each of these three components of a comprehensive asthma care program are difficult to separate. The available trials (2-9) are too small and the results are too inconsistent, with potential biases in patient selection and withdrawals, and problems with data collection and analyses, for any firm conclusions to be made as to the contribution of written self-management plans.In the trenches, beyond the world of efficacy studies in academia, the picture is rather bleak: the Asthma in Canada survey (10), involving 1001 randomly selected asthmatic participants, reported that only 19% had received a written action plan. Jin et al (11) surveyed Canadian specialists and family physicians, and found that the majority of the Canadian physicians did not prescribe written action plans. Thus, it is clear that the adoption of written action plans in Canada has been poor. Why do physicians not follow guidelines? Qualitative research shows that action plans are actually unpopular with both patients and health care professionals. Jones et al (12) reported that almost all participants were ambivalent about the usefulness or relevance of written action plans. The variability of design and recommendations of peak flow-based plans reveals an uncertainty as to the correct advice, and many plans are confusing to patients and health professionals who are not experts in asthma care. The Asthma in Canada survey showed that only 11% of asthmatic patients who had an action plan recalled that it contained information on how to deal with a flare-up; clearly these data question the 'real world' effect of written plans. The first step on written plans is increased frequency and dose of inhaled corticosteroids (ICSs). Is this an evidence-based recommendation? The evidence is not overwhelming, and results of good studies have been negative (13). Even in a clinical trial setting, when oral prednisone was indicated according to the plan, patients were adherent only 56% of the time (14).Peak flow plans are also imprecise -peak flow is well known both to underestimate the severity of outflow obstruction and to be relatively insensitive to major changes in the degree of airflow obstruction. Douglass et al (15) reported that some occupational groups are less likely to have selfmanagement plans, presumably reflecting perceived barriers by physicians to implementing plans in these groups. Interestingly, the most likely groups to have action plans were those least likely to need them! Most proponents of written asthma self-management plans propose that they should be targeted to those most at risk. These targeted groups include adolescents and young adults, who often will not or cannot read these plans. Health educators recommend that all printed material for health education be at a readability level of grade 5 or lower; however, not one of the national action ...

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A Randomized Trial Comparing Peak Expiratory Flow and Symptom Self-management Plans for Patients with Asthma Attending a Primary Care Clinic

Cited by 148 publications

References 38 publications

Outcomes measurement for asthma following acute presentation to an emergency department

Outcomes measurement for asthma following acute presentation to an emergency department

The use of the self-management plan system of care in adult asthma

Do Written Self‐Management Plans Improve Asthma Control? The Evidence Is Not Conclusive

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