Community-based asthma care: trial of a "credit card" asthma self-management plan

D’Souza, Wendyl; Crane, Julian; Burgess, Carl; Karu, H Te; C, Fox; Harper, Marvin B.; Robson, Bridget; Howden‐Chapman, Philippa; Crossland, Lisa; Woodman, Kate; al, et

doi:10.1183/09031936.94.07071260

Cited by 77 publications

(44 citation statements)

References 7 publications

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“…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%

“…This would suggest that either system of monitoring may be used to enable patients to recognise poor asthma control. However, there is data to indicate that in the situation of an attack of asthma, most patients prefer the use of both the peak flow and symptoms, rather than one means of monitoring their control [9]. This would suggest that patients should be offered both peak flow and symptom-based methods of assessment if feasible.…”

Section: Peak Flow Versus Symptoms (Or Both?)mentioning

confidence: 99%

“…This is illustrated by the series of the studies of the use of the credit card plan, which provides simple management guidelines based on the assessment of asthma severity, printed on a small plastic card the size of a credit card. In these studies the participants expressed a preference that the plan should not be bigger or present more detail, suggesting that complicated plans may not necessarily be suitable for general use [9,18]. Indeed there is a need for the development of simpler plans including two stage plans which provide simple instructions on when the patient should seek urgent medical care in the situation of a severe exacerbation of asthma.…”

Section: Amount Of Detailmentioning

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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Section: Standard Prototype Planmentioning

confidence: 99%

Section: Peak Flow Levelsmentioning

confidence: 99%

Section: Peak Flow Versus Symptoms (Or Both?)mentioning

confidence: 99%

Section: Amount Of Detailmentioning

confidence: 99%

See 2 more Smart Citations

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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“…[1][2][3][4] Prospective monitoring, in association with an asthma action plan, is one of the most important self-management methods and improves outcomes and quality of life of asthmatic patients. [5][6][7] On the other hand, retrospective monitoring allows fine diagnosis assessment and punctual therapy evaluation. [8][9][10][11] However, its application to routine clinical practice poses several still controversial questions: particularly, to whom and exactly when should retrospective monitoring be applied?…”

Section: Introductionmentioning

confidence: 99%

Retrospective Monitoring in the Management of Persistent Asthma

et al. 2011

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BACKGROUND: There is still considerable disagreement on several aspects of monitoring asthma with symptom score and peak expiratory flow (PEF). OBJECTIVE: To investigate patient adherence to a retrospective diary-card monitoring method in patients with poorly controlled persistent asthma, in a clinical management setting; to develop improved methods for fast manual entry data into a computer; and to generate real-time informative graphs of the data. METHODS: In 115 consecutive adult patients we applied a diary-card monitoring method in which the patient records symptom score and PEF. We analyzed the diary cards of 84 patients. We used SigmaPlot software to graph the data, and linear regression to analyze the relationship between days of expected diary-card completion and days of actual correct diary-card completion (completed entries). RE-SULTS: Linear regression gave an overall correlation coefficient (r 2 ) of 0.65. Surprisingly, the r 2 values in the patients with mild, moderate, and severe asthma were 0.24, 0.44, and 0.99, respectively, revealing a striking correlation between adherence and severity. Moreover, when we arbitrarily set 75% as the minimum acceptable rate of days of completed diary-card entries, 68% of the patients were in the over-75% category. Remarkably, 100% of the patients with severe asthma were above the 75% cut-off. The graphing method we tested proved user-friendly, flexible, and quick, allowing computerized processing of 30 days of data sets in 5 min, and generation of high-quality selfexplanatory graphs that facilitate rapid management decision making via visual pattern recognition. CONCLUSIONS: In a clinical setting, retrospective monitoring of patients with moderate and severe persistent asthma by symptom score and PEF is feasible, and patient adherence appears to be good, particularly in patients with severe asthma. We recommend a lower priority on retrospective monitoring in patients with mild persistent asthma. Monitoring should be carried out according to a definite follow-up protocol. Improving the quality and standardization of the monitoring graph is a priority.

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Periodic Treatment Regimens With Inhaled Steroids in Asthma or Chronic Obstructive Pulmonary Disease

Schayck¹,

Broek²,

Otter³

et al. 1995

JAMA

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Objective.\p=m-\To determine whether inhaled corticosteroids can be discontinued in the stable phase of asthma or chronic obstructive pulmonary disease (COPD) or if this therapy should be continued.Design.\p=m-\Nonrandomizedopen uncontrolled 5-year trial. Setting.\p=m-\Prospectivestudy in general practice.Patients.\p=m-\Forty-eightpatients with steroid-dependent asthma or COPD who had shown a decline in forced expiratory volume in 1 second (FEV1) of at least 80 mL per year and at least one exacerbation per year during the first 2 years of bronchodilator treatment. Subjects were treated additionally with inhaled steroids for another 2 years and were finally given the option to stop using steroids. Sixteen patients were willing to stop using beclomethasone and were studied for another year. No recruitment bias took place in this consecutive sample in the fifth year of follow-up. Two of 16 patients developed carcinomas and dropped out.Interventions.\p=m-\Two years of bronchodilator treatment alone (400 \ g=m\ g of salbutamol or 40 \g=m\g of ipratropium bromide four times daily), followed by 2 years of additional inhaled corticosteroid treatment (400 \g=m\g of beclomethasone two times daily), and finally 1 year of bronchodilator treatment alone. Main Outcome Measures.\p=m-\Declinein lung function (FEV1), change in bronchial hyperresponsiveness, indicated by a provocative concentration of histamine causing a 20% fall in FEV1 (PC20), morning peak expiratory flow rate (PEFR), diurnal PEFR, week-to-week variation of PEFR, bronchial symptoms, and exacerbations.Results.\p=m-\Thecourse of FEV1 during the year in which beclomethasone was discontinued was not significantly different when compared with the 2-year period of beclomethasone treatment. Neither did the course of PC20, morning PEFR, diurnal PEFR, symptom score, and exacerbation rate change. Only the week-to\x=req-\ week variation of the PEFR increased after discontinuing steroids.Conclusions.\p=m-\Discontinuing inhaled steroids is possible in some patients with asthma or COPD after 2 years of regular treatment. This might indicate that for certain groups of patients with mild asthma or COPD, periodic treatment schedules with inhaled steroids is the treatment policy for the future.

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Community-based asthma care: trial of a "credit card" asthma self-management plan

Cited by 77 publications

References 7 publications

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

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

Retrospective Monitoring in the Management of Persistent Asthma

Periodic Treatment Regimens With Inhaled Steroids in Asthma or Chronic Obstructive Pulmonary Disease

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