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Randomized Controlled Trial
. 2015 Jun 15;191(12):1374-83.
doi: 10.1164/rccm.201407-1338OC.

Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?

Beverley J Sheares  1 , Robert B Mellins  1 , Emily Dimango  2 , Denise Serebrisky  3 , Yuan Zhang  4 , Michael R Bye  1 , Mark E Dovey  5 , Sami Nachman  6 , Vincent Hutchinson  7 , David Evans  1   8
Affiliations
Randomized Controlled Trial

Do Patients of Subspecialist Physicians Benefit from Written Asthma Action Plans?

Beverley J Sheares et al. Am J Respir Crit Care Med. .

Abstract

Rationale: Asthma clinical guidelines suggest written asthma action plans are essential for improving self-management and outcomes.

Objectives: To assess the efficacy of written instructions in the form of a written asthma action plan provided by subspecialist physicians as part of usual asthma care during office visits.

Methods: A total of 407 children and adults with persistent asthma receiving first-time care in pulmonary and allergy practices at 4 urban medical centers were randomized to receive either written instructions (n = 204) or no written instructions other than prescriptions (n = 203) from physicians.

Measurements and main results: Using written asthma action plan forms as a vehicle for providing self-management instructions did not have a significant effect on any of the primary outcomes: (1) asthma symptom frequency, (2) emergency visits, or (3) asthma quality of life from baseline to 12-month follow-up. Both groups showed similar and significant reductions in asthma symptom frequency (daytime symptoms [P < 0.0001], nocturnal symptoms [P < 0.0001], β-agonist use [P < 0.0001]). There was also a significant reduction in emergency visits for the intervention (P < 0.0001) and control (P < 0.0006) groups. There was significant improvement in asthma quality-of-life scores for adults (P < 0.0001) and pediatric caregivers (P < 0.0001).

Conclusions: Our results suggest that using a written asthma action plan form as a vehicle for providing asthma management instructions to patients with persistent asthma who are receiving subspecialty care for the first time confers no added benefit beyond subspecialty-based medical care and education for asthma. Clinical trial registered with www.clinicaltrials.gov (NCT 00149461).

Trial registration: ClinicalTrials.gov NCT00149461.

Keywords: action plans; asthma; minority; physicians; self-management.

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Figures

Figure 1.
Figure 1.
Written asthma action plan form.
Figure 2.
Figure 2.
Participant flow for written asthma action plan (WAAP) study.
Figure 3.
Figure 3.
(A) Daytime asthma symptom frequency (baseline through 12 mo); shown are the reductions in daytime symptoms for each group (P < 0.0001). (B) Nocturnal asthma symptom frequency (baseline through 12 mo); shown are the reductions in nocturnal symptoms for each group (P < 0.0001). (C) Frequency of β-agonist use (baseline through 12 mo); shown are the reductions in β-agonist use for each group (P < 0.0001). WAAP = written asthma action plan.
Figure 4.
Figure 4.
Emergency department visits for asthma (baseline through 12 mo). Shown are the reductions in emergency department visits for the written asthma action plan (WAAP) group (P < 0.0001) and for the control group (P = 0.0006).
Figure 5.
Figure 5.
Hospitalizations (baseline through 12 mo). Shown are the reductions in hospitalizations for asthma for each group (P = 0.9).
Figure 6.
Figure 6.
Days with activity limitations (baseline through 12 mo). Reduction in days with activity limitation due to asthma for written asthma action plan (WAAP) group, P < 0.0005; for control group, P < 0.0001.
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References

    1. National Asthma Education Prevention Program. Expert panel report 3 (EPR-3): guidelines for the diagnosis and management of asthma—summary report 2007. J Allergy Clin Immunol. 2007;120(5 Suppl):S94–S138. [Published erratum appears in J Allergy Clin Immunol 2008;121:1330.] - PubMed
    1. Bateman ED, Hurd SS, Barnes PJ, Bousquet J, Drazen JM, FitzGerald M, Gibson P, Ohta K, O’Byrne P, Pedersen SE, et al. Global strategy for asthma management and prevention: GINA executive summary. Eur Respir J. 2008;31:143–178. - PubMed
    1. Lougheed MD, Lemière C, Dell SD, Ducharme FM, Fitzgerald JM, Leigh R, Licskai C, Rowe BH, Bowie D, Becker A, et al. Canadian Thoracic Society Asthma Committee. Canadian Thoracic Society Asthma Management Continuum—2010 Consensus Summary for children six years of age and over, and adults. Can Respir J. 2010;17:15–24. - PMC - PubMed
    1. Lefevre F, Piper M, Weiss K, Mark D, Clark N, Aronson N. Do written action plans improve patient outcomes in asthma? An evidence-based analysis. J Fam Pract. 2002;51:842–848. - PubMed
    1. Sheares BJ, Vazquez TL, Evans D. Assessing physician barriers to the use of written treatment plans in asthma [abstract] Proc Am Thoracic Soc. 2005;2:A906.

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