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Asthma - Management
What information is needed in self-management education and action plans?

  • Give all people with asthma self-management education and a written action plan.
  • At each review, repeat education and advise on:
    • Taking medication and avoiding known trigger factors.
    • Recognizing poor asthma control (worsening symptoms or peak flow readings) and early signs of an exacerbation (sudden persistent worsening symptoms).
    • Presenting for follow up annually or more frequently if symptoms are not controlled.
  • A typical asthma action plan should include:
    • When to increase treatment (as defined by symptoms or peak expiratory flow rate).
    • How to change treatment in case of deterioration and when to go back to maintenance medication.
    • When to seek medical help.
Clarification / Additional information
  • Tailor self-management education and written action plans to the needs of the individual. Such plans may be particularly helpful in some high-risk people with a history of insidious deterioration of asthma, poor perception of deteriorating breathing, and poor adherence to medication, and in people with frequent exacerbations. Provide such people with a 'crash course' of oral corticosteroids and instructions, preferably in writing, on when to start treatment:
    • Advise people that poor asthma control may be suggested by:
      • Worsening symptoms (cough, wheeze, breathlessness), especially at night or during exercise.
      • Worsening peak expiratory flow rate (PEFR) compared with previous readings.
    • Advise people with worsening symptoms for a couple of days or a decrease in PEFR to initiate their personalized action plan. This plan should be based on the person's current medication, history, and severity of an exacerbation. Consider the following approach:
      • If a person's PEFR is > 75% (best or predicted), advise regular use of a short-acting beta2-agonist for 1–2 days until symptoms improve. If there is no benefit, start a course of oral prednisolone.
      • If a person's PEFR is 50–75% (best or predicted), advise starting a course of oral prednisolone with regular use of their short-acting beta2-agonist. If no benefit is seen after 1–2 days, seek medical help.
      • If a person's PEFR is < 50%, advise starting a course of oral prednisolone along with regular use of their short-acting beta2-agonist and seek medical help.
  • Examples of asthma action plans are available online from the National Asthma Campaign (www.asthma.org.uk).
Basis for recommendation
  • These recommendations are based on the British Guideline on the Management of Asthma: a national clinical guideline [SIGN and BTS, 2009]:
    • Studies vary widely in populations, setting, and disease severity. One approach cannot be assumed to be successful in all circumstances. Less evidence is available from primary care settings, and results are less consistent. Overall, self-management education packages appear to be effective, but no one individual component is consistently shown to be effective in isolation. A consistent finding in many studies has been improvements in people's self efficacy, knowledge, and confidence [SIGN and BTS, 2009].
    • Increasing low-dose inhaled corticosteroids (ICS) by as much as fourfold at the beginning of an exacerbation may be suitable for some people on low doses of maintenance ICS, but doubling ICS during an exacerbation has not been shown to provide benefit and is no longer recommended [SIGN and BTS, 2009].

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