Effectiveness of written action plans for acute asthma: A systematic review

ABSTRACT Objective: Self-management is an essential part of achieving asthma control and improving long-term outcomes. While guidelines recommend the provision of written asthma action plans (AAPs), few patients presenting to emergency departments (ED) have one. This systematic review examined if individualized written AAPs reduce relapses in adults following an ED visit for acute asthma. Data sources: Comprehensive searches of seven electronic databases and grey literature were conducted. Study selections: Randomized controlled trials (RCTs) examining the effectiveness of individualized written AAPs to reduce relapses after ED visits for acute asthma were included. Study quality was determined using the Cochrane Risk of Bias (RoB) tool; intervention fidelity was assessed. Results: From 695 potentially relevant studies, three RCTs were included. The RoB was low in two studies and high in one study; description of intervention fidelity varied across studies. The provision of individualized written AAPs in adults following an ED visit for acute asthma did not reduce the risk of relapse after ED discharge (risk ratio [RR] = 0.66; 95% confidence intervals [CI]: 0.36, 1.23; I2 = 40%). There was a 49% reduction in the risk of relapse after ED discharge when only studies with low RoB were pooled (RR = 0.51; 95% CI: 0.31, 0.83; I2 = 0%). Conclusion: This review did not provide conclusive evidence to support the consideration of individualized written AAPs for the reduction of relapses after an ED visit; however, the low frequency of events, small number of studies and samples, and their methodological quality might play an important role in this overall finding.

[1]  B. Rowe,et al.  Effectiveness of Educational Interventions to Increase Primary Care Follow-up for Adults Seen in the Emergency Department for Acute Asthma: A Systematic Review and Meta-analysis. , 2016, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[2]  B. Rowe,et al.  Action plans in patients presenting to emergency departments with asthma exacerbations: Frequency of use and description of contents. , 2014, Canadian respiratory journal.

[3]  L. Boulet,et al.  Major care gaps in asthma, sleep and chronic obstructive pulmonary disease: a road map for knowledge translation. , 2013, Canadian respiratory journal.

[4]  M. Chignell,et al.  Asthma action plans are highly variable and do not conform to best visual design practices. , 2012, Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology.

[5]  L. Boulet,et al.  Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. , 2012, Canadian respiratory journal.

[6]  J. Higgins.  Cochrane handbook for systematic reviews of interventions. Version 5.1.0 [updated March 2011]. The Cochrane Collaboration , 2011 .

[7]  I. Stiell,et al.  Admissions to Canadian hospitals for acute asthma: a prospective, multicentre study. , 2010, Canadian respiratory journal.

[8]  N. Anthonisen.  Asthma in the emergency room in Canada. , 2010, Canadian respiratory journal.

[9]  Julian P T Higgins,et al.  Graphical displays for meta‐analysis: An overview with suggestions for practice , 2010, Research synthesis methods.

[10]  L. Boulet,et al.  Suboptimal asthma control: prevalence, detection and consequences in general practice , 2008, European Respiratory Journal.

[11]  B. Rowe.  Prospective Multicenter Trial of an Action Plan following Emergency Department Discharge for Acute Asthma , 2006 .

[12]  L. Boulet,et al.  Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. , 2006, Canadian respiratory journal.

[13]  Barbara Resnick,et al.  A new tool to assess treatment fidelity and evaluation of treatment fidelity across 10 years of health behavior research. , 2005, Journal of consulting and clinical psychology.

[14]  B. Rowe,et al.  Improving quality of asthma care after emergency department discharge: evidence before action. , 2005, Annals of emergency medicine.

[15]  Barbara Resnick,et al.  Enhancing treatment fidelity in health behavior change studies: best practices and recommendations from the NIH Behavior Change Consortium. , 2004, Health psychology : official journal of the Division of Health Psychology, American Psychological Association.

[16]  D. Altman,et al.  Measuring inconsistency in meta-analyses , 2003, BMJ : British Medical Journal.

[17]  M J Hensley,et al.  Self-management education and regular practitioner review for adults with asthma. , 2002, The Cochrane database of systematic reviews.

[18]  L. Boulet,et al.  Evaluation of two different educational interventions for adult patients consulting with an acute asthma exacerbation. , 2001, American journal of respiratory and critical care medicine.

[19]  M. Harrison,et al.  Clinical practice guidelines: necessary but not sufficient for evidence-based patient education and counseling. , 2001, Patient education and counseling.

[20]  C. R. Reed,et al.  Asthma education in the Emergency Department. On behalf of the MARC Investigators. , 2000, Annals of emergency medicine.

[21]  C. Camargo,et al.  Patient education in the emergency department. , 2000, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[22]  C. R. Reed,et al.  Asthma Education in the Emergency Department , 1999 .

[23]  Judith Stephenson,et al.  Why do we need randomised controlled trials to assess behavioural interventions? , 1998, BMJ.

[24]  S. Field,et al.  The effect of a peak flow-based action plan in the prevention of exacerbations of asthma. , 1997, Chest.

[25]  R. Pauwels,et al.  GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION , 1996 .

[26]  P. Barry,et al.  Emergency treatment of asthma. , 1995, Thorax.

[27]  R. J. Hayes,et al.  Empirical evidence of bias. Dimensions of methodological quality associated with estimates of treatment effects in controlled trials. , 1995, JAMA.

[28]  J. Couriel,et al.  The perception of asthma , 1986, Australian paediatric journal.

[29]  PERCEPTION OF BREATHLESSNESS IN ASTHMA , 1983, The Lancet.