Asthma Management Handbook

Preparing written asthma action plans for adults

Recommendations

For every person with asthma, develop an individualised written asthma action plan that is appropriate for their treatment regimen, asthma severity, culture, language, literacy level, and ability to self-manage.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

A written asthma action plan should include all of the following:

  • the person’s usual asthma and allergy medicines
  • clear instructions on how to change medication (including when and how to start a course of oral corticosteroids)
  • when and how to get medical care, including during an emergency
  • name of the person preparing the plan
  • the date.

Note: A range of templates is available from National Asthma Council Australia's Asthma Action Plan Library.

Table. Options for adjusting medicines in a written asthma action plan for adults Opens in a new window Please view and print this figure separately: https://www.asthmahandbook.org.au/table/show/42

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Ensure the person has a prescription for any medicines they may need to follow their action plan (e.g. prednisolone). Explain which medicines they should have available at all times, or when to fill prescriptions to have medicines available (e.g. before travel).

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

Review the written asthma action plan every year, and whenever there is a significant change in treatment or asthma status.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

When reviewing a written asthma action plan, consider the following:

  • Does the person know where their written asthma action plan is?
  • Have they used it? If so, any problems?
  • Are listed medicines and instruction for actions current and appropriate?
  • Are contact details for medical care and acute care up to date?

Table. Checklist for reviewing a written asthma action plan

  • Ask if the person (or parent) knows where their written asthma action plan is.
  • Ask if they have used their written asthma action plan because of worsening asthma.
  • Ask if the person (or parent) has had any problems using their written asthma action plan, or has any comments about whether they find it suitable and effective.
  • Check that the medication recommendations are appropriate to the person’s current treatment.
  • Check that all action points are appropriate to the person’s level of recent asthma symptom control.
  • Check that the person (or parent) understands and is satisfied with the action points.
  • If the written asthma action plan has been used because of worsening asthma more than once in the past 12 months: review the person's usual asthma treatment, adherence, inhaler technique, and exposure to avoidable trigger factors.
  • Check that the contact details for medical care and acute care are up to date.

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How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

For people who are unable to read a written asthma action plan easily due to poor eyesight or when written English is inappropriate, consider a pictorial action plan.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

For every person with a history of anaphylaxis (or risk factors), also provide a written anaphylaxis plan.

How this recommendation was developed

Consensus

Based on clinical experience and expert opinion (informed by evidence, where available).

More information

Written asthma action plans for adults

Every person with asthma should have their own written asthma action plan.

When provided with appropriate self-management education, self-monitoring and medical review, individualised written action plans consistently improve asthma health outcomes if they include two to four action points, and provide instructions for use of both inhaled corticosteroid and oral corticosteroids for treatment of flare-ups.1 Written asthma action plans are effective if based on symptoms2 or personal best peak expiratory flow (not on percentage predicted).1

How to develop and review a written asthma action plan

A written asthma action plan should include all the following:

  • a list of the person’s usual medicines (names of medicines, doses, when to take each dose) – including treatment for related conditions such as allergic rhinitis
  • clear instructions on how to change medication (including when and how to start a course of oral corticosteroids) in all the following situations:
    • when asthma is getting worse (e.g. when needing more reliever than usual, waking up with asthma, more symptoms than usual, asthma is interfering with usual activities)
    • when asthma symptoms get substantially worse (e.g. when needing reliever again within 3 hours, experiencing increasing difficulty breathing, waking often at night with asthma symptoms)
    • when peak flow falls below an agreed rate (for those monitoring peak flow each day)
    • during an asthma emergency.
  • instructions on when and how to get medical care (including contact telephone numbers)
  • the name of the person writing the action plan, and the date it was issued.

Table. Options for adjusting medicines in a written asthma action plan for adults Opens in a new window Please view and print this figure separately: https://www.asthmahandbook.org.au/table/show/42

Table. Checklist for reviewing a written asthma action plan

  • Ask if the person (or parent) knows where their written asthma action plan is.
  • Ask if they have used their written asthma action plan because of worsening asthma.
  • Ask if the person (or parent) has had any problems using their written asthma action plan, or has any comments about whether they find it suitable and effective.
  • Check that the medication recommendations are appropriate to the person’s current treatment.
  • Check that all action points are appropriate to the person’s level of recent asthma symptom control.
  • Check that the person (or parent) understands and is satisfied with the action points.
  • If the written asthma action plan has been used because of worsening asthma more than once in the past 12 months: review the person's usual asthma treatment, adherence, inhaler technique, and exposure to avoidable trigger factors.
  • Check that the contact details for medical care and acute care are up to date.

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Templates for written asthma action plans

Templates are available from National Asthma Council Australia:

  • National Asthma Council Australia colour-coded plan, available as a printed handout that folds to wallet size and as the Asthma Buddy smartphone application
  • Asthma Cycle of Care asthma action plan
  • A plan designed for patients using budesonide/eformoterol combination as maintenance and reliever therapy
  • Remote Indigenous Australian Asthma Action Plan
  • Every Day Asthma Action Plan (designed for remote Indigenous Australians who do not use written English – may also be useful for others for whom written English is inappropriate).

Some written asthma action plans are available in community languages.

Software for developing electronic pictorial asthma action plans34 is available online.

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References

  1. Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004; 59: 94-99. Available from: http://thorax.bmj.com/content/59/2/94.full
  2. Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2002; Issue 3: CD004107. Available from: http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004107/full
  3. Roberts NJ, Mohamed Z, Wong PS, et al. The development and comprehensibility of a pictorial asthma action plan. Patient Educ Couns. 2009; 74: 12-18. Available from: http://www.ncbi.nlm.nih.gov/pubmed/18789626
  4. Roberts NJ, Evans G, Blenkhorn P, Partridge M. Development of an electronic pictorial asthma action plan and its use in primary care. Patient Educ Couns. 2010; 80: 141-146. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19879092