Do asthma action plans reduce hospitalization and emergency department visits in asthma self-management programs?

From the Guidelines

Yes, asthma action plans reduce hospitalization and emergency department visits in asthma self-management programs. These written plans provide patients with clear instructions on how to monitor their symptoms, adjust medications, and know when to seek medical help. According to a recent review 1, asthma self-management education, which includes personalized written asthma action plans, reduces health services utilization, such as emergency department visits, and improves quality of life.

Key Components of Asthma Action Plans

The plans typically use a color-coded system (green, yellow, red) corresponding to different levels of symptom control. In the green zone, patients maintain controller medications like inhaled corticosteroids at their prescribed doses. The yellow zone indicates worsening symptoms, prompting increased use of rescue medications like albuterol and possibly short-term increases in controller medications. The red zone signals a medical emergency requiring immediate bronchodilator use and medical attention.

Effectiveness of Asthma Action Plans

The effectiveness of asthma action plans stems from improved medication adherence, earlier intervention during symptom worsening, and increased patient confidence in managing their condition. As noted in a Cochrane review 1, self-management interventions with written action plans demonstrate the greatest benefits, including reduced asthma-related hospital admissions and reduced emergency department visits.

Implementation and Review of Asthma Action Plans

For maximum benefit, action plans should be personalized, regularly reviewed with healthcare providers, and updated as needed based on changes in the patient's condition or treatment regimen. A study by the National Asthma Education Prevention Program's (NAEPP's) Expert Panel Report 2 1 emphasizes the importance of written action plans as part of an overall effort to educate patients in self-management, especially for patients with moderate or severe persistent asthma and patients with a history of severe exacerbations.

Benefits of Asthma Action Plans

The use of written action plans has been associated with a 70-percent reduction in mortality risk for patients with severe persistent asthma, as reported in a case control study 1. Overall, the evidence supports the use of asthma action plans as a crucial component of asthma self-management programs to reduce hospitalization and emergency department visits.

From the Research

Asthma Action Plans and Hospitalization

• Asthma action plans have been shown to reduce hospitalization and emergency department visits in some studies 2, 3.
• A randomized controlled trial found that patients who received a written personalized asthma action plan had fewer emergency department visits and hospitalizations compared to those who received standard care 2.
• Another study found that asthma action plans, in conjunction with asthma education and regular follow-up, can improve patients' symptoms and quality of life and reduce hospitalization 3.

Reduction in Emergency Department Visits

• The use of asthma action plans has been associated with a reduction in emergency department visits in some studies 2, 4.
• A study found that patients who used an asthma action plan had a lower risk of relapse after an emergency department visit for acute asthma 5.
• However, another study found that the provision of individualized written asthma action plans did not reduce the risk of relapse after emergency department discharge in adults with acute asthma 5.

Effective Patient-Health Care Provider Communication

• Asthma action plans have been shown to be an effective tool for patient-health care provider communication and patient self-management 2, 3.
• A study found that the use of asthma action plans can improve patient adherence to asthma medications and reduce the risk of asthma exacerbations 2.
• Another study found that asthma action plans can help patients triage and manage symptoms at home, reducing the need for emergency department visits 4.

Limitations and Variability in Study Findings

• The effectiveness of asthma action plans in reducing hospitalization and emergency department visits may vary depending on the study population and methodology 5, 6.
• Some studies have found that the use of asthma action plans is associated with a reduced risk of asthma exacerbations, while others have found no significant reduction in risk 5, 6.
• Further research is needed to fully understand the effectiveness of asthma action plans in reducing hospitalization and emergency department visits for patients with asthma 5, 6.