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

摘要

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: asthma symptom frequency, emergency visits, or 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.