Volume 177 - Issue 8
Should we still give our asthmatic patients written individualised management plans?
Authors: Andrew M Thornett, Jonathan W Newbury and Andre J Duszynski
Med J Aust 2002; 177 (8): 459-459.
Published online: 21 October 2002
Published online: 21 October 2002
To the Editor: Comprehensive care has been shown to improve outcome in asthma management when it has four components — asthma education, self-monitoring, written self-management plans, and regular medical review.1,2
A recent Cochrane Review has explored the role of one of these components — written self-management plans — and concluded that there is "no consistent evidence that written plans produced better patient outcomes".3 Should this cause us to change our management strategies in Australian general practice? Does this mean that our patients are not able to care for their own asthma without our intensive assistance?
These findings update a 1998 review of the role of written asthma management plans as part of comprehensive care in 1998: "In five studies which compared subjects who managed their asthma by self-adjustment according to individualised written plan with those whose medications were adjusted by the doctor, lung function data (FEV1 [forced expiratory volume in one second] and PEF [peak expiratory flow]) were significantly higher in the self-managed group."1
In Australian general practice, between 30% and 50% of patients are given a written asthma management plan.4 These plans form part of known beneficial comprehensive asthma care plans, such as the Six-Step Asthma Management Plan5 or the Asthma 3+ Visit Plan.4
The small number of available high quality trials for this most recent review led the authors to say, "Available trials are too small and the results too inconsistent to form any firm conclusions", and suggests that more trials are needed to produce a conclusive result.3
We should be careful not to lose the positive effects of improved chronic disease management in asthma by over-responding to this one review of one component of comprehensive care.
References
- Gibson PG, Coughlan J, Wilson AJ, et al. The effects of self-management education and regular practitioner review in adults with asthma. The Cochrane Library, Issue 4, 1998. Oxford, Update Software.
- Gibson PG, Coughlan J, Wilson AJ, et al. Self-management education and regular practitioner review for adults with asthma. The Cochrane Library, Issue 3, 2001. Oxford: Update Software. i1149935
- Toelle BG, Ram FSF. Written individualised management plans for asthma in children and adults (Cochrane Review). The Cochrane Library, 2002. Issue 3. Oxford: Update Software. i1149937
- Bubner T, Duszynski A, Beilby J. Final report: asthma 3+ visit plan executive summary and recommendations. Adelaide: Adelaide University: Department of General Practice, 2002. i1149939
- Coughlan J, Wilson A, Gibson P. Summary report of the 1999 evidence-based review of the Australian six step asthma management plan. Sydney: NSW Health, 2000. i1149941
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