The role of written action plans in childhood asthma.
OBJECTIVE
The aim of this article is to examine the evidence for the effectiveness of a written action plan as an important element of guided self-management and to identify key features associated with its effectiveness in children and adolescents.


RESULTS
Various written action plans are available for use; however, few have been specifically designed or validated for children. Strong, but limited pediatric evidence confirms that the addition of a written action plan to guided self-management education significantly improves outcome. Use of daily controller medication, with no step-up therapy other than as needed inhaled beta2-agonist, best prevents asthma exacerbations. Symptom-based appear superior to peak-flow based written action plans. The paucity of pediatric trials does not permit the identification of other keys features that enhance the dispensing of written action plans by healthcare professionals or uptake of recommendations by children, adolescents and their parents.


CONCLUSIONS
Written action plans are effective tools to facilitate self-management. While step-up therapy is not superior to daily controller medication, symptom-based are superior to peak-flow based action plans for preventing exacerbations, other keys features associated with effectiveness have yet to be identified.
Ducharme
Francine M
FM
Department of Pediatrics, Montreal Children's Hospital, McGill University Health Centre, 2300 Tupper Street, Montreal, Canada. francine.ducharme@mcgill.ca
Bhogal
Sanjit K
SK
D000293:Adolescent; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000517:prevention & control / Q000523:psychology* / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D002986:Clinical Trials as Topic; D003191:Comprehensive Health Care; D003194:Computer-Assisted Instruction; D006285:Health Planning; D006801:Humans; D010043:Outcome and Process Assessment, Health Care; D010347:Patient Care Planning; D010349:Patient Compliance; D010353:Patient Education as Topic; D012648:Self Care; D016896:Treatment Outcome
D018927:Anti-Asthmatic Agents