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Asthma management plans
Gretchen W. Cook Asthma, a complex disease, requires management strategies that vary from person to person. One individual’s method of managing asthma may be to simply reduce exposure to allergens or other asthma triggers. Another person’s strategy may involve a multifaceted approach that includes everything from allergen avoidance to control medicines to an emergency plan. Understanding asthma control strategies and implementing them appropriately is the purpose of an asthma management plan. The goal is to reduce the incidence and severity of asthma symptoms—to prevent asthma attacks.
thing: a written set of personalized instructions from the health care provider, agreed to by the patient, to prevent asthma symptoms or treat them before they escalate out of control. Such a plan also includes instructions on what to do if asthma does get out of control. It is a step-by-step outline of asthma management.
Asthma Management Plan or Asthma Action Plan?
Why a Plan?
“Asthma management plan” and “asthma action plan” are terms used interchangeably to describe the same
Having a plan in place offers real advantages. Planning requires forethought, which means the planner
18
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ASTHMA MAGAZINE
July/August 2004
has evaluated different scenarios and the best response to each. Asthma is a condition that must be addressed with an appropriate response to symptoms or to a situation in which there is an increased risk of symptoms. Asthma symptoms that are ignored or dismissed can lead to a serious or even life-threatening exacerbation requiring an emergency department visit or hospital stay. In developing an asthma management plan, a physician or nurse practitioner typically works with the
person with asthma to determine a course of action for every stage in the progression of asthma symptoms. Most asthma emergencies are preceded by several days, or at least hours, of deterioration. When planned interventions are implemented in a timely manner, many asthma episodes can be avoided or reduced in their severity. Asthma Management Plans Promote Health
According to Leanne Noren, regional director of the American Lung Association for Washington State (ALAW), Western Washington Region, her organization’s asthma management program has made significant improvements in the quality of life of many children with asthma. “Asthma management plans are a key element of our Clean Air for Kids campaign,” says Noren. “This program uses a community-based layoutreach instructor to work with families to educate them about asthma, and provide them the tools and equipment they need to manage asthma. As a result of ALAW’s asthma management programs, 91% of families surveyed indicated that their children’s asthma management had been improved and that the severity of asthma attacks was reduced significantly. “The asthma management plan should go everywhere the person with asthma goes,” says Noren, “wherever that person spends significant time.” This means school, day care, and maybe Grandmother’s house for children; work, the gym, and on vacation for adults. One of the best things about an asthma management plan is that it is an economical way to improve the health of a person with asthma. “We work to develop no-cost or low-cost ways to help people with asthma,” says Noren. “Managing the symptoms [either through the avoidance of asthma triggers or the use of controller medications] and addressing
problems early is an easy intervention that saves health care resources and improves quality of life for families with asthma.” Elements of a Plan
Most asthma management plans comprise 3 parts. Although the format may vary from plan to plan, in many plans these parts are labeled “control,” “caution,” and “critical.” Control The most basic information that every plan should contain relates to asthma control—the steps a person should take to maintain asthma control every day. Typically this part of the plan includes controller medicines, their dosages, and any other instructions relating to their use. It may also include environmental-control actions to help the person avoid exposure to known asthma triggers.
This section may also outline measures for the person with asthma to take before exposure to a trigger. For example, the plan may list the steps to take before exercise for people with exercise-induced asthma. The goal is for the person with asthma, in taking certain preventive steps, to remain symptom-free. For those patients who use peakflow meters, the control stage of a plan may be outlined on the basis of daily peak-flow scores and corresponding peak-flow zones. Peak-flow values that remain in the “green zone,” or 80% to 100% of the person’s personal best peak-flow measurement, indicate that the person is successfully controlling his or her asthma. Caution The next section of an asthma management plan, the caution stage, addresses additional actions that
Setting Up a Plan The American Lung Association of Washington has worked to increase awareness of asthma and its management. The agency’s Web Site features a section on asthma management and asthma action plans. Just go to www.alaw.org, click on the “Childhood Asthma” tab, and then look for “Asthma Management Plan.” (www.alaw.org/ childhood_asthma/asthma_management_plan/). Printable plans in several different languages are available, as is a version that can be filled out online by a physician or nurse practitioner.
ASTHMA MAGAZINE
to subscribe call 1.800.654.2452
|
19
The “critical” stage outlined in the asthma management plan may instruct the patient to call the doctor or seek emergency care.
should be taken if symptoms develop. This is the step that should be implemented when the person’s regular medicines and trigger-avoidance measures fail to control asthma symptoms. Some of the signs of worsening asthma are coughing, wheezing, shortness of breath, and nighttime awakening. In many cases, when symptoms develop or peak-flow scores drop, the plan will call for the person to continue or increase controller medicines and add rescue medicines, or fastacting asthma drugs, that quickly alleviate asthma symptoms. For those who do peak-flow monitoring, the caution stage is when the person is in the “yellow zone,” or 60% to 80% of his or her personal best score. (In some asthma management plans, the yellow zone comprises scores ranging from 50% to 80%.) Critical The critical stage of an asthma management plan outlines what to do when symptoms do not abate— that is, wheezing does not stop or returns less than 3 hours after the use of a rescue medicine. The person may be very short of breath and may have difficulty completing a sentence in a single breath. For individuals 20
|
ASTHMA MAGAZINE
who use peak-flow meters, readings during this stage are usually in the “red zone”—less than 60% or 50%. These symptoms and peak-flow scores indicate that the asthma exacerbation is critical and that immediate medical assistance is required. If an asthma episode reaches this critical stage, the typical asthma management plan will call for an increase in the use of control medicines, the use of fast-acting relief medicines, and, possibly, the addition of an oral corticosteroid. Most plans instruct the user to call the doctor when an asthma attack reaches this point. The call may yield further instructions for home management or a request to proceed quickly to a hospital. Get It in Writing
Perhaps the most important advantage of an asthma management plan is that it helps the person get all information regarding the treatment of his or her asthma in writing. Steps set forth in writing are less likely to be forgotten, misunderstood, or skipped—and by getting the asthmamanagement plan in writing, the user is more likely to understand the plan and ask questions about it. Knowledge is a key component to understanding asthma and managing
July/August 2004
it in such a way that the person with asthma is able to live an active, healthy, and symptom-free life. Use It
Just as reading a diet book won’t make you thin, having an asthma management plan doesn’t guarantee that your asthma will be well managed. The plan must be read, understood, and followed accurately. An asthma management plan should not be a document that is filed away with the insurance papers. Noren says, “An asthma management plan is a way to empower families to better manage asthma.” For this goal to be accomplished, the plan must be well developed, properly carried out, and modified as required. When these steps are taken, the asthma management plan is a powerful tool with which to improve the lives of those with asthma. Gretchen W. Cook is a freelance writer in Jackson, Miss., who specializes in family and health topics. She has had asthma since the age of 6.
Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone 314-453-4350. doi:10.1016/j.asthmamag.2004.05.004
thing: a written set of personalized instructions from the health care provider, agreed to by the patient, to prevent asthma symptoms or treat them before they escalate out of control. Such a plan also includes instructions on what to do if asthma does get out of control. It is a step-by-step outline of asthma management.
Asthma Management Plan or Asthma Action Plan?
Why a Plan?
“Asthma management plan” and “asthma action plan” are terms used interchangeably to describe the same
Having a plan in place offers real advantages. Planning requires forethought, which means the planner
18
|
ASTHMA MAGAZINE
July/August 2004
has evaluated different scenarios and the best response to each. Asthma is a condition that must be addressed with an appropriate response to symptoms or to a situation in which there is an increased risk of symptoms. Asthma symptoms that are ignored or dismissed can lead to a serious or even life-threatening exacerbation requiring an emergency department visit or hospital stay. In developing an asthma management plan, a physician or nurse practitioner typically works with the
person with asthma to determine a course of action for every stage in the progression of asthma symptoms. Most asthma emergencies are preceded by several days, or at least hours, of deterioration. When planned interventions are implemented in a timely manner, many asthma episodes can be avoided or reduced in their severity. Asthma Management Plans Promote Health
According to Leanne Noren, regional director of the American Lung Association for Washington State (ALAW), Western Washington Region, her organization’s asthma management program has made significant improvements in the quality of life of many children with asthma. “Asthma management plans are a key element of our Clean Air for Kids campaign,” says Noren. “This program uses a community-based layoutreach instructor to work with families to educate them about asthma, and provide them the tools and equipment they need to manage asthma. As a result of ALAW’s asthma management programs, 91% of families surveyed indicated that their children’s asthma management had been improved and that the severity of asthma attacks was reduced significantly. “The asthma management plan should go everywhere the person with asthma goes,” says Noren, “wherever that person spends significant time.” This means school, day care, and maybe Grandmother’s house for children; work, the gym, and on vacation for adults. One of the best things about an asthma management plan is that it is an economical way to improve the health of a person with asthma. “We work to develop no-cost or low-cost ways to help people with asthma,” says Noren. “Managing the symptoms [either through the avoidance of asthma triggers or the use of controller medications] and addressing
problems early is an easy intervention that saves health care resources and improves quality of life for families with asthma.” Elements of a Plan
Most asthma management plans comprise 3 parts. Although the format may vary from plan to plan, in many plans these parts are labeled “control,” “caution,” and “critical.” Control The most basic information that every plan should contain relates to asthma control—the steps a person should take to maintain asthma control every day. Typically this part of the plan includes controller medicines, their dosages, and any other instructions relating to their use. It may also include environmental-control actions to help the person avoid exposure to known asthma triggers.
This section may also outline measures for the person with asthma to take before exposure to a trigger. For example, the plan may list the steps to take before exercise for people with exercise-induced asthma. The goal is for the person with asthma, in taking certain preventive steps, to remain symptom-free. For those patients who use peakflow meters, the control stage of a plan may be outlined on the basis of daily peak-flow scores and corresponding peak-flow zones. Peak-flow values that remain in the “green zone,” or 80% to 100% of the person’s personal best peak-flow measurement, indicate that the person is successfully controlling his or her asthma. Caution The next section of an asthma management plan, the caution stage, addresses additional actions that
Setting Up a Plan The American Lung Association of Washington has worked to increase awareness of asthma and its management. The agency’s Web Site features a section on asthma management and asthma action plans. Just go to www.alaw.org, click on the “Childhood Asthma” tab, and then look for “Asthma Management Plan.” (www.alaw.org/ childhood_asthma/asthma_management_plan/). Printable plans in several different languages are available, as is a version that can be filled out online by a physician or nurse practitioner.
ASTHMA MAGAZINE
to subscribe call 1.800.654.2452
|
19
The “critical” stage outlined in the asthma management plan may instruct the patient to call the doctor or seek emergency care.
should be taken if symptoms develop. This is the step that should be implemented when the person’s regular medicines and trigger-avoidance measures fail to control asthma symptoms. Some of the signs of worsening asthma are coughing, wheezing, shortness of breath, and nighttime awakening. In many cases, when symptoms develop or peak-flow scores drop, the plan will call for the person to continue or increase controller medicines and add rescue medicines, or fastacting asthma drugs, that quickly alleviate asthma symptoms. For those who do peak-flow monitoring, the caution stage is when the person is in the “yellow zone,” or 60% to 80% of his or her personal best score. (In some asthma management plans, the yellow zone comprises scores ranging from 50% to 80%.) Critical The critical stage of an asthma management plan outlines what to do when symptoms do not abate— that is, wheezing does not stop or returns less than 3 hours after the use of a rescue medicine. The person may be very short of breath and may have difficulty completing a sentence in a single breath. For individuals 20
|
ASTHMA MAGAZINE
who use peak-flow meters, readings during this stage are usually in the “red zone”—less than 60% or 50%. These symptoms and peak-flow scores indicate that the asthma exacerbation is critical and that immediate medical assistance is required. If an asthma episode reaches this critical stage, the typical asthma management plan will call for an increase in the use of control medicines, the use of fast-acting relief medicines, and, possibly, the addition of an oral corticosteroid. Most plans instruct the user to call the doctor when an asthma attack reaches this point. The call may yield further instructions for home management or a request to proceed quickly to a hospital. Get It in Writing
Perhaps the most important advantage of an asthma management plan is that it helps the person get all information regarding the treatment of his or her asthma in writing. Steps set forth in writing are less likely to be forgotten, misunderstood, or skipped—and by getting the asthmamanagement plan in writing, the user is more likely to understand the plan and ask questions about it. Knowledge is a key component to understanding asthma and managing
July/August 2004
it in such a way that the person with asthma is able to live an active, healthy, and symptom-free life. Use It
Just as reading a diet book won’t make you thin, having an asthma management plan doesn’t guarantee that your asthma will be well managed. The plan must be read, understood, and followed accurately. An asthma management plan should not be a document that is filed away with the insurance papers. Noren says, “An asthma management plan is a way to empower families to better manage asthma.” For this goal to be accomplished, the plan must be well developed, properly carried out, and modified as required. When these steps are taken, the asthma management plan is a powerful tool with which to improve the lives of those with asthma. Gretchen W. Cook is a freelance writer in Jackson, Miss., who specializes in family and health topics. She has had asthma since the age of 6.
Reprint orders: Mosby, Inc., 11830 Westline Industrial Dr., St. Louis, MO 63146-3318; phone 314-453-4350. doi:10.1016/j.asthmamag.2004.05.004