Is it time for asthma action plan apps?

Abstract

In 1991, the National Heart, Lung, and Blood Institute published the first evidence-based guideline for the diagnosis and management of asthma. [1] National Heart Lung and Blood InstituteNational Asthma Education Program. Expert panel report: guidelines for the diagnosis and management of asthma. J Allergy Clin Immunol. 1991; 88: 425-534 Abstract Full Text PDF PubMed Google Scholar This guideline recommends that patients with asthma should be taught self-management skills and be given an asthma action plan (AAP) so that early loss of control could be treated by the patient at home. In 1997, an updated guideline reinforced the model of green, yellow, and red zone intervention strategies to facilitate maintenance of asthma control. [2] National Asthma Education Program National Heart, Lung, and Blood InstituteExpert Panel Report 2: Guidelines for the Diagnosis and Management of Asthma (EPR-2 1997). US Dept of Health and Human Services; National Institutes of Health, Bethesda, MD1997 Google Scholar In a Cochrane Review of self-management plans for asthma, children who have an AAP have a lower risk of an exacerbation requiring an acute care visit and reduced symptom days. [3] Bhogal S. Zemek R. Ducharme F.M. Written action plans for asthma in children. Cochrane Database Syst Rev. 2006; 3: CD005306 PubMed Google Scholar In addition, symptom-based plans were more effective for reducing symptomatic days per week than plans based on peak flows. In a subsequent study, individualized written action plans based on personal best peak flows and recommending inhaled and oral corticosteroids for treatment of exacerbations were found consistently to improve asthma health outcomes. [4] Gibson P.G. Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax. 2004; 59: 94-99 Crossref PubMed Scopus (350) Google Scholar The specific interventions to recommend in an AAP also have been described. [5] Dinakar C. Oppenheimer J. Portnoy J. et al. Management of acute loss of asthma control in the yellow zone: a practice parameter. Ann Allergy Asthma Immunol. 2014; 113: 143-159 Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar Unfortunately, it is estimated that up to 50% of children do not receive an AAP as recommended by the guidelines. [6] Simon A.E. Akinbami L.J. Asthma action plan receipt among children with asthma 2-17 years of age, United States, 2002-2013. J Pediatr. 2016; 171: 283-289.e1 Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar Smartphone-based vs paper-based asthma action plans for adolescentsAnnals of Allergy, Asthma & ImmunologyVol. 118Issue 3PreviewAdolescents with asthma are at risk of poor outcomes and are traditionally difficult to reach. Full-Text PDF