The Effectiveness of Written Asthma Action Plan at the National Guard Health Affairs' Asthma Clinic.

Abstract

IntroductionBronchial asthma has grown in epidemic proportions, and it is one of the most chronic diseases that affect many societies in the world. As managing asthma is complex, new management approaches have been developed, such as the written asthma action plan. This study aims to assign a baseline for the patients’ knowledge about asthma and its management and to assess their need for an asthma action plan. Then, to identify the effect of the written asthma action plan on the following parameters: exacerbations rate, and the frequency of using rescue mediations. Also, to compare the quality of life, functional limitations, and the level of patients’ self-confidence in treating their asthma before and after using the written asthma action plan.MethodThis study is a cross-sectional and interventional mixed-method study design. It was conducted at the National Guard Health Affairs (NGHA) asthma clinics between October 2017 to November 2017. Asthmatic patients who were above five years old and had no other lung comorbidities were evaluated before and after following the written asthma action plan by using three previously validated and published surveys that consist of five sections: demography, knowledge, quality of life, exacerbation rate, and overall evaluation.ResultsThis study enrolled 58% (209) males and 42% (154) females. Regarding asthma medication knowledge and attack management, 62.3% of the patients do not adhere to their maintenance medications when they do not have asthma symptoms. Also, only 24.9% were very confident about knowing how to use their inhalers. For the impact of asthma on patients’ quality of life and the functional limitations, we found that 42.1% of patients were absent from school or work more than once a week because of asthma. While 61.0% of patients did not attend social events twice or less per week because of their asthma. The third section of the survey was about asthma exacerbation related events during the past year, we found that 39.0% of patients had one or more asthma attacks, 41.6% visited the emergency room (ER) once or more during the past year, and 28.1% of patients have been hospitalized because of their asthma. Finally, the section about patients’ evaluation of their asthma and their confidence about managing their condition, we found that around 20% of patients had poor or no control over their condition.In the second phase of the study, which includes 60 subjects, we found that following the action plan helps in increasing the patients’ knowledge about their condition, and improves their quality of life and functional limitations as they learned how to cope with their symptoms. In addition, it has increased the confidence level of patients about controlling their asthma and decreasing the asthma exacerbation related events rates. Overall, the patients’ evaluation of their asthma has been increased significantly (p-value= 0.023).ConclusionMost of the asthmatic patients had insufficient knowledge and/or poor adherence to their treatment which impacted their quality of life. The written asthma action plan was effective in increasing the patients’ knowledge about their condition, improving their quality of life and functional limitations, and increasing their confidence level about controlling their asthma.