Symptom-based Action Plan Research Articles

A Multidisciplinary Team Approach to the Care of Patients With Advanced Interstitial Lung Disease (ILD) in the Outpatient Setting

SESSION TITLE: Diffuse Lung Disease Posters SESSION TYPE: Original Investigation Poster PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM PURPOSE: A significant number of patients with idiopathic pulomary fibrosis (IPF) are hospitalized during their disease course; hospitalizations from respiratory causes are associated with increased mortality. We examined the outcomes associated with our outpatient-based patient-centered multidisciplinary care model for advanced ILD, including looking at ER visits, hospitalizations, and in-hospital deaths. METHODS: A retrospective chart review was completed on patients with known advanced ILD who had undergone outpatient multidisciplinary assessment, either at an ILD clinic or in the community, and had individualized action plans for effective symptom management in place that were escalated based on patient needs. Data was collected on demographics, diagnosis, disease severity, periodic multidisciplinary assessments, symptom-based action plans (for dyspnea, cough, respiratory infections, etc) and advance care planning. Follow-up data was collected on subsequent ER visits, hospitalizations, and overall functional status. RESULTS: 12 Patients were reviewed; 10 had a diagnosis of IPF. Mean DLCO and supplemental oxygen requirements at latest assessments were 24% and 15L, respectively. All patients were seen by a multidisciplinary care team consisting of physicians, respiratory therapists, physiotherapists, occupational therapists, dieticians and nurses. All patients had home care, advance directives, and action plans in place. Mean follow-up period from initial assessment to death was 8 months (1-21 months). There were no presentations to ER and only 8 total admissions to hospital among 12 patients (mean of 0.67) following initial multidisciplinary assessments. 7 Patients were managed at home, 1 in hospice and 2 on palliative care wards in the days prior to death. One patient died in hospital; one patient is still alive. All patients were independent of their BADLs in the weeks prior to death or latest assessment. CONCLUSIONS: Implementation of an outpatient multidisciplinary care model for advanced ILD may lead to decreased acute care utilization, including ER visits and hospitalizations. Use of individualized, symptom-based action plans help patients maintain (better symptom control, independence, and the ability to live at home. CLINICAL IMPLICATIONS: Effective symptom management in ILD can decrease burden the on patients, families, and health care systems, minimizing the need for acute care hospitalization. This may have a significant positive impact on mortality in this patient population. DISCLOSURE: The following authors have nothing to disclose: Jean Du Plessis, Meena Kalluri, Janice Richman-Eisenstat No Product/Research Disclosure Information

Does self-monitoring by means of symptom diaries improve asthma control in children?

Objective: Keeping symptom diaries on a regular basis may facilitate the execution of symptom-based action plans, enhance the patients’ adherence to treatment program and finally allow better asthma control. We hypothesize that disease control in children who keep symptom diaries regularly would be better compared to children who do not keep symptom diaries regularly. Methods: Asthmatic children, aged between 6 and 17 years, who were monitored at least 2 years at our outpatient clinic and examined at least twice within the last year, were enrolled in this study. The patients were assigned to the following two groups: group I included the patients who keep symptom diaries regularly and group II included the patients who do not keep symptom diaries regularly. Asthma control parameters of patients during the last year were investigated. The number of asthma attacks require systemic corticosteroid use, the frequency of emergency department (ED) admissions and the number of attacks requiring hospitalization, forced expiratory volume in 1 s (FEV1) values and asthma control test (ACT) scores were compared. Results: 89 (26.2%) of 340 patients included in the study were identified to keep a symptom diary regularly. Although age (p = 0.20) and sex (p = 0.48) did not differ significantly between the groups, regular use of anti-inflammatory drug was found to be significantly higher in group I (p < 0.001). When all of the study parameters were compared using a multivariate analysis, the number of systemic corticosteroid use, ED visits, attacks requiring hospitalization and ACT scores and FEV1 did not differ significantly between the groups (p > 0.05 in all of the parameters). Conclusions: Keeping a symptom diary on a regular basis in asthmatic children was shown to have neither beneficial effect on the day-to-day asthma control nor a decrease in the future risk of asthma control.

Review: symptom-based action plans reduce acute care visits more than peak flow-based plans in children with asthma

Review: symptom-based action plans reduce acute care visits more than peak flow-based plans in children with asthma

Normal ageing of the lung: implications for diagnosis and monitoring of asthma in older people

WHAT WE NEED TO KNOW: Is there an increased loss of elastic recoil over and above that due to ageing alone? How do we interpret inflammatory changes in the light of age-related airway inflammation? Is there an interaction between perception of airway narrowing and severity or control of disease? Are symptom-based action plans appropriate? Is control of the disease affected by the distribution of inhaled therapeutic aerosols and dry powder particles? WHAT WE NEED TO DO: Include patients aged 80 years and over in clinical trials. Assess functional and inflammatory parameters with appropriate age-matched controls in clinical trials. Assess feasibility and efficacy of symptom-based action plans versus those based on objective monitoring. Assess the responsiveness of elderly people to currently recommended therapies.

Daily versus As-Needed Corticosteroids for Mild Persistent Asthma

Although guidelines recommend daily therapy for patients with mild persistent asthma, prescription patterns suggest that most such patients use these so-called controller therapies intermittently. In patients with mild persistent asthma, we evaluated the efficacy of intermittent short-course corticosteroid treatment guided by a symptom-based action plan alone or in addition to daily treatment with either inhaled budesonide or oral zafirlukast over a one-year period. In a double-blind trial, 225 adults underwent randomization. The primary outcome was morning peak expiratory flow (PEF). Other outcomes included the forced expiratory volume in one second (FEV1) before and after bronchodilator treatment, the frequency of exacerbations, the degree of asthma control, the number of symptom-free days, and the quality of life. The three treatments produced similar increases in morning PEF (7.1 to 8.3 percent; approximately 32 liters per minute; P=0.90) and similar rates of asthma exacerbations (P=0.24), even though the intermittent-treatment group took budesonide, on average, for only 0.5 week of the year. As compared with intermittent therapy or daily zafirlukast therapy, daily budesonide therapy produced greater improvements in pre-bronchodilator FEV1 (P=0.005), bronchial reactivity (P<0.001), the percentage of eosinophils in sputum (P=0.007), exhaled nitric oxide levels (P=0.006), scores for asthma control (P<0.001), and the number of symptom-free days (P=0.03), but not in post-bronchodilator FEV1 (P=0.29) or in the quality of life (P=0.18). Daily zafirlukast therapy did not differ significantly from intermittent treatment in any outcome measured. It may be possible to treat mild persistent asthma with short, intermittent courses of inhaled or oral corticosteroids taken when symptoms worsen. Further studies are required to determine whether this novel approach to treatment should be recommended.

The Effect of a Peak Flow-Based Action Plan in the Prevention of Exacerbations of Asthma

To determine the effect of a symptom-based and a peak flow-based action plan in preventing acute exacerbations in subjects with poorly controlled asthma. A randomized controlled trial in which subjects who had required urgent treatment for their asthma were allocated to receive no action plan, a symptom-based plan, or a peak flow-based action plan. A university hospital asthma clinic. One hundred fifty subjects were recruited after attending an emergency department or a clinic for urgent treatment of asthma. All subjects received evaluation and education for asthma before being randomly allocated to receive no action plan, a symptom-based action plan, or a peak flowmeter and a peak flow-based action plan. Subjects were assessed by questionnaire at 3 and 6 months after enrollment with questions relating to their asthma control and their need for urgent treatment or hospital admission for asthma. At 6 months after enrollment, although all three intervention groups experienced improvement in their asthma control, there was a striking reduction in emergency department visits for asthma only in the peak flow-based action plan group (p=0.006). No significant difference in emergency visits was apparent between the symptom-based action plan and no action plan groups. We conclude that a peak flow-based action plan is effective, at least in the short term, in protecting patients with asthma against severe exacerbations of their disease.