Written Asthma Action Plans

An integral part of asthma management is the development of a written asthma action plan by the person with asthma and/or their carer together with their doctor.

An asthma action plan helps the person with asthma and/or their carer recognise worsening asthma and gives clear instructions on what to do in response.

The process of developing a written asthma action plan is important, as this should be a discussion of the person’s individual asthma and its management. The written plan is a reminder of that discussion.

Written asthma action plans are one of the most effective asthma interventions available. Use of a written asthma action plan:

• reduces absences from work or school

• reduces hospital admissions

• reduces emergency visits to general practice

• reduces reliever medication use

• improves lung function.

Doctors should consider developing a written asthma action plan when discussing asthma management with people with asthma and/or their carers.

People with asthma and/or their carers should ask their doctor about developing an asthma action plan if they do not already have one.

How does a written asthma action plan work?

The aim of an asthma action plan is to help the person with asthma and/or their carer take early action to prevent or reduce the severity of an asthma attack. 

The asthma action plan may be based on symptoms and/or peak expiratory flow (PEF) measurements and is individualised according to the pattern of the person’s asthma.

In children, symptom-based plans are preferred.

Once completed, the asthma action plan is given to the person with asthma and/or their carer to keep.

Parents should give a copy of their child’s asthma action plan to the school, pre-school and/or childcare facility.

Regular review of the asthma action plan is important as a person’s level of asthma severity or control may change over time.

What should a written asthma action plan include?

Different asthma action plans suit different people, but all plans should have the same essential features. The plan should: 

• be in a written format

• be individually prescribed, rather than a general example

• contain information that allows the patient and/or their carer to recognise exacerbations (flare-ups)

• contain information on what action to take in response to those exacerbations.

Basic details should include the date, the patient’s name, and their doctor’s contact details. Some also include contact details for the patient’s carer or emergency contact person.

Many plans follow a traffic light system for assessing the severity of exacerbations, moving from green for ‘under control’ to red for ‘emergency’.

Whichever system is used, the response plan needs to cover:

• Maintenance/preventer therapy: doses and frequencies of regular medications

• Treating exacerbations: how to adjust treatment in response to particular signs and symptoms

• Managing increased severity: when to start oral corticosteroids and seek medical advice

• Danger signs: when and how to seek urgent medical help

Peak expiratory flow (PEF) measurement

Inclusion of PEF measurements in the asthma action plan can be beneficial for people with more severe or difficult-to-control asthma, and those who are not readily aware of symptoms of limited airflow.

When PEF is used, the asthma action plan should be based on personal best rather than on predicted values.

Care should be taken when increasing treatment for falls in PEF if there are no symptoms, as there is a risk of over-treatment.

PEF measurement is not recommended for children under 12 years. In most children with asthma, change in symptoms is as effective as PEF for indicating that asthma is getting worse.

For more information on PEF go to the Asthma Management Handbook 2006: Role of PEF monitoring

A small number of people with asthma may benefit from long-term PEF monitoring. For more information and a PEF chart template go to Peak Flow Chart.

More information

National Asthma Council Australia. Asthma Management Handbook 2006: Asthma action plans

Australian Institute of Health and Welfare. Asthma in Australia 2005 (Section 6.1) (http://www.aihw.gov.au/publications/index.cfm/title/10158)

Gibson PG, Powell H. Written action plans for asthma: an evidence-based review of the key components. Thorax 2004; 59: 94–99.
(http://thorax.bmj.com/cgi/content/abstract/59/2/94)

Gibson PG, Powell H, Coughlan J et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst Rev 2002;(3).
(http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD001117/frame.html)