The Road Map for Better Breathings
by Jenese Reynolds, MD
The national asthma guidelines say that all people who have asthma should have a written asthma action plan. They are especially needed by people who have moderate or severe asthma, a history of severe flare-ups, or poorly controlled asthma. But, like a quick-relief inhaler, even those with rare symptoms need to have one on hand. The plan should explain what to do for: 1) daily treatment (with medications and environmental controls), and 2) how to recognize and handle worsening asthma.
There are many different asthma action plan formats, the best one is the one that works the best for the person with asthma and/or their caregiver. It can be peak flow- or symptom-based, and range from very simple to very detailed. When making a written asthma action plan with a patient, a clinician should:
- think about the reading level of the patient and use a plan that they will understand.
- avoid using any medical jargon and write briefly and clearly.
- instruct patients/caregivers to use the action plan for exposure to a known trigger, including a cold or flu.
- consider adding the option of doubling inhaled corticosteroids, or adding oral steroids, in the yellow zone.
- be sure patients/caregivers understand exactly what to do and how long to stay in the yellow or red zones before contacting the doctor's office or seeking emergency care.
- include contact information for during and after office hours.
- ask if a child carries their inhaler at school – they will need to know when, and show how, to use the inhaler correctly. The school will need a copy of the action plan with the clinician's signature.
Patients and/or caregivers should:
- read the plan back to the clinician to make sure they know exactly what to do.
- ask questions about the steps if they do not make sense or if they will have trouble following them.
- not agree to an action plan that they do not plan to follow. If the plan will not work, tell the clinician so that a better plan can be made together.
- get copies of the plan for all the places that need one, i.e. home, babysitter, and workplace. Put the plan where it can be found easily, like on the refrigerator door.
The action plan should be reviewed at every visit. One good way to do that is to talk about times when asthma might be a problem and what should be done. For instance, a clinician could ask "If you find yourself in a smoky place and start having symptoms, what would you do?" If asthma control gets better or worse, the plan should be changed and reviewed again with the patient and/or caregiver. If it's kept up-to-date and each step is clear, an asthma action plan can be the road map that keeps a person with asthma breathing easier wherever they go, whatever they do.
Dr. Reynolds is a family physician with expertise in providing clinical care to adults and children with asthma. She is a member of the faculty at the Michigan State University Family Medicine Residency Center in Flint, Michigan, and Assistant Professor at the MSU College of Human Medicine.