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A Road Map for Asthma Care

by Jennifer Jones, RRT I magine that you've been invited to a family reunion. The

reunion is several states away from where you live, and you plan

to travel with other nearby relatives. In order for everyone to go,

you'll have to take at least three cars. How will you know how to

get there? And how will you coordinate the trip with the other fami-

ly members who are also driving? More than likely, you'll be given a

map that will tell you exactly how to get there. Each of your family

members will probably be given the same map. This ensures that

everyone will be heading in the same direction and will eventually

arrive at the same place.

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A map is just one type of com- munication tool that we use; we use many different types of these tools every day. Maps tell us how to get from one point to the next. Similarly, written instructions can help us with programming our VCRs (if we'd only read them!) and written instructions can also help us with managing asthma.

Increasing in popularity, asthma action plans (also referred to as asth- ma control or management plans) are now helping people with asthma fol- low the right management path. Many health care providers are now using these written plans to help communicate to patients the most important points of asthma manage- ment. As a result, patients are finding it easier to figure out when to call the doctor, what their peak flow readings indicate, and simply what medicine to take and when to take it.

W h a t i s a n A s t h m a

A c t i o n P l a n ?

There are a variety of asthma action plans in use, but most of them relay the same type of information. A typi- cal plan will include:

Medications - T h e most important part of managing asthma is to under- stand how to take the medications. An action plan will list each specific medicine and indicate how much to take and when to take it. Medications will often be listed as either a "reliev- er" (such as albuterol) or a "con- troller" (such as cromolyn sodium).

Warning signs - Action plans usually list the most common warning signs of an asthma episode. They specify which are early warning signs and which are late warning signs that indi- cate asthma is getting out of control. However, some plans are customized, allowing you to specify the warning signs that you experience with asthma.

Triggers - Since the factors that trig- ger asthma (such as dust, smoke,

pollen and animal dander) are so individual, this part of the action plan should always be customized. Common triggers should be listed and you should circle the triggers that play a role in your asthma. Your health care provider should help you develop strategies to limit your expo- sure to these triggers.

Physician's name and phone num- ber - If an action plan is going to be made available to others, such as a babysitter or a school nurse, it is very important to have some general information outlined. The plan should include your name, address

and phone number as well as your work phone and who to contact in case of emergency. This plan should also include your physician's name and phone number.

H o w D o A s t h m a A c t i o n P l a n s H e l p ?

Asthma action plans contain key information that can help in situa- tions where you might not know what to do. With the authorization of the health care provider, an asthma action plan can give instructions to alter the amount of medication to be taken in certain situations. For exam- ple, if asthma symptoms persist or

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worsen, an extra dose of medication may be indicated. In turn, if a reliever medication, such as albuterol, is needed more frequently than pre- scribed, it is usually a sign that it is not doing the job, and an anti- inflammatory medication may be needed. If this is the case, an asthma action plan will direct you to see your health care provider or seek emer- gency care. In such situations, an asthma action plan can eliminate con- fusion and make it much easier for both the patient and health care provider to manage asthma. When everyone is on the same page, there is much less room for error.

Another common feature of asth- ma action plans is the coordination of peak flow scores with warning signs and the specific actions that should be taken. For example, if your peak flow reading falls between 50 and 80 percent of predicted, the plan sum- marizes the warning signs that you may be experiencing and, in most cases, instructs you to take additional specified medication and to contact your physician's office. This feature is helpful to people who use peak flow meters on a regular basis to monitor

their asthma. Using the peak flow meter zones of red, yel- low and green (with each col- ored zone associated with a personalized range of peak flow scores) makes the plan easy for children and other individuals to interpret.

Numerous studies have shown that when a patient is provided with a simple, cus- tomized plan that communi- cates specific information and instructions, their emergency visits decrease, indicating that they have better control over their asthma. This is obvious- ly helpful to the patient, but it is also helpful for insurance companies and managed care organizations for it reduces the costs associated with asth-

ma in hospitals, clinics and emer- gency rooms.

A S t a r t i n g P l a c e f o r A s t h m a E d u c a t i o n

Written asthma action plans can be helpful for everyone managing the complexities of asthma, but they can be particularly helpful in relieving the anxiety of someone who has been newly diagnosed with asthma. When one is first confronted with having to manage asthma, it can seem confusing and overwhelming. Although an action plan does not include all the information that someone with asthma requires, it is a starting point and it reduces the amount that the person has to rely on his or her own judgment when first managing the condition. Educating a patient with asthma should be a gradual, ongoing process. Often, at a patient's first visit, the health care provider over- whelms the patient with information on how their medicines work, how to eliminate triggers, and how to start a peak flow diary. (And, even worse, some do not provide any information at all.) An asthma

action plan facilitates the transfer of information about asthma and sets a precedent for effective and ongoing communication between the patient and the physician.

If you have asthma or are a par- ent of a child with asthma, an asthma action plan can help you understand the steps to managing asthma and provide you with a tool to communi- cate with others. Once you've started to follow a written asthma plan, you're headed toward a lifetime of control, with little chance of missing any turns along the way.

Jennifer Jones, RRT, is director of Pediatric &Adult Lung Health Programs for the American Lung Association in Tucson, Arizona.

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