Writing an asthma action plan

Both health professionals and governments are anxious about this year’s flu season,¹ and case numbers are already climbing.²

It’s a reminder that colds and flu are back to trouble us — especially people with asthma, for whom respiratory infections can trigger severe attacks.

For our patients with asthma, knowing what to do and acting quickly could help prevent worsening asthma symptoms that result in a trip to the emergency department and another course of oral corticosteroids.

That’s why we need to make sure every child, adolescent and adult with asthma has their own up-to-date action plan, recorded in a format they (or their parents) can easily understand, and kept somewhere they can access immediately when needed. Asthma action plans should provide clear, individualised instructions on how to adjust medication in response to asthma symptoms, and state when and how to get medical care, including during an emergency. The instructions need to be specific and based on the person’s usual treatment.

What, when and how many inhalations?

This is key advice that patients need to know and needs to be included in the action plan, but the wide range of day-to-day asthma treatment regimens now in use — particularly for adolescents and adults — can make it complicated. A patient’s day-to-day treatment could be salbutamol or terbutaline taken as needed, low-dose budesonide–formoterol as needed; an inhaled corticosteroid maintenance treatment plus salbutamol as needed; one of an increasingly long list of inhaled combinations of corticosteroid and a long-acting beta2 agonist (again with salbutamol as needed); or a combination of an inhaled corticosteroid and formoterol taken both daily as maintenance treatment and as-needed for symptom relief. The list is growing as more treatments are approved by the TGA and PBS.

This means there are now at least seven different options for a patient’s usual symptom reliever. These cover a long list of brand names and can be delivered by either metered-dose inhalers or dry-powder inhalers. The number of inhalations taken to relieve symptoms varies between products, and each has a different daily maximum.

All these variations mean that prescribers need to be familiar with a lot of variables — or have a reliable cheat sheet on hand. This is where the Australian Asthma Handbook can help.

How-to information on asthma plans

The recently updated Australian Asthma Handbook (asthmahandbook.org.au) includes detailed information on writing asthma action plans. It shows specific recommended options for increasing treatment in response to worsening symptoms for each of the possible current regimens. The latest update includes new and updated key tables to guide us in preparing asthma action plans.

From the Australian Asthma Handbook home page, find Management and choose Written asthma action plans from the menu. You can choose information on preparing action plans for adults or children. The webpage on Preparing written asthma action plans for adults and adolescents includes a table setting out the Options for adjusting medicines in a written asthma action plan, set out according to the patient’s usual treatment.

For guidance on the usual dose of reliever medicines for adults to take in response to symptoms, choose Management, Adults, Initial treatment, then Relievers. Find the link to the table Usual (non-emergency) as-needed reliever doses for adults and adolescents ≥ 12 years.

There is a library of action plan templates available on the National Asthma Council website (nationalasthma.org.au). Choose Asthma action plans from the Health Professionals menu. There you can also find How-to videos with step-by-step guides on correct inhaler technique.

References

^{1. Attwooll, J. Flu return ‘inevitable’ in 2022. News GP (website). 4 February 2022. https://www1.racgp.org.au/newsgp/clinical/flu-return-inevitable-in-2022}

^{2. Australian Government Department of Health. Australian Influenza Surveillance Report No 03 - fortnight ending 08 May (online report). https://www1.health.gov.au/internet/main/publishing.nsf/Content/cda-surveil-ozflu-flucurr.htm}

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