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Promoting Patient Self-Management with Asthma Action Plans

 inhalersIt is estimated that over 3.8 million people in Canada currently suffer from asthma[1], approximately 250 people in Canada die from asthma each year[2] and approximately 317 Canadians are diagnosed with asthma every day[3].

Yet, more than 50% of Canadian patients with asthma remain poorly controlled, with both clinicians and patients grossly underestimating the magnitude of uncontrolled asthma.[4]

Why is that?

There are still many gaps between research evidence and clinical practice:

  • Many patients don't have their asthma objectively diagnosed and followed with spirometry.
  • Most healthcare professionals don't assess their patients' asthma control according to guideline criteria and are therefore unaware of their patients’ poor control.
  • Most patients with asthma are undertreated, largely because poor control is undetected.
  • Many healthcare professionals don't provide their patients with an asthma action plan to empower patients to self-manage their asthma. Specifically, only 4% of Canadian physicians report consistently providing a written asthma action plan[5], and less than 2% of patients report receiving one[6].

There is a robust evidence base, including a 2003 Cochrane review of 18 randomized controlled trials that demonstrates that asthma action plans, when combined with education and regular clinical review, reduce hospitalizations, emergency room visits, missed school/work, nocturnal asthma symptoms, and unscheduled visits to the doctor.[7] They also improve quality of life.

Similar conclusions were reached by a more recent review of reviews encompassing 270 randomized controlled trials.[8] Note, that without regular follow-up, asthma action plans and even education are not sufficient to make an impact.[9]

Accordingly, the use of asthma action plans has been recommended by Canadian and international guidelines for over 25 years. [10],[11],[12],[13]

A practical evidence-based care tool for your practice.

In partnership with the Lung Health Foundation, we are excited to bring you a newly updated version of our Asthma Action Plan Program based on the most recent guidelines from the Canadian Thoracic Society on the diagnosis and management of asthma. The free 1-hour interactive course is comprised of the latest evidence and practical resources that you can use to immediately implement asthma action plans in your practice - giving your patients with asthma a clear and safer understanding of their symptoms and how they should be managed.

If you are looking for more lung health topics, explore the other programs we have developed in association with the Lung Health Foundation and other partners.

  1. COPD In Primary Care
  2. Spirometry: A Clinical Primer
  3. Emergency Department Asthma Care Pathway
  4. Paediatric Emergency Department Asthma Care Pathway
  5. Radon

[1] Public Health Agency of Canada. Report from the Canadian Chronic Disease Surveillance System: Asthma and chronic obstructive pulmonary disease (COPD) in Canada. Published 2018.

[2] Hermus G, Stonebridge C, Goldfarb D, Thériault L, Bounajm F. Cost risk analysis for chronic lung disease in Canada. Published 2012.

[3] The Hospital for Sick Children (SickKids). Asthma in Ontario. (n.d.)

[4] FitzGerald JM, Boulet LP, McIvor RA, Zimmerman S, Chapman KR. Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. Can Respir J. 2006;13(5):253-259. doi:10.1155/2006/753083

[5]  Djandji F, Lamontagne AJ, Blais L, et al. Enablers and determinants of the provision of written action plans to patients with asthma: a stratified survey of Canadian physicians. NPJ Prim Care Respir Med. 2017;27(1):21.. doi:10.1038/s41533-017-0012-3

[6] Price C, Agarwal G, Chan D, et al. Large care gaps in primary care management of asthma: a longitudinal practice audit. BMJ Open. 2019;9:e022506. doi:10.1136/ bmjopen-2018-022506

[7] Powell H, Gibson PG. Options for self-management education for adults with asthma. Cochrane Database Syst Rev. 2003;2002(1):CD004107. doi:10.1002/14651858.CD004107

[8] Pinnock H, Parke HL, Panagioti M, et al. Systematic meta-review of supported self-management for asthma: a healthcare perspective. BMC Med. 2017;15(1):64. doi:10.1186/s12916-017-0823-7

[9] Gatheral TL, Rushton A, Evans DJW, et al. Personalised asthma action plans for adults with asthma. Cochrane Database Syst Rev. 2017;2017(4). doi:10.1002/14651858.cd011859.pub2

[10] Lougheed MD, Lemière C, Dell SD, et al. Canadian Thoracic Society Asthma Management Continuum -- 2010 Consensus Summary for children six years of age and over, and adults. Can Respir J. 2010;17(1):15-24. doi:10.1155/2010/827281

[11] Lougheed MD, Leniere C, Ducharme FM, et al. Canadian Thoracic Society 2012 guideline update: Diagnosis and management of asthma in preschoolers, children and adults: executive summary [published correction appears in Can Respir J. 2013 May-Jun;20(3):185]. Can Respir J. 2012;19(6):e81-e88. doi:10.1155/2012/214129

[12] Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention. Published 2020.

[13] Scottish Intercollegiate Guidelines Network, British Thoracic Society. British guideline on the management of asthma. Updated 2019.