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Written Action Plans

Home Management Written Action Plans

Written Asthma Action Plans

Personalised written asthma action plans show patients how to make short term changes to their treatment in response to changes in their symptoms or PEF. An action plan should provide instructions on maintenance therapy, early asthma attack management and crisis management.

Discuss the benefits of having and using a written Asthma Action Plan (AAP) with the patient, including: fewer attacks, doctor visits, hospitalisations and time off work. This evidence comes from general populations with mild to moderate asthma, not patients with severe asthma. (Gibson et al. 2004)
There are action plans available for patients using single inhaler maintenance and reliever therapy (sMART) and Anti-Inflammatory Reliever (AIR) therapy. See Asthma Australia and the National Asthma Council websites for downloadable action plans
As clinicians an AAP should be recommended as an essential tool in asthma self-management. Asthma attacks occur without warning and an AAP provides instruction on how and when to intervene early to prevent severe episodes.

There are four key elements of an AAP:

1: When to increase treatment

2: How to increase treatment

3: How long to stay on increased treatment

4: When to seek further medical attention (urgent care)

Ensuring patients’ understand the action plan and agree to implement the actions is critical in the development and prescription of the plan.

Increasing treatment in severe asthma when there is a worsening of symptoms or a decrease in PEF:

Because patients are already taking maximum doses of inhaled medications, additional asthma medications will be necessary in accordance with the asthma guidelines.
If patients do not improve with additional treatment or their symptoms worsen despite taking increased medication, they usually need urgent medical/hospital treatment.

“Example” Asthma Action Plan for Patients with Severe Asthma

How I feel	Action	Additional Advice/Action
Everyday asthma care	Take your usual asthma and allergy medicines as directed	Regular review e.g. every 6-12 months
When I feel worse [doctor and patient to agree on specific trigger points for initiating prednisolone]	Make sure you are taking your prescribed dose of each inhaled medication Additional asthma medications will be necessary [Doctor: Provide specific advice on the side effects of medications, depending on the individual]	[Doctor: Provide specific advice for each individual patient, depending on the speed at which they usually deteriorate. For patients measuring their PEF, discuss a specific cut point with the patient at which they should start oral corticosteroids.]
Emergency My reliever inhaler is not helping or I need it more than every 3 hours; I find it difficult to walk or talk; I find it difficult to breathe; I’m wheezing a lot or I have a very tight chest or I’m coughing a lot; My peak flow is below _____	Contact Medical Team/Go to hospital by ambulance (call 000) Keep taking reliever as often as needed	[Doctor: provide specific advice for each patient: For example, not improving with additional asthma medication or severe shortness of breath, Bronchodilator not lasting 3 hours Peak flow of less than XX% of personal best. Provide additional advice specific to the patient, based on their previous asthma attacks]

Using an Asthma Action Plan

Asthma action plans (AAPs) need to be agreed by patient and clinician and recorded in a retrievable written or digital form to which the patent can refer when needed.
An AAP should be reviewed (or created if the patient does not have one) after every asthma attack, medication change or at a minimum once per year for adults and 6-monthly for children
Ensure the patient understands and agrees with the AAP.
Patient education of AAPs is important to ensure that the patient has a thorough understanding of what is being asked of them during an asthma attack (McDonald & Gibson, 2009)
Reach agreement with the patient and family about action points. Be aware that patients with severe asthma may delay presenting because of family issues, fear of oral corticosteroid side-effects etc. (Foster et al. 2017)
Paper is not the only option for AAPs, with many patients choosing digital apps to self-monitor and store action plans. Local Australian examples include:
- Asthma Buddy
- Asthma Australia’s Asthma Connect App (currently under development)
- Menzie’s app for Lung Health (for Aboriginal and Torres Strait Islander people)

There is a wide range of written Asthma Action Plans including ones for Aboriginal people, and some translated into common community languages on the National Asthma Council website.

Asthma Action Plan presented with permissions from the National Asthma Council Australia.

Emergency Hospital Plans

Discuss with the patient and their family what happens when they have to go to hospital.
Recommend always calling 000 rather than getting someone to drive patient to hospital. Treatment commences in the ambulance, before the patient gets to hospital.
In some states, it may be possible to register patient as “Severe Asthma Patient” with ambulance services.
Ensure that the GP or Respiratory Physician details an emergency action plan explaining what symptoms are like during an asthma attack and which treatment works best. Always supply a couple of copies of this plan to patient (or take a photo of it on their phone) so they can hand it over when they get to A&E.
Teach patients to say: “I have severe asthma. This emergency action plan tells you what I need.”
If patients are unable to speak, recommend they use a pen and paper to communicate their asthma symptoms or use their phone to text.