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GPs should provide written asthma action plans, say gold standard guidelines

GPs are urged to offer all patients with asthma a tailored, written asthma action plan, in newly revised asthma guidelines from the main advisory bodies.

The updates to the guidance from the British Thoracic Society (BTS) and Scottish Intercollegiate Guidelines Network (SIGN) – the gold-standard for asthma management in the UK – significantly raise the prominence of supported self-management in caring for asthma patients.

The self-management chapter, which now comes ahead of sections on pharmacological and non-pharmacological management, states that ‘self-management education, supported by a written personalised asthma action plan, should be offered to all patients on general practice “active asthma” registers’.

The guidance adds: ‘Primary care practices should ensure that they have trained professionals and an environment conducive to providing supported self-management.’

The Primary Care Respiratory Society (PCRS-UK) said it ‘wholeheartedly endorses’ the revised guidance, which also includes rewrites of the sections on non-pharmacological management and the organisation of asthma care pathways.

Dr Duncan Keeley, from PCRS-UK executive and a GP in Thame, Oxfordshire, told Pulse the self-supported management updates were ‘the most important change’ to the guidelines, and were supported by ‘overwhelming evidence’.

Dr Keeley said: ‘There is now overwhelming evidence from trials – which are all referenced in the guidelines – that using personal asthma action plans improves outcomes.

‘The vast majority of asthma care and the review of patients with asthma goes on in primary care, so GPs and asthma nurses need to be thinking more of giving patients clear self-management plans to control their symptoms when they get worse.’

He added: ‘[The revised guidance] is a further and more powerful statement of the evidence that this is a beneficial intervention for people with asthma. I think that is the most important change.’

BTS/SIGN British guideline on the management of asthma – October 2014

>>>> Clinical Newswire

Readers' comments (7)

  • John Glasspool

    Sure- we'll give gold-standard care, when we receive gold-standard funding.

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  • I aim for diamante standard at all times.

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  • Azeem Majeed

    Asthma UK has a range of support materials to support self-care on its website including an asthma action plan.

    See http://goo.gl/49gwEV

    Asthma UK do not have a video on care planning but one is offered by Diabetes UK - the principles of care planning are similar for different diseases.

    See http://goo.gl/OuYdhM

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  • Vinci Ho

    I think the evidence of self management plan is more important and with more proven success than perhaps diabetes , because patients are so often confused about the purposes of their inhalers , for instance. How often do you come across a patient using inhaled steroid PRN and short acting beta2 agonist 2puffs bd ?

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  • Mmmm and how many GPs actually fill them out...that'll be the PNs doing that as usual. They should be done but as a resp nurse yet to find a GP using them unless they have a special interest

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  • Need to be standardised so all GP practices use the SAME template as should the read codes, not just for EMIS, but for when the pt moves to another practice using another computer system. Astonishing that a charity ASTHMA UK provides simple and clear Action plans and to date, but this cannot be saved to the pts record like other Mentor PILS ( from EMIS) Primary/secondary care do not provide ( to date )a standardised Action plan. The EMIS Asthma action plan (PILS) is not consistently found under Mentor and it does not pick up the pt's data e.g. Best PEFR, asthma triggers that have been recorded earlier. It does quote a resource...the Australian Action Plan! The idea is to prevent death, not just collect data for QOF. see Sudden Death from Asthma (Bateman et al 1979). 35 years later (from 1979) and we are not much better. Hopefully this can be improved. Try and use the same IT platform e.g. Clarity now share with RCGP for Appraisal, so PAAP could share with Asthma UK which is 'Easy to Use Easy to Learn' as well as Secondary care when discharging pts back to primary care, avoiding a different format of plan- otherwise the pt will be confused/ignore the plan and their inhalers/meds.

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  • Leading the patient through the use of an asthma plan is the way to go. Coaching them so that they can work within given parameters I think leads to better control. Time taken to do this is well invested...

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