Don't write off paediatric asthma action plans just yet.

Children with asthma can experience poor control of their disease, resulting in decreased quality of life, recurrent asthma exacerbations, and hospital presentations. Health-related outcomes can be improved with comprehensive asthma management, and an important component of asthma selfmanagement is the Asthma Action Plan (AAP). Of particular significance in paediatrics is the fact that the primary caregivers have an important role in overseeing their child’s asthma management. Current international guidelines recommend that asthma management includes education about asthma medication and use of inhalation delivery devices, prevention of symptoms, management of acute episodes, self-management monitoring and control of asthma, with regular review and the provision of the AAP to help the patient and/or caregiver recognise and manage acute asthma episodes. Despite existing evidence on the benefit of having an AAP there are still many questions that remain about the individual patient’s confidence and understanding, and the effects of subsequent education, in their utilisation of their AAP. Some but not all of these questions are addressed in the study by Tan et al. published in this issue of the PRCJ. The authors conducted a questionnaire survey which aimed to explore the reasons for the reported increase in caregivers’ confidence to provide care to their child during an acute asthma episode associated with having a Written AAP (WAAP). They report that compared to caregivers who did not possess a WAAP, those with a WAAP demonstrated better understanding and recognition of the symptoms of an acute episode and had a better understanding of medications including being more confident with medication use and less concerned about possible side effects of asthma medications. However, no difference was noted between caregivers (with or without a WAAP) in their likelihood to stop medications without consulting their physician, seek acute care consultation, and their confidence in self-management of their children’s asthma at home. How does continuing to use the AAP as part of overall asthma management expand the opportunities for further improvements in asthma self-management? Fostering and then further developing an ongoing relationship with children, adolescents and caregivers to enhance their understanding of asthma management knowledge and confidence is vital to self-management. For example, a simple discussion on the role of the AAP and what this means for asthma management at home and/or school can assist with identifying barriers that may compromise adherence to asthma medications. A tailored approach with specialist care from medical and nursing staff has been shown to lead to better asthma control, lung function and adherence to asthma management. However, changing health-related activities and behaviours can be an ongoing challenge for caregivers and clinicians. One of the challenges for clinicians is the potential confusion over which type of AAP to use. Over the years the AAP has evolved, not only in design but also in the way in which it is described. In the literature the AAP is referred to as an ‘asthma medication plan’, ‘living with asthma plan’, ‘treatment plan’, ‘asthma control plan’, ‘WAAP’, or ‘written selfmanagement plan’ – and therefore it is important that the type of plan used in a community and/or hospital setting is consistent with the organisation’s asthma management guidelines, whether these guidelines are local, national, or international. But while possession of an AAP can play an important role in meeting this challenge, the instructions we provide need to be in layman’s language with minimal medical terminology; they need to have clearly defined actions that educate how to identify and monitor for signs and symptoms of asthma, and be clear and concise on how to use asthma medications and devices for acute and interval management as well as when and how to seek further medical advice. Tan et al. found that caregivers with a WAAP were more likely to understand bronchoconstriction, feel capable and safe to manage their child’s asthma, have increased confidence to change doses of medications during an asthma episode, perceive inhaled asthma medications to be safe, and understand the use of controller medication. Their study also highlights that the provision rates of AAPs to caregivers remains suboptimal (only 56% in this cohort) and needs to improve. Their results show that gaps in caregiver knowledge, understanding and confidence in asthma management can be reduced with provision of a carefully designed AAP, combined with education targeting the recognition of asthma-related symptoms, Don’t write off paediatric asthma action plans just yet