Relationship Between the Use of Asthma Action Plans and Asthma Exacerbations in Children With Asthma

Abstract

The purpose of this integrative review is to describe and assess current research findings and summarize the relationship between action plans and asthma exacerbations in children with asthma. Medline, CINAHL Plus with full text, PubMed, and Cochrane Library databases were searched as well as bibliographies of included studies. Three hundred eighty-five studies were identified. Thirteen studies were identified meeting inclusion criteria. Eight studies compared asthma action plans (AAPs) with no AAPs. Five studies compared peak flow AAPs to symptom AAPs. Of the 8 studies comparing AAPs with no AAPs, 5 studies concluded that the plans were beneficial to pediatric asthma. One study concluded that AAPs may increase risk for readmission to the hospital. Another study concluded that there is no evidence to suggest that AAPs along with an educational package were beneficial in reducing morbidity in the subsequent 12 months for preschoolers. A third study concluded there were greater costs in the group with AAPs without better outcomes. Of the 5 studies comparing peak flow AAPs with symptom AAPs, 3 studies found that AAPs are effective for pediatric patients but there is no benefit of peak flow AAPs over symptom AAPs. Two studies found that peak flow meter use along with an AAP was a more effective way to decrease hospitalizations. Data suggest that AAPs are beneficial to pediatric asthma patients. Either peak flow–based or symptom-based plans are effective in the control of asthma exacerbations. However, there does not appear to be evidence to support the use of peak flow–based AAPs over symptom-based AAPs.