Asthma in Australia 2008Header
Table of Contents | Chapter 1  2  3  4  5  6  7  8  | Appendix 1 2 | References |


6. Management

| Introduction | 6.1 Written asthma action plans | 6.2 Medications used to treat asthma |

6.1 Written asthma action plans

| Introduction | 6.1.1 Possession of written asthma action plans | 6.1.2 Time trends | 6.1.3 Population subgroups | Summary |

Key points

  • The majority of people with asthma do not have a written asthma action plan, despite national guidelines recommending their use for the management of asthma for nearly 20 years.
  • Young men and those living in socioeconomically disadvantaged areas are less likely to possess a written asthma action plan than others.

Introduction                     [back to top]

A written asthma action plan enables people with asthma to recognise deterioration in their condition promptly and respond appropriately, by integrating changes in symptoms or peak expiratory flow measurements with written instructions to adjust medication. The aim of an asthma action plan is to help the process of early intervention and to prevent or reduce the severity of acute asthma episodes. It has been found that use of a written asthma action plan reduces the need for extra medication, urgent visits to doctors, hospitalisations and deaths as well as improves lung function (Abramson et al. 2001; Gibson et al. 2004). Written asthma action plans have formed part of national guidelines for the management of asthma since 1989 (Woolcock et al. 1989) and have been promoted in public education campaigns by the National Asthma Council Australia (NAC 2006).

6.1.1 Possession of written asthma action plans                     [back to top]

Less than one-quarter (22.5%) of Australians with asthma reported possessing a written asthma action plan in 2004–05 (Table 6.1). Of those who possessed a written asthma action plan in 2004–05, more than 90% were obtained from doctors and about three-quarters were considered ‘standard’, that is, similar to that recommended by the National Asthma Council Australia.

Recent estimates of the possession of asthma action plans from state health surveys vary. Relatively high rates were reported in New South Wales in 2005 and 2006 (46% and 38%, respectively) and Victoria in 2006 (54%) (Table 6.1). Estimates of possession from among adults with asthma in Queensland and South Australia were closer to the national average, at around 18.5–20.8%. Some of the apparent variation between surveys (and, hence, states) may be due to differences in the way asthma action plans were described to participants.

Table 6.1: Possession of asthma action plans by people with current asthma, 2001–2007

6.1.2 Time trends                     [back to top]

There was a rise in the proportion of adults with asthma who reported they had asthma action plans between 1992 and 1995 (Figure 6.1). Since that time, the rate of ownership declined in the South Australian series. More recent survey results show an increase in the possession of asthma action plans in New South Wales and nationally. In 2005, almost half (46%) of people aged 16 years and over with asthma in New South Wales reported possessing an asthma action plan. Data from the NHS (all ages) show that, overall, significantly more people with asthma had a written asthma action plan in 2004–05 (22.5%) than in 2001 (17%).

Figure 6.1: Possession of asthma action plans by adults with current asthma, Australia, 1990–2007

6.1.3 Population subgroups                     [back to top]

Age and sex

Children with asthma who were aged 5–14 years were significantly more likely to have a written asthma action plan than people aged 15 years and over (Figure 6.2). Among those aged 15–64 years, more females than males had a written asthma action plan (p < 0.0001).

States and territories

In 2004–05, the proportion of people with current asthma who reported having a written asthma action plan was relatively low in Western Australia (15%) compared with the national average (22.5%) (Figure 6.3).

Figure 6.2: Possession of a written asthma action plan by people with asthma, by age and sex, 2004–05

Figure 6.3: Possession of a written asthma action plan by people with current asthma, by state and territory, all ages, 2004–05

Urban, rural and remote areas

Data from the two most recent National Health Surveys conducted in 2001 and 2004–05 show that, overall, possession of a written asthma action plan did not differ significantly between those living in major cities, inner regional areas or other areas of Australia (data not shown). In New South Wales in 2006, there was also no difference in possession of asthma action plans among people living in urban versus rural areas (Centre for Epidemiology and Research 2007).

Socioeconomic disadvantage

Australian data show a lower rate of possession of written asthma action plans among people with asthma living in localities with greater levels of socioeconomic disadvantage. In 2004–05, the proportion of people with current asthma who reported having a written asthma action plan was highest among those living in the most advantaged localities of Australia (27%) and lowest for those living in the most disadvantaged localities (19%) (Figure 6.4). There was a significant overall trend of increasing rates of possession of plans with higher levels of socioeconomic advantage (p trend = 0.002).

In contrast, data from the New South Wales Health Survey Program show no evidence of significant variation according to socioeconomic disadvantage of locality (Centre for Epidemiology and Research 2007). A study of children in Victoria also found no evidence of such a trend (Vuillermin et al. 2007), with children residing in disadvantaged areas just as likely to have been provided with a written asthma plan than children residing in less disadvantaged areas (p = 0.81).

Figure 6.4: Possession of a written asthma action plan by people with current asthma, by socioeconomic status, Australia, 2004–05

Summary                     [back to top]

Although written asthma action plans have been recommended in national guidelines for the management of asthma for almost 20 years, the majority of people with asthma do not have one. Young adults, particularly men, those living in socioeconomically disadvantaged areas and those living in Western Australia were least likely to possess a written asthma action plan in 2004–05.

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