Asthma in Australia 2005
A written asthma action plan (AAP) enables people with asthma to recognise a deterioration in their condition promptly and respond appropriately, by integrating changes in symptoms or peak expiratory flow measurements with written instructions to introduce or alter their medication. The aim of an AAP is to assist the process of early intervention and to prevent or reduce the severity of acute asthma episodes. There is evidence that, in patients with asthma, the use of a written AAP in conjunction with training in self-management and regular medical review improves outcomes. This includes less need for hospitalisation, urgent GP visits, and additional medication, as well as better lung function (Gibson et al. 2002). It has also been shown that written AAPs reduced the risk of death from asthma by 70% (Abramson et al. 2001). 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 NAC (NAC 2002) .
AAPs may be provided in various formats. The following features, which are common to most of the AAPs that have been shown to be beneficial,are considered to be the four essential components:
1. The AAP should be in a written format.
2. It should be individually prescribed, rather than a generic example.
3. It should contain information that allows the user to recognise the onset of an exacerbation.
4. It should contain information on what action to take in response to that exacerbation (usually increase or commence steroids and/or seek urgent medical care).
While most existing surveys on the use of AAPs have asked about the possession of a written AAP, most have not specifically established whether it contains the other essential components.
Possession of written asthma action plans
In recent surveys the proportion of adults with current asthma who possess an asthma action plan ranged from 15% to 22% (Table 6.1).
People with recent asthma symptoms or with more severe asthma were more likely to report that they possessed a written AAP. In New South Wales in 1997, 43% of adults with severe asthma possessed a written AAP (Marks et al. 2000) . In the same state, in 2003, 41.2% of people who had taken treatment for asthma or had symptoms of asthma in the last 4 weeks reported having a written AAP (Centre for Epidemiology and Research 2004) . At the same time, in Victoria, 51% of people who had experienced asthma symptoms in the last 12 months had an AAP (Department of Human Services, unpublished data 2004).
Table 6.1: Possession of asthma action plans: people with current asthma, Australia, 1998–2001
Time trends in the possession of written asthma action plans
The data from the series of South Australian Health Omnibus surveys show that, between 1992 and 1995, there was a rise in the proportion of adults with asthma who reported that they had AAPs (Figure 6.1). This trend is confirmed by the NAC studies in eastern Australia in 1990 and 1993. However, the rate of AAP ownership has declined since 1995 in the South Australian series. No other time series is available for the recent period, but the single studies performed in recent years in other states and nationally show rates of possession of AAPs equivalent to the most recent, lower, rates found in the South Australian series (Table 6.1).
Figure 6.1: Possession of asthma action plans: adults with current asthma, Australia, 1990–2001
Differentials in the possession of written asthma action plans
Age and sex
Among people with asthma, the highest rate of possession of written AAPs was among children and the lowest rate was among young adults (Figure 6.2). In the adult age range, females were more likely than males to report having a written AAP, except in the elderly. Males aged 15 to 34 years and females aged 65 years and over had a very low rate of possession of written AAPs (10.8% and 7.1%, respectively).
Figure 6.2: Possession of a written asthma action plan in people with current asthma, by broad age group and sex, Australia, 2001
States and territories
The proportion of people with current asthma who reported having a written AAP was relatively high in the Australian Capital Territory and New South Wales and relatively low in Western Australia, Tasmania and Queensland (Figure 6.3).
Figure 6.3: Possession of a written asthma action plan in people with current asthma, by state and territory, all ages, Australia, 2001
Urban, rural and remote areas
There was no significant difference in the rate of ownership of a written AAP among people with current asthma living in major cities, or in regional and remote areas (p trend=0.1) (Figure 6.4).
Figure 6.4: Possession of a written asthma action plan in people with current asthma, by remoteness, all ages, Australia, 2001
Culturally and linguistically diverse background
In the 2001 National Health Survey (ABS 2002a), approximately 17% of people from English-speaking backgrounds reported possession of written asthma action plans, compared to 13% from non-English-speaking backgrounds (ACAM 2003). This difference was not statistically significant.
There was a lower rate of possession of written AAPs among people with asthma living in localities with greater levels of socioeconomic disadvantage (p trend=0.04), (Figure 6.5).
Figure 6.5: Possession of a written asthma action plan in people with current asthma, by socioeconomic status, all ages, Australia, 2001
The majority of people with asthma do not have a written asthma action plan. Although there was apparently an increase in the use of AAPs during the early part of the 1990s, coinciding with the public awareness campaigns of the National Asthma Council (Comino et al. 1996), this trend has not been sustained. Young adults, adult men, and persons living in outer regional and remote areas and in socioeconomically disadvantaged areas were least likely to have a written AAP. People with more severe asthma or those experiencing symptoms were also more likely to have AAPs. There was some variation among the states and territories in the proportion of people with asthma who reported possessing a written AAP.
There are no data on the extent to which the AAPs that are in use incorporate those elements that are required for their effectiveness.
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