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Winter, 2012

NACI Breaking News

Patients Should Demand Asthma Action Plans

Asking Dr. Stuart Stoloff about asthma action plans (AAPs) is like asking Eli Manning, quarterback for the New York Giants, about football: He's at the top of his game, and passionate about it. With asthma, trying to maintain control without an asthma action plan is like asking football players to go out on the field without a game plan.

"An AAP is just one spoke in the wheel, a component in a greater, open dialogue between clinician and patient," said Stoloff, M.D., a clinical professor in the Department of Family and Community Medicine at the University of Nevada School of Medicine, and a family medicine practitioner. He also served as a member of the National Asthma Education and Prevention Program's Expert Panel II and III Guidelines for the Diagnosis and Management of Asthma.

Dr. Stoloff is talking about a partnership where the patient, and/or patient's family, actively works with the healthcare provider to learn about asthma, how to identify asthma triggers and symptoms, and ways to address them (including how to administer medication correctly.)

Image of football coach diagramming plays for his team

Developing individualized written AAPs, and educating patients on their use, is the foundation for this partnership since it removes the guesswork from treating asthma, and improves patient outcomes. That's why the National Asthma Education and Prevention Program's (NAEPP) clinical practice guidelines encourage patients and their health professionals to establish and maintain a partnership for asthma care.

LeRoy M. Graham, M.D.—a pediatric pulmonologist in Atlanta who sees a diverse array of patients at his practice—agrees.

He also partners with communities of faith through his Not One More Life asthma-education program, to teach and empower patients in the African American community who have asthma to make informed decisions.

Dr. Graham emphasizes that no matter what the patient's background, a clinician still needs to assess whether that patient has the understanding, tools, and techniques to follow the potentially life-saving instructions contained in a written AAP.

"We've simplified the language of our asthma action plan to a 6th grade level and shortened it to one page, because patients tend to pick up their action plans in a moment of crisis," said Graham. "When someone is panicking, we want their understanding and technique to be perfect—that's the time that it needs to be perfect."

That's why every time a clinician in Graham's practice hands out an AAP, he or she walks the patient through it.

"You can't just hand someone a piece of photocopied paper—you need time for active listening and you need time to secure complete buy-in by the patient," said Stoloff.

Dr. Stoloff states that this is one reason why AAPs continue to be underused, despite a call for their use 15 years ago in the NAEPP's first clinical practice guidelines. The NAEPP's current guidelines recommend that all patients who have asthma receive a written AAP as part of an overall effort to educate patients in asthma self-management. Using written AAPs is also one of the NAEPP's recommended six priority messages for improving asthma care and control. Written action plans are particularly recommended for patients who have moderate or severe persistent asthma, a history of severe exacerbations, or poorly controlled asthma.

Stoloff is disappointed by their underuse. But he has a solution.

"It's time to get patients engaged to such a level that they demand this type of care," said Stoloff. "An AAP can empower patients to gain control over their asthma."

Thousands of miles away, in Georgia, Dr. Graham echoes this sentiment. He calls it "radical healthcare consumerism," and encourages patients—especially minority and lower-income patients who bear the biggest asthma burden—to be more direct with their clinicians.

"People don't want to be passive. We don't encourage them to be rude to their provider—we just teach them how to be direct," said Graham. "I tell them: 'You have to enter this partnership and hold me accountable. Challenge me to make sure that you or your child gets better. If you're not doing your part, you or your child can't get better.'"

Graham reports that this approach works because it gives patients, and the parents of patients, the confidence they need to request the care they deserve, not just an asthma action plan. He anticipates that empowerment will lead to improvement, which will bridge gaps and improve asthma care for everyone.

Download or order a copy of the NHLBI's Asthma Action Plan or My Asthma Wallet Card.

Next: GIP in Focus

Last Updated February 2012

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