Written action plans for asthma in children

 

Abstract

Background

While all asthma consensus statements recommend the use of written action plan (WAP) as a central part of asthma management, a recent systematic review of randomised trials highlighted the paucity of trials where the only difference between groups was the provision or not of a written action plan.

Objectives

The objectives of this review were firstly to evaluate the independent effect of providing versus not providing a written action plan in children and adolescents with asthma, and secondly to compare the effect of different written action plans.

Search methods

We searched the Cochrane Airways Group Specialised Register (November 2004), which is derived from searches of CENTRAL, MEDLINE, EMBASE, CINAHL, as well as handsearched respiratory journals, and meeting abstracts. We also searched bibliographies of included studies and identified review articles.

Selection criteria

Randomised controlled trials were included if they compared a written action plan with no written action plan, or different written action plans with each other.

Data collection and analysis

Two authors independently selected the trials, assessed trial quality and extracted the data. Study authors were contacted for additional information.

Main results

Four trials (three RCTs and one quasi-RCT) involving 355 children were included. Children using symptom-based WAPs had lower risk of exacerbations which required an acute care visit (N = 5; RR 0.73; 95% CI 0.55 to 0.99). The number needed to treat to prevent one acute care visit was 9 (95% CI 5 to 138). Symptom monitoring was preferred over peak flow monitoring by children (N = 2; RR 1.21; 95% CI 1.00 to 1.46), but parents showed no preference (N = 2; RR 0.96; 95% CI 0.18 to 2.11). Children assigned to peak flow-based action plans reduced by 1/2 day the number of symptomatic days per week (N = 2; mean difference: 0.45 days/week; 95% CI 0.04 to 0.26). There were no significant group differences in the rate of exacerbation requiring oral steroids or admission, school absenteeism, lung function, symptom score, quality of life, and withdrawals.

Authors' conclusions

The evidence suggests that symptom-based WAP are superior to peak flow WAP for preventing acute care visits although there is insufficient data to firmly conclude whether the observed superiority is conferred by greater adherence to the monitoring strategy, earlier identification of onset of deteriorations, higher threshold for presentation to acute care settings, or the specific treatment recommendations.

 

Plain language summary

This review examines the net impact of providing written action plans to children with asthma and their parents

We did not find any trial examining the benefit of providing versus not providing a written action plan to children with asthma.
Four clinical trials with 355 children were identified which compared the effect of symptom-based versus to peak flow written action plans when all other co-interventions were similar. Children assigned to a symptom-based plan less frequently required an acute care visit for asthma compared to those who received a peak flow based plan. Most other outcomes were similar with the exception of more children intending to continue using the symptom-based compared to the peak-flow based written action plan.

 

摘要

背景

針對氣喘幼童撰寫的書面治療計畫書

所有氣喘相關的共識原則都會建議將書面治療計畫書(written action plan ，WAP)視為氣喘治療的核心。近來一隨機試驗的系統性文獻回顧強調少數試驗的各組別間的差異僅在於是否有事先撰寫書面治療計畫書。

目標

本研究的主要目的在於評估對兒童及青少年氣喘患者提供書面治療計畫書與否的影響，其次是能比較不同書面治療計畫書的效果。

搜尋策略

我們檢索了CENTRAL、MEDLINE、EMBASE和CINAHL所衍生的Cochrane Airways Group Specialised Register(2004年11月)，也以人工方式檢索了呼吸相關期刊並檢閱相關摘要。我們也檢索了已涵括之試驗與回顧文章的參考資料。

選擇標準

凡是有是否提供書面治療計畫書或給予不同書面治療計畫書進行比較的隨機性對照試驗都被納入本研究的範圍。

資料收集與分析

有兩個審閱者分別獨立的進行試驗篩選、評估試驗品質和萃取數據的工作。此外，也會與作者聯繫以取得更多資料。

主要結論

本研究納入共355個兒童的4個試驗(其中3個是臨床隨機試驗，1個試驗為類臨床試驗)。取得根據症狀撰寫的治療計畫書者發生需要緊急照護惡化的風險比例會降低(樣本數為5，相對風險為073，95％的信賴區間介於0.55至0.99之間)。需要進行治療以預防一個患者進行緊急治療的人數為9人(95％信賴區間介於5至138間)。兒童對使用症狀監控的偏好優於尖峰呼吸量的監控(樣本數為2，相對風險為1.21，95％信賴區間介於1.0至1.46間)，但父母身上並無偏好傾向(樣本數為2，相對風險為0.96，95％信賴區間介於0.18至2.11間)。被分派至尖峰吐氣流量為基礎的治療計畫書的兒童每星期減少半天出現症狀的時間(樣本數為2，平均差為0.45天/週，95％信賴區間介於0.04至0.26間)。各組在需要口服類固醇或照護症狀惡化之速率、無法就學比例、肺部功能、症狀等級、生活品質和停藥的比例並沒有明顯差異。

作者結論

研究證據顯示，雖然有一些不夠充分的數據明確認為較遵從監測策略、較早是別惡化症狀、提高需要緊急照護環境的臨界值提高，但是根據症狀所提出的治療計畫書會比尖峰吐氣流量的治療計畫書更能夠預防緊急照護狀況的發生。

翻譯人

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

本研究檢視提供書面治療計畫書給患有氣喘的兒童及其父母所產生的淨衝擊。我們並沒有發現任一試驗檢驗提供或不提供書面治療計畫書給患有氣喘的兒童的療效。4個涵蓋355名兒童的臨床試驗，在所有其他介入的因素都雷同的狀況下，比較根據症狀的治療計畫書和尖峰呼氣量治療計畫書的效力。與接受尖峰呼氣量治療計畫書的組別相較，被分配到根據症狀提供治療建議書的兒童較少發生需要緊急照護的狀況。大多數的試驗結果都相似，但較多兒童傾向於繼續使用以症狀為基礎的書面治療計畫書，而不是以尖峰吐氣量為基礎的書面治療計畫書。