Application of asthma action plans to childhood asthma: national survey repeated

Define the way childhood asthma action plans are currently being used in New Zealand; determine New Zealand doctor's recommendations about the use of an increased dose of inhaled steroids in asthma action plans; and determine if there has been any change (during the last 7 years) in the way asthma action plans are used.

A postal survey was sent to all 297 paediatricians and paediatric registrars in New Zealand, and to a random sample of 500 general practitioners (GPs). The questions related to asthma action plan use, the inclusion of an increased dose of inhaled steroid in those plans, and details of the way doctor's adjusted inhaled steroid dose. Comparisons were made for selected questions between this survey and the same survey conducted in 1995.

Valid responses were received from 179 (60%) paediatricians and paediatric registrars, and 233 (47%) GPs. 165 (70.8%) GPs and 137 (76.5%) paediatricians/paediatric registrars indicated that they used written action plans for children with asthma in their care. 184 (61.5%) respondents who used asthma action plans included a step involving an increase in the dose of inhaled steroid, compared to 83.6% in 1995 (p<0.001). GPs in 2002 were less likely to use action plans (p<0.001) and include a step with an increased dose of inhaled steroid (p=0.003) Paediatricians and paediatric registrars in 2002 were just as likely to use action plans (p=0.549), but less likely to include a step with an increased dose of inhaled steroid (p<0.001). GPs in 2002 were significantly more likely (than paediatricians and paediatric registrars) to include a step involving an increased dose of inhaled steroid (p<0.001) There has been a change in the practice of New Zealand GPs, paediatricians, and paediatric registrars--with a decreased tendency to double the dose of inhaled steroids in childhood action plans, thus suggesting doctors are cognisant of conclusions drawn by 'evidence-based medicine'.

There has also been a decline in the proportion of asthmatic children receiving a written asthma action plan, and this is inconsistent with recommendations contained in consensus documents.