Providing individualized written asthma action plans during the pediatric emergency department visit

Introduction: Among children presenting to the pediatric emergency department (PED) with an asthma exacerbation, the objective was to determine if creating an individualized written asthma action plan (WAAP) during the PED visit, when compared with standard discharge instructions, led to fewer asthma-related unplanned return visits up to three months after the PED visit. Secondary outcomes included rates of routine follow up with a healthcare provider, asthma control scores and caregiver confidence measures.Methods: Children ages 2-17 who presented to the PED with an asthma exacerbation and did not already have a WAAP were randomized to receive discharge instructions including a WAAP versus standard discharge instructions. The WAAP was ordered by the physician and reviewed with families by a respiratory therapist as part of a brief educational session during the PED visit. Parents completed follow-up surveys at one and three months after the PED visit.Results: 91 families were enrolled and 83/91 (91%) completed at least one follow-up survey. Fewer families in the WAAP group reported an unplanned visit to a healthcare provider during the follow-up period [WAAP 7/39 (18%), Control 17/44 (39%), p = 0.038]. Inhaled corticosteroids were prescribed more commonly in the WAAP group [WAAP 29/45 (64%), Control 15/46 (33%), p = 0.002]. There was no difference in rates of routine follow-up visits, asthma control scores or caregiver confidence measures during the follow-up period.Conclusions: Families who were provided a written asthma action plan during their pediatric emergency department visit for an asthma exacerbation reported fewer unplanned visits during the subsequent three months.