Asthma Action Plans in Reducing Pediatric Emergency Visits

Abstract

Introduction: Written asthma action plans (WAAP) based on peak flow or symptoms are guideline-recommended, but uptake in pediatric primary care is low (<30%). Evidence for efficacy in reducing exacerbations is mixed. Methods: Systematic review of 9 RCTs (n=3,211) comparing WAAP (symptom-based, 3 zones: green/yellow/red) versus no WAAP in children 2-18 years with persistent asthma. Primary outcome: emergency department (ED) visits for asthma over 12 months. Secondary: school days missed, oral steroid courses. Results: WAAP reduced ED visits (RR 0.68, 95% CI 0.52-0.89, NNT=12) and school days missed (mean difference -2.4 days/year). No difference in oral steroid courses or hospitalization. Benefit was greater when WAAP was combined with regular provider review (every 3-6 months). Discussion: WAAP effectiveness depends on patient/caregiver health literacy and integration into routine care. Written alone without reinforcement is ineffective. Conclusion: Symptom-based WAAP with quarterly review reduces ED visits and school absenteeism in pediatric asthma.