Background: Non-adherence to treatment advice is a common phenomenon in asthma and may account for a significant proportion of the morbidity. Comprehensive care that includes asthma education, written self-management plan and regular review has been shown to improve asthma outcomes, but the contribution of these components has not been established.
Objectives: To determine whether the provision of a written asthma self-management plan increases adherence and improves outcome.
Search strategy: A search was carried out on the Cochrane Airways Group trials register. There was no language restriction. The search of the databases used the following terms: action plan OR self OR self-care OR self-manag* OR educ* AND adher* OR comply OR compli*. Authors of included studies were contacted for any unpublished or on-going studies and bibliographies of all included studies and reviews were searched for further studies.
Selection criteria: Only randomised controlled trials (RCTs) in patients with asthma were considered. Participants must have been assigned to receive an individualised written asthma management plan (symptom or peak flow based) about the actions required for regular asthma management and/or the actions to take in the event of an asthma exacerbation.
Data collection and analysis: Study quality was assessed and data abstracted by two reviewers independently.
Main results: Six trials met the inclusion criteria. The written management plans were either peak flow or symptom based, which were compared against each other or compared to no written management plan. Reported outcomes included: hospitalisation, emergency department visits, oral corticosteroid use, lung function, days lost from school/work, unscheduled doctor visits and respiratory tract infections. There was no consistent evidence that written plans produced better patient outcomes than no written plan. For some outcomes, there appeared to an advantage of one type of plan over the other, but there was no consistency - one type of plan was not consistently more effective than another.
Reviewer's conclusions: The available trials are too small and the results too inconsistent to form any firm conclusions as to the contribution of written self management plans in the known beneficial effects of a comprehensive asthma care programmes.