Community based asthma care: trial of a 'credit card' asthma self-management plan

Although asthma self-management plans are widely recommended as essential in the long-term treatment of adult asthma, there have been few studies examining their use. Our objective was to assess the effect of a 'credit card' adult asthma self-management plan in a community experiencing major health problems from asthma, by means of a before and after intervention trial of the efficacy of the ''credit card'' plan, when introduced through community-based asthma clinics.

The participants were 69 Maori people with asthma. The 'credit card' plan consisted of written guidelines for the self-management of asthma, based on self-assessment of asthma severity, printed on a plastic card. On one side, management guidelines were based on the interpretation of peak expiratory flow rate (PEFR) recordings, whilst the reverse side was based on symptoms. The outcome measures used were before and after comparison of markers of asthma morbidity and requirement for acute medical treatment; and a structured questionnaire assessing the acceptability and use of the credit card plan.

Following the introduction of the plan, the mean PEFR increased from 347 to 389 l.min-1, the percentage of nights woken fell from 30.4 to 16.9 %, and the number of days ''out of action'' fell from 3.8 to 1.7 %. The requirements for acute medical treatment also fell during the intervention period. Most participants commented favourably on the content and usefulness of the plan. In the situation of worsening asthma, 28 % of subjects found the peak flow side of the card most helpful, 7 % the symptoms side, and 48 % found both sides equally helpful.

The credit card asthma self-management plan, when introduced in a programme of community-based clinics, is both an effective and acceptable system for self-managing asthma.