Tracking Asthma Symptoms Daily Reduces ER Visits in Children

Children with asthma who keep track of their daily symptoms with a written plan take significantly fewer trips to the emergency department than children who use plans based on peak-flow monitoring, according to a recent review.

"It is our theory that children using the symptom-based plan will use it more often if it [is effective in getting them] to control asthma by taking preventive medication," said Roger Zemek, a review co-author and physician at the Children's Hospital of Eastern Ontario in Canada.

The data analysis showed that compared to using a peak-flow plan, using a symptom-based plan reduced kids' need to visit the emergency department or doctor for severe asthma symptoms by 27 percent.

After receiving an asthma diagnosis, patients often work with their health care providers to create an asthma action plan. The plan is a personalized, written set of instructions that tells patients how to manage chronic symptoms of asthma, as well as prevent and manage acute symptoms that require emergency medical care.

Asthma plans may include a list of triggers that worsen asthma and names and dosages of medications to take to control symptoms.

With an asthma action plan, doctors instruct patients to keep daily tabs on their asthma in one of two ways: by monitoring asthma symptoms or by monitoring peak-flow readings. A peak-flow meter is a handheld device that measures lung function and determines how well a person's asthma is being controlled.

The review appears in the current issue of The Cochrane Library, a publication of The Cochrane Collaboration, an international organization that evaluates medical research. Systematic reviews draw evidence-based conclusions about medical practice after considering both the content and quality of existing medical trials on a topic.

The authors mined four previously published randomized controlled trials involving 355 children and adolescents. Two of the studies took place in the United States; the other two were conducted in the United Kingdom. Each compared the effectiveness of symptom-based asthma action plans to action plans based on peak-flow monitoring.

Researchers determined that only nine children needed to use a symptom-based action plan to prevent one asthma flare that required a doctor or hospital visit. There were no significant differences between the two types of plans in terms of missed school days, missed work time for parents or hospital admissions for asthma symptoms.

Not only did the symptom-based plans reduce the risk of asthma flares, but children also preferred them to peak-flow monitoring plans, although parents did not show a preference. In addition, more children in the symptom-based group continued using their action plan after the study's end.

"Research outside of this review has shown that children do have difficulty using peak-flow monitors and they have been found to not measure accurately the true inflammation. Using the symptom-based plan requires less of a time constraint on children and families, in addition to providing a medical benefit," Zemek said.