Systematic review of randomized controlled trials examining written action plans in children: what is the plan?

OBJECTIVES To evaluate the independent effect of a written action plan vs no plan and to compare different plans to identify characteristics of effective plans in children with asthma. DATA SOURCES We searched the Cochrane Airways Group Clinical Trials Register until March 2006, including MEDLINE, EMBASE, CINAHL, and the Cochrane Central Register of Controlled Trials, for randomized controlled trials that evaluated asthma action plans in the pediatric population. STUDY SELECTION Eligible studies were randomized or quasi-randomized controlled trials with participants aged 0 to 17 years diagnosed with asthma. Of 428 citations, 1 trial compared a peak flow-based plan with none and 4 parallel-group trials compared symptom-based plans with peak flow-based plans. Intervention Provision of a written action plan. Control groups received no action plan or another type of plan. All co-interventions (both medical and educational) were similar in both groups. Main Outcome Measure The number of children with at least 1 acute care asthma visit. RESULTS Written action plan use significantly reduced acute care visits per child as compared with control subjects. Children using plans also missed less school, had less nocturnal awakening, and had improved symptom scores. As compared with peak flow-based plans, symptom-based plans significantly reduced the risk of a patient requiring an acute care visit. CONCLUSIONS Although there are limited data to firmly conclude that provision of an action plan is superior to none, there is clear evidence suggesting that symptom-based plans are superior to peak flow-based plans in children and adolescents.