Personal asthma plans save lives, Singapore study finds

Principal investigator Tan Ngiap Chuan (above) says caregivers of children with asthma may be too panicky during a severe asthma attack, but if they have a written game plan, they can refer to it in an emergency.
PHOTO: Personal asthma plans save lives, Singapore study finds

SINGAPORE - Parents and caregivers who are given a written game plan drawn up by their doctors are better placed to prevent deadly asthma attacks in their children, a study of nine polyclinics has found.

Getting a hard copy of instructions appears to work better than relying on memory of what the doctor said during clinic visits, according to the study of 170 caregivers by SingHealth Polyclinics.

Principal investigator Tan Ngiap Chuan, 47, said that when an emergency strikes, caregivers may be too panicky to think clearly. But they can easily refer to the one-page document, known worldwide as the "written asthma action plan", said the family physician and director of research at SingHealth Polyclinics.

The plan is made for each individual patient, and details what to do if, say, asthma symptoms such as wheezing surface. In such cases, the advice may be to administer a specific number of puffs of the inhaler.

And if the situation worsens, for example, if the child can speak only in short sentences, he will have to be taken to the hospital.

Such a document was recommended in Health Ministry guidelines in 2008, but never evaluated on how useful it is for Singapore patients until now.

One in 10 adults reported having suffered from asthma in their lifetime, says the latest National Health Survey.

Explaining the reasons for conducting the research, Dr Tan said: "We were concerned that children are not treated in a timely fashion.

"And if we gave the plan to caregivers, would they even use it?"

The study, published in the international Primary Care Respiratory Journal in April, found that caregivers who make use of the plan have greater confidence in handling an impending asthma attack.

Nearly all of them could tell asthma apart from a viral infection like the flu, compared to 78 per cent of caregivers who did not get a plan.

Seven in 10 also knew they could change the dose of asthma medication when their child was having an attack, in order to prevent it from escalating. But only about half of those in the second group said the same.

Administrative clerk Sabaria Saini said the document gives her peace of mind in caring for her 12-year-old daughter. "An attack can happen any time," said the 49-year-old.

So far, there has not been a serious episode, but Madam Sabaria has done as instructed by the plan and given her daughter extra puffs of the inhaler when symptoms emerge.

"It is not difficult to take care of asthmatic children, as long as you know the steps to take," she added.

In the light of the findings, SingHealth has rolled out a free mobile app so users can have their personal plan on the go. Print copies issued by its polyclinics now carry a QR code, which can be read by the app.

Going forward, Dr Tan hopes that doctors islandwide, including private general practitioners, will systematically hand out a plan for each asthma patient.

"We would like caregivers to ask for it from their doctors if they are not given one," he said, adding that the document can help patients avoid life-threatening episodes.

At SingHealth's polyclinics, which treated 13,000 asthma patients of all ages last year, at least 10 per cent of them showed up in the throes of an asthma attack, which is potentially fatal.

Said Dr Tan: "If everybody has a plan, we can reduce this rate even further."

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