I am in the process of trying to increase the use of asthma action plans at my practice. Looking at the standard plans available (in particular the asthma UK plan), there are 4 asthma 'zones'.
I don't have any problems with zone 1 (asthma well controlled, PEF >85% of best), zone 3 (asthma more severe PEF 50 - 70% of best) or zone 4 (emergency PEF < 50% of best).
I'm just not sure about zone 2 - ('asthma worse' or PEF 70% - 85% of best). For those patients on standard inhaled steroid (IHCS) doses, if they regularly find themselves in zone 2 they should be starting a long acting beta 2 agonist (LABA). They can't really do from this from comfort of their own home. So what to do? Should you tell patients in this zone to take their reliever more often and if the symptoms persist make an appointment? That was my plan, but I wondered if anyone had different ideas.
The other thing I am not sure about in zone 2 is how long patients should be in zone 2 before they decide to make an appointment. Initially I thought it should be at least 3 - 4 days, but then I wondered if 7 would be OK. As long as their PEF is > 70% of best it can't do any harm to wait a week, can it? I am sure a lot of patients run at this level for longer without telling us at all. Clearly you would tailor a plan for someone with more brittle or severe asthma more cautiously.
If any one has any thoughts or experience of asthma plans, I would very much appreciate your comments.