367 - The Use of Picture-based Asthma Action Plan to Improve Asthma Care in Inner City Children

Picture-based asthma action plans (PAAP) have been introduced to improve asthma care. Previous studies only evaluated PAAP feasibility with one study revealing youth satisfaction of PAAP. There are no studies reporting asthma outcomes with using PAAP or comparing standard written asthma action plan (WAAP) to PAAP

Objective:

We conducted a single-site, RCT to evaluate PAAP impact on asthma symptoms, outcomes, parent satisfaction, and quality of life (QOL) in inner-city children with asthma vs WAAP.

Design/Methods:

Patients age 3-18 were randomly assigned to either a personalized PAAP or WAAP and followed every 3 months for 2 visits. Asthma Control Test (ACT), FEV1 and FEV1%, numbers of steroid bursts, asthma-related ED visits, admissions, ability to identify medication, parent satisfaction, and asthma-related QOL were collected. Statistical analysis was performed by using median and Fisher-exact test of proportional differences.

Results:

42 (PAAP=17, WAAP=25) and 29 (PAAP=13, WAAP=16) patients were enrolled in the 1^st and 2^nd visit. There were no significant differences in asthma severity, control, and patients’ demographic data at enrollment. The ability to identify asthma medications, number of steroid bursts, asthma-related ED visits, admissions, QOL scores were not different between 2 groups at both visits. 96% of the WAAP group agreed that a PAAP will help them to identify their inhalers compared to the PAAP group (70%) (P=0.04). ACT at baseline was well controlled ( >18) in both groups. However, there was a significant increase (P = 0.04) in median ACT score in the PAAP group (1^st visit ACT 20, 2^nd visit ACT 24) when compared to WAAP group (1^st visit ACT 18, 2^nd visit ACT 20).

Conclusion(s):

This study revealed the benefit of using PAAP on asthma control with higher ACT score in PAAP group at a large tertiary care, inner-city, children’s hospital. Participants also expressed that PAAP will benefit their asthma care. Regardless, the ability to identify asthma medications and other asthma outcomes did not differ in both groups at 3 and 6 months. This suggests that using WAAP may be adequate for inner-city children with asthma, however studies with larger sample sizes and longer durations are required.