Fourteen randomised controlled trials (people with asthma or their parents n=4,438, doctors n=107, general practice teams n=43) were included in the review. One study was graded A, three were graded B and 10 were graded C.
Interventions aimed at people with asthma:
Four self management interventions (one grade B, three grade C) showed a significant increase in the number of people with asthma with action plans in the intervention group compared to control. One randomised controlled trial (grade C) reported significantly higher action plan use following structured group or individual self-management education with subsequent educational reinforcement (p=0.008).
For interventions utilising telephone consultations to reinforce action plan use, one randomised controlled trial (grade C) reported a significant increase in people with asthma having action plans (p=0.001). Two randomised controlled trials (both grade C) reported increases in understanding and use of action plans.
One randomised controlled trial (grade B) using postal prompts to adults with asthma inviting them for review at their general practice and enclosing partially personalise action plans for completion during consultation reported greater understanding of how to use their action plans (p=0.05) than participants receiving blank action plans.
Two randomised controlled trials (grade C) utilising asthma clinics to promote action plan use reported increased ownership at six months post intervention, although only one study reported a statistically significant increase (p=0.001).
One randomised controlled trial (grade A) evaluating the effectiveness of asthma management systems reported that more children with asthma had action plans (44 per cent) compared to those receiving usual general practitioner care (34 per cent), odds ratio 2.2 (95% confidence interval: 1.2, 4.1). A second randomised controlled trial (grade C) evaluating an asthma management system intervention reported significantly higher action plan use at six months post intervention compared to receiving specialist out-patient or general practitioner monitoring (p<0.001).
Interventions aimed at health professionals:
One randomised controlled trial (grade C) reported that a medical education intervention encouraging action plan use facilitated action plan use for up to two years post intervention (p=0.02). One randomised controlled trial using a practice-based quality improvement and educational intervention showed no overall effect on action plan ownership (grade B).