Having a personalised asthma action plan and managing symptoms of allergic rhinitis can help

Affecting about a tenth of the adult population in Singapore, asthma is a common enough chronic respiratory condition. The management of it, however, is highly dependent on the patient’s understanding of his condition.

The patient learns to recognise triggers and to avoid them, as well as to use daily medications to control symptoms and quick-relief inhalers to manage the flare-ups.

But not all patients are able to maintain good control. More frequent use of quick-relief inhalers is a classic indication that asthma control may be deteriorating. The presence of nocturnal symptoms such as breathlessness, cough, phlegm and wheezing is also another sign that reflects declining level of control.

In a local longitudinal study conducted by the Department of Research, SingHealth Polyclinics, it was found that 59% of asthma patients had nocturnal symptoms at recruitment.

A key finding of the study was that patients who were not on any asthma action plan (AAP) were more likely to have nocturnal symptoms compared with those who were on a plan or had updated it. The study was published in Nature Partner Journals’ Primary Care Respiratory Medicine.

The AAP is not just a personalised record of the patient’s symptoms. It systematically guides the patient how to adjust the medication should symptoms escalate so that an asthma attack can be prevented. In the event of an attack, it also informs the patient how and where to seek immediate medical attention.

“As the patient may not remember what to do during the critical window period, a written AAP allows them to better control their asthma via symptom recognition and appropriate line of therapeutic action. It will give them the confidence to adjust their medications quickly and appropriately,” said Dr Tan Ngiap Chuan, Principal Investigator of the study.

Dr Tan’s team also found that patients with allergic rhinitis were more at risk for nocturnal symptoms. Appropriate management of the allergic rhinitis can thus lead to better asthma control in the long-run.


“Primary care physicians are wellplaced to assist patients to attain asthma control by prescribing an AAP, reviewing it regularly, and revising the plan if necessary. They can also educate their patients and steer them towards evidencebased treatment for allergic rhinitis, which can range from periodic anti-histamine alone to combination of anti-histamine and nasal steroid to immunotherapy,” shared Dr Tan.