NIHR Global Health Research Unit on Respiratory Health (RESPIRE)

Image-based asthma action plans could improve asthma control and reduce service delivery costs in Malaysia

A RESPIRE study has found that asthma supported self-management with a pictorial asthma action plan could improve asthma control and reduce costs in Malaysia

Approximately 100 million people in Southeast Asia live with asthma. In Malaysia, 68% of people with asthma visit their doctor, 50% have to go to the emergency department, and 10% have to stay in hospital for longer periods of time.

Only a third of people with asthma go to regular asthma care clinics where they can get personalised support from their healthcare professional to manage their asthma by themselves, called supported self-management. Part of this care usually includes a text-based asthma action plan, which describes in a written format how people with asthma can adjust their treatment according to how the disease is affecting them at that time. About 60% of adults with asthma in Malaysia struggle to understand the text-based format of traditional action plans.

The study

RESPIRE researchers designed and tested an image-based asthma action plan to attempt to overcome inequities for people with limited numeracy and literacy skills. The aim of the study was to understand if using the image-based action plan improved people’s control over their asthma (reduced the number of asthma attacks). They also wanted to know if it had an impact on the amount of medication used, how frequently people had to go to, or stay in, hospital, and how many days people with asthma lost from their work or other usual activities.

The researchers carried out the study in the district of Klang, Selangor, Malaysia between September 2019 and July 2020. 59 participants completed the study which involved a 6-month follow-up.


This study found that it is feasible to train primary healthcare professionals to use image-based asthma action plans with adult patients in Malaysia. The image-based asthma action plan for adults has the potential to contribute to improving asthma control.

Asthma control

In this study, using the image-based asthma action plan improved the participants’ asthma control at both the 3-month and 6-month points. There was a reduction in the number of asthma attacks and emergency visits to and stays in hospital.

Cost savings from the use of the action plan

The researchers found that there were cost savings by comparing the actual cost of treatment to the estimated cost if the image-based asthma action plan had not been used. For each participant over the 6 months, there was an estimated cost saving of RM268.92 (USD63.65).

Future potential

This study has shown that it is feasible to use image-based asthma action plans with adults in the context of the Malaysian primary care system. The study is now proceeding to a full trial within the new grant funding awarded to RESPIRE.

Professor Shariff Ghazali Sazlina was the lead author on this publication and is carrying out research in RESPIRE while based at Universiti Putra Malaysia. She believes the trial will help give evidence of the full potential of image-based asthma action plans in Malaysia and beyond.

An image-based action plan has the potential to contribute to improving asthma control and its effectiveness is to be evaluated in a randomised controlled trial.

Professor Shariff Ghazali SazlinaLead author on the publication

Read the paper

This publication is available from npj Primary Care Respiratory Medicine

Cite as

Sazlina, S.G., Lee, P.Y., Cheong, A.T. et al. Feasibility of supported self-management with a pictorial action plan to improve asthma control. npj Prim. Care Respir. Med. 32, 34 (2022).