Asthma Action Plan
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1
2ASTHMA ACTION PLAN
Name: _________________________________________
Date:________________ Personal best: ______________
Dates Reviewed:_________________________________
GREEN ZONE means GO ahead with your activities. You are doing well.
Take daily asthma control medicine: ___________________________
A
__________________________________________________________
Peak flow is more than ___________ (80% of personal best).
Take asthma rescue medicine (_______) 15 minutes before exercise.
No coughing, wheezing or other asthma symptoms
B
Avoid your asthma triggers:
smoke
colds
cockroaches
day or night.
1
2
3
dust
pets
strong odors
cold air
molds
pollen
Usual activities cause no breathing problems.
4
5
6
7
8
9
Work on your asthma management goals: ___________________________
YELLOW ZONE means SLOW DOWN. Your asthma is getting worse.
Take 2 puffs asthma rescue medicine with spacer NOW,
A
OR
Do one asthma rescue medicine nebulizer treatment NOW
Peak flow is ________ to _______ (50 to 80% of personal best), OR
Try to be calm, get away from your triggers.
Coughing, wheezing, feeling short of breath day or night, OR
Asthma warning symptoms are present:
If you are not better (still have symptoms or peak flow in yellow zone):
itchy chin
sore throat
headache
1
2
3
Call your provider or clinic for advice at: ________________________
B
stomach ache
sneezing
runny nose
4
5
6
Take asthma rescue medicine every 4 to 6 hours for 1 to 2 days.
watery eyes
not eating well
C
7
8
other ____________________________________
Take the usual dose asthma daily control medicine.
9
D
Other: ____________________________________________________
E
RED ZONE means DANGER. Your asthma needs immediate attention!
Take 2 puffs asthma rescue medicine now (or 1 nebulizer treatment)
Peak flow is less than _________( 50% of personal best), or
Call your provider or clinic right away! _______________________
Very short of breath, breathing very fast, OR
If you can not contact anyone, get help at the emergency room.
Cannot do your usual activities, have trouble walking,
talking or playing, OR
Take asthma rescue medicine again in 20 minutes.
Ribs show when you take a breath.
Then take asthma rescue medicine again in 20 minutes if you need it.
EMERGENCY! CALL 911 or get to the emergency room right away!
If you have any of these:
albuterol is not helping
red zone signs do not go away
grunting when breathing
sweaty, clammy or pale skin
blue-gray color around lips
or _____________________.
Graphics courtesy of
1/05
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