Asthma Action Plan - American Academy Of Pediatrics Page 2
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2How to Use this Form
The Asthma Action Plan is to be completed by a primary care provider for each individual (child or adult)
that has been diagnosed with asthma. The Asthma Action Plan should be regularly modified to meet the
changing needs of the patient and medicine regimes. The provider should be prepared to work with
families to gain an understanding of how and when the Asthma Action Plan should be used. Please
complete all sections of the Asthma Action Plan. Please write legibly, and refrain from using
abbreviations.
The Asthma Action Plan is an education and communication tool to be used between the health care
provider and the patient, with their family and caregivers, to properly manage asthma and respond to
asthma episodes. The patient, and their family or caregivers, should fully understand the Asthma Action
Plan, especially related to using the peak flow meter, recognizing warning signs, and administering
medicines. Patients, families, and caregivers should be given additional educational materials related to
asthma, peak flow monitoring, and environmental control.
Persons with asthma, parents, grandparents, extended family, neighbors, school staff, and childcare
providers are among the persons that should use the Asthma Action Plan.
A spacer should be prescribed for all patients using a metered-dose inhaler (MDI).
Children over the age of six years may be given peak flow meters to monitor their asthma and determine
the child’s zone.
Parents of children under the age of six years should use symptoms to determine the child’s zone.
Zone Instructions
The Personal Best peak flow should be determined when the child is symptom free. A diary can be used
to determine personal best and is usually part of a peak flow meter package. A peak flow reading should
be taken at all asthma visits and personal best should be redetermined regularly. Because peak flow
meters vary in recording peak flow, please instruct your patients to bring their personal peak flow meter to
every visit.
Green: Green Zone is 100 percent to 80 percent of personal peak flow best, or when no symptoms are
present.
List all daily maintenance medicines. Fill in actual numbers, not percentages, for peak flow
readings.
Yellow: Yellow zone is 80 percent to 50 percent of personal peak flow best, or when the listed symptoms
are present.
Add medicines to be taken in the yellow zone and instruct the patient to continue with green zone
(maintenance) medicines. Include how long to continue taking yellow (quick reliever) medicines
and when to contact the provider.
Red:
Red zone is 50 percent or below of personal peak flow best, or when the listed symptoms are
present.
List any medicines to be taken while waiting to speak to a provider or preparing to go to the
emergency room.
Peak Flow Chart
Green 100%
100
110
120
130
140
150
160
170
180
190
200
210
220
230
240
250
260
270
280
290
300
310
320
Yellow 80%
80
90
95
105
110
120
130
135
145
150
160
170
175
185
190
200
210
215
225
230
240
250
255
Red 50%
50
55
60
65
70
75
80
85
90
95
100
105
110
115
120
125
130
135
140
145
150
155
160
Green 100%
330
340
350
360
370
380
390
400
420
440
460
480
500
520
540
560
580
600
620
640
660
680
700
Yellow 80%
265
270
280
290
295
305
310
325
335
350
370
385
400
415
430
450
465
480
495
510
535
545
560
Red 50%
165
170
175
180
185
190
195
200
210
220
230
240
250
260
270
280
290
300
310
320
330
340
350
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