Asthma Action Plan

Asthma Action Plan
For: ______________________________ Date: ________________________
Doctor: ____________________________ Doctor's Phone Number: _______________________
Hospital/Emergency Department Phone Number: _____________________________

Green Zone: Doing Well
No cough, wheeze, chest tightness, or shortness of breath during the day or night
Can do usual activities
And, if a peak flow meter is used,

Peak flow: more than _________________
(80 percent or more of my best peak flow)

My best peak flow is: _______________

Take these long-term control medicines each day (include an anti-inflammatory).
Medicine How much to take When to take it

Take these medicines before exercise if your asthma is excercise-induced
Medicine How much to take
2 or 4 puffs When to take it
5 to 60 minutes before

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Yellow Zone: Asthma Is Getting Worse
Cough, wheeze, chest tightness, or shortness of breath, or
Waking at night due to asthma, or
Can do some, but not all, usual activities
-Or-

Peak flow: ____________ to ______________
(50 to 79 percent of my best peak flow)

First
Add: quick-relief medicine--and keep taking your GREEN ZONE medicine.
Take short-acting beta2-agonist _______________________

2 or 4 puffs, every 20 minutes for up to 1 hour
Nebulizer, once
Second
If your symptoms (and peak flow, if used) return to GREEN ZONE after 1 hour of above treatment:
Continue monitoring to be sure you stay in the green zone.
-Or-

If your symptoms (and peak flow, if used) do not return to GREEN ZONE after 1 hour of above treatment:
Take short-acting beta2-agonist: _______________________

2 or 4 puffs, every 20 minutes for up to 1 hour
Nebulizer, once


Add oral steroid: ___________________________
________ mg per day
For ___________ (3 10) days


Call the doctor before/ within _____ hours after taking the oral steroid.


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Red Zone: Medical Alert!
Very short of breath, or
Quick-relief medicines have not helped, or
Cannot do usual activities, or
Symptoms are same or get worse after 24 hours in Yellow Zone
-Or-

Peak flow: less than __________________
(50 percent of my best peak flow)

Take this medicine:
Short-acting beta2-agonist ______________________________
4 or 6 puffs or Nebulizer

Oral steroid __________________________ mg

Then call your doctor NOW.
Go to the hospital or call an ambulance if:

You are still in the red zone after 15 minutes AND
You have not reached your doctor.


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Danger Signs
Trouble walking and talking due to shortness of breath
Lips or fingernails are blue
Take 4 or 6 puffs of your quick-relief medicine AND
Go to the hospital or call for an ambulance at (phone) _______________________ NOW!