Asthma Action Plan


 

 

Name___________________________________________________                           Date____________

 

GREEN ZONE:  Doing Well

·        No cough, wheeze, chest tightness or shortness of breath day or night

·        Can do usual activities

And, if a peak flow meter is used,

Peak flow: more than__________________ (80% of my best peak flow)

My best peak flow is:  __________________

 

Take These Long-Term -Control Medicines Each Day

Medicine

How Much to Take

When to Take it

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

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 80% of my best peak flow)

First, add the following quick-relief medicine—and keep taking your GREEN ZONE medicine_________________________________________

·        2 puffs every 20 minutes for up to one hour

·         __________________by nebulizer, may repeat in 30 minutes

Second, if your symptoms (and peak flow, if used) return to GREEN ZONE after 1 hour of the above treatment:

·        Take the quick-relief medicine every 4 hours for 1 to 2 days

-Or-

If your symptoms (and peak flow, if used) do not return to GREEN ZONE after 1 hour

·        Call the doctor

·        ________________________________________________

·        ________________________________________________

 

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% of my best peak flow)

Take This Medicine: ____________________________________________

·        2  puffs every 20 minutes up to 1 hour, or

·        _________________by nebulizer, may repeat in 30 minutes

·        Begin oral corticosteroid_____________________________

·        Call the doctor, or if necessary go to the emergency department or call 911


 

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