My Asthma Action Plan

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Topic Overview


My name:__________________


Doctor's name: ___________________


Doctor's phone: _______________

Controller medicine

How much?

How often?

Other instructions









Quick-relief medicine

How much?

How often?

Other instructions









GREEN ZONE This is where I want to be!

YELLOW ZONE My asthma is getting worse.

RED ZONE Danger!


Symptoms

  • I have no shortness of breath, cough, wheezing, or chest tightness.
  • I can do all of my usual activities.
  • I sleep well at night.

Symptoms

  • I'm coughing or wheezing or have chest tightness or shortness of breath.
  • Symptoms keep me up at night.
  • I can do some but not all of my usual activities.

Symptoms

  • I'm very short of breath.
  • I can't do my usual activities.
  • Quick-relief medicine doesn't help, or my symptoms don't get better after 24 hours in the yellow zone.

Peak flow (if I use a peak flow meter)

  • _________ or more (80% or more of my personal best)

Peak flow (if I use a peak flow meter)

  • ______ to ____ (50% to 79% of my personal best)

Peak flow (if I use a peak flow meter)

  • _____ or lower (less than 50% of my personal best)

Actions

  • [ ] Take controller medicine(s) every day.
  • [ ] Avoid asthma triggers.
  • [ ] ____ minutes before exercise, take quick-relief medicine called ________________.

Actions

  • [ ] Take _____ puff(s) of my quick-relief medicine called ________________. Repeat ____ times.
  • [ ] If my symptoms don't get better or my peak flow has not returned to the green zone in 1 hour, then:
    • [ ] Take _____ puff(s) of my medicine called ________________. Take it ___ times a day.
    • [ ] Begin or increase treatment with corticosteroid pills. Take ______ mg of ________________ every _______________.
    • [ ] Call my doctor at _______________.

Actions

  • [ ] Take _____ puff(s) of my quick-relief medicine called _____________. Repeat _____ times.
  • [ ] Begin or increase treatment with corticosteroid pills. Take ________ mg now.
  • [ ] Call my doctor at ______________. If I cannot contact my doctor, I need to go to the emergency department. Call 911 or _________________.
  • [ ] Other numbers I might call are ______________, ______________, ______________.

EMERGENCY: If it's hard to walk or talk because of shortness of breath or if my lips or fingertips are blue, I need to CALL 911 or go to the hospital for help right away.

Credits

Current as of: February 24, 2020

Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Rohit K. Katial, MD - Allergy and Immunology




La Enciclopedia de salud contiene información general de salud. No todos los tratamientos o servicios descritos son beneficios cubiertos para los miembros de Kaiser Permanente ni se ofrecen como servicios de Kaiser Permanente. Para obtener una lista de beneficios cubiertos, consulte su Evidencia de cobertura o Descripción resumida del plan. Para los tratamientos recomendados, consulte con su proveedor de atención médica.