my asthma action plan

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.