Asthma: Your Action Plan

Following your asthma action plan can help you have fewer problems. Here's a sample plan you can use.

Sample action plan

Name of controller medicine How much do you take? How often do you take it? Other instructions






Name of quick-relief medicine How much do you take? How often do you take it? Other instructions






My asthma zones, part 1

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.

My asthma zones, part 2

GREEN ZONE This is where I want to be! YELLOW ZONE My asthma is getting worse. RED ZONE Danger!

Peak flow (if you use a peak flow meter)

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

Peak flow (if you use a peak flow meter)

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

Peak flow (if you use a peak flow meter)

  • Less than _____ (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, I need to CALL 911 or go to the hospital for help right away.