Asthma: Your Action Plan

Medicine List

Controller medicine action plan

Fill in the blank spaces and boxes that apply for all sections.

  • Name of your controller medicine:
    • ____________________________________________
  • How much of this medicine do you take?
    • ____________________________________________
  • How often do you take this medicine?
    • ____________________________________________
  • Other instructions?
    • ____________________________________________

Quick-relief medicine action plan

  • Name of your quick-relief medicine:
    • ____________________________________________
  • How much of this medicine do you take?
    • ____________________________________________
  • How often do you take this medicine?
    • ____________________________________________

Asthma Zones

GREEN ZONE: This is where you want to be!

Green zone symptoms

  • You have no shortness of breath or chest tightness. You are not coughing or wheezing.
  • You can do all of your usual activities.
  • You sleep well at night.

Green zone peak flow (if you use a peak flow meter)

  • ______ or more (80% or more of your personal best)

Green zone actions (Check the boxes and fill in the blank spaces that apply.)

[ ] You take your controller medicine(s) every day.

[ ] You are staying away from your asthma triggers.

[ ] You take quick-relief medicine (called _____________________) ______ minutes before exercise.

YELLOW ZONE: Your asthma is getting worse.

Yellow zone symptoms

  • You are short of breath or have chest tightness. You are coughing or wheezing.
  • You have symptoms that keep you up at night.
  • You can do some, but not all, of your usual activities.

Yellow zone peak flow (if you use a peak flow meter)

  • ______ to ______ (50% to 79% of your personal best)

Yellow zone actions (Check the boxes and fill in the blank spaces that apply.)

[ ] Take _____ puff(s) of quick-relief medicine called ______________________. Repeat _____ times.

[ ] If your symptoms don't get better or your peak flow has not returned to the green zone in 1 hour, then:

  • [ ] Take _____ puff(s) of medicine called ______________________. Take it ____ times a day.
  • [ ] Begin or increase treatment with corticosteroid pills. Take ______ mg of medicine called ____________________________ every __________.
  • [ ] Call your doctor at this number: ____________________.

RED ZONE: Danger!

Red zone symptoms

  • You are very short of breath.
  • You can't do your usual activities.
  • Quick-relief medicine doesn't help. Or your symptoms don't get better after 24 hours in the yellow zone.

Red zone peak flow (if you use a peak flow meter)

  • Less than _______ (less than 50% of your personal best)

Red zone actions (Check the boxes and fill in the blank spaces that apply.)

[ ] Take _____ puff(s) of quick-relief medicine called ____________________________. Repeat ______ times.

[ ] Begin or increase treatment with corticosteroid pills. Take ________ mg now.

[ ] Call your doctor at this number: _________________. If you can't contact your doctor, go to the emergency department. Call 911 or ___________________.

[ ] Other numbers you might call are: ___________________________________.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You have severe trouble breathing.

Call your doctor now or seek immediate medical care if:

  • You are in the red zone of your asthma action plan.
  • You've used your quick-relief medicine but are still having trouble breathing.
  • You cough up blood.
  • You have new or worse trouble breathing.
  • You cough up dark brown or bloody mucus (sputum).

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You need to use quick-relief medicine more than 2 days each week within a month (unless it's just for exercise).
  • Your coughing and wheezing get worse.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter H178 in the search box to learn more about "Asthma: Your Action Plan".