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Developing an Asthma Action Plan

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An Asthma Action Plan for Your Child continued...

If your child’s peak flow reading falls into the red zone, this means it’s time to act quickly with the doctor’s instructions. First, read your child’s asthma action plan and make sure you are giving the proper emergency treatment. If this asthma treatment fails to help your child’s asthma symptoms, then go to the emergency room or call 9-1-1.

The asthma action plan outlines everything you need to do for a normal day with no asthma problems to a time of asthma emergency. Make sure your child’s teacher and any other adult caregiver has a copy of this asthma action plan.

Review Your Asthma Action Plans

Asthma action plans should be reviewed with your asthma doctor at least once a year. Changes in the asthma action plan may be needed because of changes in your peak flow numbers or the medications you are taking.

Always keep your asthma action plan where it can be easily found by you or your family.

 

Print Out Asthma Action Plan

Print out and use this asthma action plan to record important information about your asthma or a family member’s asthma (including teenagers and children).

 

Date:Person's Name / Clinic Number
Disease Severity:
Doctor:
Phone:
Nurse or Therapist:
Phone:
Evening / Weekend
Phone:

 

Personal Best Peak Flow (PF):

GREEN ZONE: All Clear
Where you or your family member should be every day -- NO asthma symptoms. Able to do usual activities and sleep without coughing, wheezing, or difficulty breathing. Peak flow is 80% to 100% of personal best.

 

ACTION: Control asthma. Use these medicines every day, on good days and bad days, to prevent asthma symptoms. Use a spacer with metered dose inhalers (or other asthma inhaler and/or medications prescribed for a child).

 

Medication
____
Dose
____
Morning
____
Afternoon
____
Evening
____
Bedtime
____
Medication
____
Dose
____
Morning
____
Afternoon
____
Evening
____
Bedtime
____
Medication
____
Dose
____
Morning
____
Afternoon
____
Evening
____
Bedtime
____
Medication
____
Dose
____
Morning
____
Afternoon
____
Evening
____
Bedtime
____
Medication
____
Dose
____
Morning
____
Afternoon
____
Evening
____
Bedtime
____
Medication
____
Dose
____
Morning
____
Afternoon
____
Evening
____
Bedtime
____
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