Asthma Action Plan
Name___________________________________________________ Date____________ GREEN ZONE: Doing Well · No cough, wheeze, chest tightness or shortness of breath day or night · Can do usual activities And, if a peak flow meter is used, Peak flow: more than__________________ (80% of my best peak flow) My best peak flow is: __________________ Take These Long-Term -Control Medicines Each Day Medicine How Much to Take When to Take it YELLOW ZONE: Asthma Is Getting Worse · Cough, wheeze, chest tightness or shortness of breath, or · Waking at night due to asthma, or · Can do some but not all usual activities -Or- Peak flow: ___________to__________(50% to 80% of my best peak flow) First, add the following quick-relief medicine—and keep taking your GREEN ZONE medicine_________________________________________ · 2 puffs every 20 minutes for up to one hour · __________________by nebulizer, may repeat in 30 minutes Second, if your symptoms (and peak flow, if used) return to GREEN ZONE after 1 hour of the above treatment: · Take the quick-relief medicine every 4 hours for 1 to 2 days -Or- If your symptoms (and peak flow, if used) do not return to GREEN ZONE after 1 hour · Call the doctor · ________________________________________________ · ________________________________________________ RED ZONE: Medical Alert! · Very short of breath, or · Quick-relief medicines have not helped, or · Cannot do usual activities, or · Symptoms are same or get worse after 24 hours in YELLOW ZONE -Or- Peak flow: less than ___________________ (50% of my best peak flow) Take This Medicine: ____________________________________________ · 2 puffs every 20 minutes up to 1 hour, or · _________________by nebulizer, may repeat in 30 minutes · Begin oral corticosteroid_____________________________ · Call the doctor, or if necessary go to the emergency department or call 911
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