Asthma Action Plan

For:

Prepared by:

Date:

Good asthma control means:

• no cough or other symptoms during daytime
• no cough or symptoms during night and early morning
• able to do normal activities
• reliever medicine needed less than 3 times per week
• near normal or normal pulmonary function
• normal pulmonary function
• no visits to doctor or emergency department for asthma attacks
• no visits to the emergency department for asthma attacks

If your child is using a peak flow meter, they should understand that peak flow readings are an important part of managing asthma control, especially if they do not always notice asthma symptoms.

Daily medicines

To be taken every day even when your child feels well.

Controller:

When your child’s asthma becomes worse

If your child has a cold or their asthma is acting up (coughing, wheezing, trouble breathing), medicine must be taken more often. Follow these instructions.

Increase controller:

For this medicine: __________________________

Take ____ puffs ____ times per day for ____ days.

Reliever:

Take ____ puffs up to every 4 hours for symptoms.

Use reliever before exercise: Y / N

Oral steroids:

Type:

Dose:

When:

In an emergency

See a doctor right away if any of the following things happen:

• Reliever medicine does not work, or does not last for 4 hours.
• Your child is not getting better after 2 days.
• Your child is not getting better after 2 or 3 days.
• Your child is getting worse.

Go to the nearest Emergency Department if any of the following things happen:

• Your child cannot eat, sleep, or speak due to symptoms.
• Your child’s breathing appears jerky, or is sucking in at the throat or below the ribs.
• Extra reliever medicine does not work.