ASTHMA ACTION PLAN
Parents Name __________________________________________________________
Contact phone number ___________________________________________________
Other Emergency Contact ________________________________________________
Healthy "Green Zone"
Take daily control medicine(s). Some inhalers may be more effective with a “spacer” – use if directed.
You have ALL of these:• Breathing is good• No cough or wheeze• Sleep through the night• Can work, exercise, and play
Caution "Yellow Zone"
Continue daily control medicine(s) and ADD quick-relief medicine(s)
You have ANY of these:• Cough• Mild wheeze• Tight chest• Coughing at night
If quick-relief medicine is needed more than 2 times a week, except before exercise, then call your doctor
Red Zone "Emergency"
Take these medicines NOW and CALL 911.
Asthma can be a life-threatening illness. DO NOT WAIT !
Your asthma is getting worse fast:• Quick-relief medicine [Albuterol/LevAlbuterol] did not help within 15-20 minutes• Breathing is hard or fast• Nose opens wide • Ribs show• Trouble walking and talking• Lips blue • Fingernails blue
Parents Signature ___________________________________________
This asthma treatment plan is meant to assist, not replace, the clinical decision-making required to meet individual patient needs.