Asthma Control Plan

Name of Patient ........................................ Prepared by Dr. .........................................

This plan will help a patient control his asthma and know what to do if he has an asthma episode. Keeping a patient’s asthma under control will help to :

• Be active without having asthma symptoms. This includes being active in exercise and sports.
• Sleep through the night without having asthma symptoms.
• Prevent asthma episodes (attacks).
• Have the best possible peak flow number - lungs that work well.
• Avoid side effects from medicines.

Advice for patients:

Here are three ways to control asthma:

• Follow your medicine plan

- Follow your Green Zone plan every day to prevent asthma symptoms from starting.

- Recognize your symptoms of an asthma episode. Act quickly to stop them.

- Follow the Yellow Zone plan to stop asthma symptoms and to keep an asthma episode from getting serious.

- Follow the Red Zone plan to take care of a serious episode. This is an emergency plan!

• Whenever possible, stay away from things that bring on your asthma symptoms. For this follow “Asthma Trigger Control Plan” to reduce the number of things in your home, workplace, or classroom that bother your asthma.
• See your doctor regularly. Talk about this plan with your doctor when you visit him/her. Your doctor will mark (check) on the plan what you should do. Follow the symptoms and action steps in these three zones to help you control your asthma

Green Zone: All clear

 o Take these medicines.

This is where you should be every day.

 Name of medicine

How much to take

When to take it

 
_______________

 _______________

 _______________

 
_______________

 _______________

 _______________

Peak flow 
_______________

(80-100% of personal value)

 o Follow your “Asthma
Trigger Control Plan” to avoid things that bring on  your asthma.

No symptoms of an asthma episode.You are able to do your usual activities and sleep
without having symptoms.

 o Take
__________________________ before exercise or (Name of medicine) strenuous
physical activity.

Yellow Zone: Caution

 o Take these medicines.

This is where you
should take action to get asthma under control.

 Name of medicine

How much to take

When to take it

  _______________

 _______________

 _______________

  _______________

 _______________

 _______________

Peak flow 
_______________

(50-80% of personal value)

 o Follow your “Asthma
Trigger Control Plan” to avoid things that bring on  your asthma.

Symptoms of an
asthma episode. You may be coughing, wheezing, feeling short of breath, or
feeling like your chest is tight. These symptoms may keep you from your
usual activities or keep you from sleeping.

 o Take
__________________________ before exercise or (Name of medicine) strenuous
physical activity.

Red Zone: Medical
Alert

 o Take these
medicines.

This is an
emergency! Get help.Your asthma symptoms are serious.

 Name of
medicine

How much to take

When to take it

 
_______________

 _______________

 _______________

 
_______________

 _______________

 _______________

Peak flow 
_______________

(Below 50% of personal value)

 o Next , call the
doctor to ask about what you should do next. tell him/her this is an
emergency.

You may be
coughing, very short of breath, and/or the skin between you ribs and your
neck may be pulled in tight. You may have trouble walking or talking . You
may not be wheezing because air con not move out of your ariways.

 But, see the doctor
RIGHT AWAY or go to the hospital if any of these things are happening :

• Lips or fingernails
are blue.

• You/your child is
struggling to breathe.

• You/your child do
not feeling better 20 to 30 minutes after taking the extra medicine and
your peak flow is still under__________________________________ (50% of
personal best)

• Six hours after you
take the extra medicine, if you still need inhaled b2-agonist medicine
every 1 to 3 hours and your peak flow is under ____________________ (70%
of personal best)