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Asthma: My Action Plan

  • Green zone

    I’m feeling good.

    • I have no new shortness of breath or chest tightness.
    • I can do my usual activities.
    • I’m able to sleep as usual.
    • My peak flow is ________ (80% or more of my personal best).
    1. Continue to take my controller medicine every day as directed.
    2. Avoid my triggers.
    3. Take my quick-relief medicine before exercise as directed.

  • Yellow zone

    I’m having an asthma flare-up.

    • I have worse shortness of breath or chest tightening, or both.
    • I’m coughing or wheezing.
    • I’m having trouble doing my usual activities.
    • My symptoms are keeping me awake at night.
    • My peak flow is ________ (50% to 79% of my personal best).
    1. Take one or more puffs of my quick-relief medicine as directed for a flare-up.
    2. If my peak flow has not returned to the green zone in 20 minutes or ______ minutes, I will repeat quick-relief medicine as directed by my doctor.
    3. Start or increase treatment with corticosteroid pills as directed for a flare-up.
    4. If my symptoms are not better OR they are back within 4 hours of treatment, I will contact my doctor.

  • Red zone

    I need medical help now.

    • I'm so short of breath that I have trouble talking.
    • I can’t do my usual activities.
    • My quick-relief medicine doesn’t help.
    • My peak flow is less than ________ (50% of my personal best).
    1. Call 911 or go to the emergency room.
    2. Keep using my medicines as instructed for an asthma attack until medical staff takes over.

Use the space below to write other instructions or information from your doctor, such as chronic conditions, recent surgeries, implanted devices, medicine names and doses, emergency contacts, or warning signs specific to you. Contact your doctor if you have any symptoms that aren’t listed above.

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