The Asthma Action Plan provides your health care provider's iinstructions on caring for your asthma symptoms in certain circumstances. Think about the colors of a traffic light to help you implement this plan:
Name: ________________________________
Provider: ____________________________
Provider phone number: _______________
Date: ____________ For emergencies call 911
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Green means GO: use long-term-control medicine
Yellow means Caution: Use quick-relief medicine
Red means Stop: Get help from a doctor now!
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| Green—Go |
- Breathing is good
- No cough or wheezing
- Can work or play
Peak Flow Number:
_____ to _____
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Use long-term-control medicine.
| Medicine |
How Much to Take |
When to Take It |
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| Yellow—Caution |
- Coughing
- Wheezing
- Tight chest
- Waking up at night
Peak Flow Number:
_____ to _____
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Take quick-relief medicine to keep attack from getting bad.
| Medicine |
How Much to Take |
When to Take It |
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20 minutes before sports or other strenuous activity, take this medicine:
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| Red—Stop |
- Medicine is not helping
- Breathing is hard and fast
- Nose opens wide
- Can't walk
- Ribs show
- Can't talk well
Peak Flow Number:
_____ to _____
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Get help from a doctor now!
Take these medicines until you talk to the doctor.
| Medicine |
How Much to Take |
When to Take It |
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If your symptoms do not improve and you cannot contact your doctor,
go to the emergency room or call 911 immediately.
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