My Asthma Wallet Card
Carry This Card To Help Control Your Asthma
My Asthma Action Plan
Address |
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Telephone Number |
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Emergency Contact Name |
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Hospital/Emergency Department Number |
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My Medicine
Long-Term Control Medicines
Quick-Relief Medicines
Name |
Dose |
When To Take |
Short-acting beta2-agonist |
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Warning Signs of an Asthma Attack
Check below any things that you know may warn you of an attack coming on:
- awakening at night
- difficulty breathing
- wheezing
- coughing, especially at night
- chest tightness
- feeling very tired
- itchy or sore throat
- itchy nose
- itchy, watery or glassy eyes
- need more beta2-agonist
- than usual
- other
My Peak Flow
My best peak flow |
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Green Zone (80100 percent of best peak flow) |
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Yellow Zone (5079 percent of best peak flow) |
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Red Zone (Less than 50 percent of best peak flow) |
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Talk to Your Doctor About:
- Your asthma treatment goals and how to achieve them
- Your medications‹what they are for, how much to take, and when and how to take them
- How to use your inhaler and a peak flow meter, if you have one
- Your asthma triggers and how to avoid them
- Warning signs of an asthma attack and what you should do if your symptoms get worse
Ask for a written asthma action plan for responding to worsening symptomsand make sure you understand it.
NIH Publication No. 07-5245
January 2007
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