My Asthma Wallet Card
Carry This Card To Help Control Your Asthma
My Asthma Action Plan
| Address |
|
| Telephone Number |
|
| Emergency Contact Name |
|
| Hospital/Emergency Department Number |
|
My Medicine
Long-Term Control Medicines
Quick-Relief Medicines
| Name |
Dose |
When To Take |
| Short-acting beta2-agonist |
|
|
| |
|
|
| |
|
|
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 |
|
Green Zone
(80100 percent of best peak flow) |
|
Yellow Zone
(5079 percent of best peak flow) |
|
Red Zone
(Less than 50 percent of best peak flow) |
|
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 symptoms—and make sure you understand it.
NIH Publication No. 07-5245
January 2007
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