Asthma Action Plans
Everyone with asthma needs his or her own Asthma Action Plan. Work with your health care provider to create a plan that works for you. Your goal is to prevent and control your asthma attacks. Be sure to include the three zones created by the National Institutes of Healthexternal icon in your plan: Green for when you’re doing well, Yellow for when your asthma is getting worse, and Red for a medical alert.
Doing Well
- I don’t have cough, wheezing, chest tightness, or trouble breathing at any time.
- I can do all the things I usually do.
- When I use a peak flow meter my peak flow* is more than 80 percent or more of my best peak flow.
- Continue taking your long-term control medicine.
Asthma Is Getting Worse
- I have some cough, wheezing, chest tightness, or trouble breathing. Or
- I wake up at night because of my asthma. Or
- I can’t do some of the things I usually do. Or
- When I use a peak flow meter my peak flow* is half to three quarters of my best peak flow.
- Add your quick-relief medicine and continue your long-term control medicine.
- If your symptoms get better after an hour keep checking them and continue your long-term control medicine.
Medical Alert!
- I have a lot of trouble breathing. Or
- My quick-relief medicines don’t help. Or
- I can’t do any of the things I usually do. Or
- I was in the yellow zone for 24 hours and I’m not getting better. Or
- When I use a peak flow meter my peak flow* is less than half of my best peak flow.
- Add the other medicines your doctor has prescribed and call your doctor.
- If your symptoms don’t get better and you can’t reach your doctor, go to the hospital.
*Peak flow measurement is a quick test to measure air flowing out of the lungs.
Print and Fill Forms
These plans are easy to use. Select the one that is best for you, print a copy and fill in the information requested.
- Connecticut Department of Health Asthma Action Plans in PDF and Word formats. Includes Authorization for Administration of Medicine.external icon
- Maine Asthma Prevention and Control Program Action Management Plans in PDF and information to order NCR forms.external icon
- Minnesota Department of Health Asthma Action Plans in PDF (Child or Adult; English or Spanish).external icon
- National Heart, Lung, and Blood Institute Asthma Action Planexternal icon
- Utah Department of Health Asthma Action Plan pdf icon[PDF – 151 KB]external icon
Electronic Forms
Open these forms online and fill in all the required information before you print them out.
- Pediatric/Adult Asthma Coalition of New Jersey Asthma Action Plans in English, Spanish, or English/Spanishexternal icon (links to electronic fillable forms are on the right side of page).
- University of Michigan Hospitals and Health Centers Asthma Action Plans providing a choice of three different plans by age of the person with asthma.external icon
Computer-based interactive plan
Follow these step-by-step instructions to create a customized Asthma Action Plan.
- Minnesota Department of Health’s interactive Asthma Action Plan is a computer-based program that uses information entered by the healthcare provider to create a personalized plan for each patient.external icon The plan lists daily and rescue medications with steps to take when asthma symptoms occur.
