name
Personal Best Peak Flow Meter Number: _______
’s Action Plan
You are not breathing your best.
You are breathing your best.
You need help now.
You:
You may:
You may:
•h ave peak flow meter scores greater than _________ (80% of your personal best peak flow number)
•h ave a peak flow meter score between ____–____ (50–80% of your personal best peak flow number)
•h ave a peak flow meter score less than_________ (50% of your personal best peak flow number)
•b e coughing or wheezing at night
•b e coughing, short of breath, wheezing
•h ave early warning signs of a flare-up
• s uck in skin between ribs, above your breastbone and collarbone when breathing
• s leep through the night without coughing or wheezing •h ave no early warning signs of an asthma flare-up • can do usual activities
•h ave trouble doing your usual activities (work, school, exercise)
Take preventive medicines:
Take quick-relief medicines:
•
•
•
•
•
•
•h ave trouble walking or talking
Emergency Medicine Plan:
•
•
•
•
Continue or increase your preventive medicines. •
Continue to avoid triggers.
•
Call your doctor if:
Take quick-relief medicines 15 minutes before exercise.
•y ou stay in the yellow zone more than ____hours
• • •
Copyright © 1999-2012 Pritchett & Hull Associates, Inc. DO NOT DUPLICATE.
Call your doctor or emergency room and ask what to do.
•
• your nails or lips are blue
•y our symptoms are getting worse
•y ou have trouble walking or talking
•y ou use your quick-relief medicine more often than every 4 hours or ___times a day
• you cannot stop coughing
Pritchett & Hull Associates, Inc. Bringing Patients & Health Together ®
Call 911 if:
Atlanta, GA
800-241-4925
Product # 327
Your asthma action plan Your doctor will fill in the spaces on this treatment plan form to give you instructions on how to manage your asthma. These instructions will help you limit flare-ups, change your treatment if it is not working and know when to get emergency help. To do the best job of managing your asthma, you need to: Learn what causes your flare-ups. Things that cause flare-ups are called triggers. These vary from person to person and are not always easy to spot. Know your early warning signs. Identify and keep a record of these. They will help your doctor tell you what to do to keep a flare-up from becoming severe. Write down what makes your asthma worse and what helps—medications, removing triggers, etc. Take this record with you when you go to the doctor. Learn how to use an inhaler and a nebulizer and how to tell what breathing zone you are in. Post your completed action plan in a safe place—inside the medicine cabinet door, on the refrigerator, on the mirror. You will be more confident in following your plan if you can look at it when a flare-up begins. Continue to follow this action plan even when you are not having signs of asthma. Talk with your doctor if you think your plan needs to be changed.
When you work closely with your doctor, you can prevent asthma flare-ups or treat them before they become severe.
Copyright © 1999-2012 Pritchett & Hull Associates, Inc. DO NOT DUPLICATE.
Pritchett & Hull Associates, Inc. Bringing Patients & Health Together ®
My doctor’s phone number: __________________________
Atlanta, GA
800-241-4925