Asthma action plan

An asthma action plan is a written plan that helps you manage sudden increases in your or your child's asthma symptoms (asthma attacks). It tells you what medication you need to use, based on the severity of the attack, and when you should call a health professional or seek emergency treatment.

Your action plan is based on zones of asthma severity defined by symptoms and your personal best peak expiratory flow (PEF), which is your highest peak flow recorded over a 2- to 3-week period when your asthma is under control. Personal best is never taken during an asthma attack. If you do not know your personal best, talk to your health professional.

• Green zone. Green means go. You are in the green zone of the asthma action plan if your peak expiratory flow is 80% to 100% of your personal best measurement. You want to be in the green zone every day. You should have no asthma symptoms when you are in the green zone, and you do not need quick-relief treatment. To figure 80% of your personal best peak flow, multiply your best flow by 0.80. For example, if your personal best flow is 400, multiplying by 0.80 gives you 320.
• Yellow zone. Yellow means caution. You are in the yellow zone of your asthma action plan if your peak expiratory flow is 50% to less than 80% of your personal best measurement. You may not have any symptoms, but your lung function is reduced. When symptoms are present, they may be mild to moderate, or may keep you from your usual activities or disturb your sleep. Your action plan should state which quick-relief medications you need to take, how much to take, and when to take them. To figure 50% of your personal best peak flow, multiply your best flow by 0.50. For example, if your personal best flow is 400, multiplying by 0.50 gives you 200.
• Red zone. Red means STOP. You are in the red zone of your asthma action plan if your peak expiratory flow is less than 50% of your personal best measurement. Your symptoms may be severe, and you may have extreme shortness of breath and coughing. If your symptoms and peak expiratory flow are in the red zone, seek medical help immediately. While you are seeking emergency help, follow your action plan and take your medications as directed. You may need emergency treatment or admission to a hospital.

The best strategy for avoiding and treating asthma attacks is being able to recognize an attack and know what to do. Talk to your health professional about:

• Your triggers. Asthma triggers are substances that can cause an attack, such as pollen or cigarette smoke. Avoiding your triggers can help decrease your risk of an attack and reduce its severity.
• Your symptoms. These generally include a drop in your peak expiratory flow (PEF) and increased and more severe coughing, wheezing, shortness of breath, and tightness in your chest. The symptoms may vary between people.
• Which quick-relief medications you need to take and how to give them to yourself.
• How to evaluate whether your quick-relief medications are working.
• When emergency care is necessary. If you have a large drop in PEF, your quick-relief medications are not working, or you are very short of breath, you may need emergency care. Your health professional will help you determine these signs.
• A possible pregnancy. If you are pregnant, you may have other options for asthma medications. During an attack, your health professional may also ask that you monitor your fetus's activity by noting a change in fetal kicks.

See an example of an asthma action plan (What is a PDF document?).

If you have no symptoms and your PEF is stable, you are in the green zone. You do not need quick-relief treatment.

If your symptoms are mild or moderate (in the yellow zone), treat them at home using the medications specified in your asthma action plan. You can expect some relief of your asthma symptoms. Seek medical help if the symptoms do not go away soon after you take the prescribed medication or if the symptoms become worse.

If your symptoms are severe (in the red zone), seek medical help immediately. While you are seeking emergency help, follow your action plan and take your medications as directed. You may need emergency room treatment or admission to the hospital. After a severe asthma attack, you may need a short treatment using corticosteroids by mouth to bring your symptoms under control.

You and your health professional will work together to create an asthma action plan. You then follow your action plan when you notice a change in your asthma symptoms or PEF. An asthma action plan will help you make quick decisions about treatment so that you can avoid more serious attacks and get better.

A review of research on asthma action plans reports that plans based on personal best peak expiratory flow and that recommended both the use of inhaled and pill-form corticosteroids to treat asthma attacks improved people's asthma health outcome.¹

If you do not follow your action plan or do not use the medications it specifies, you may have a worse or longer asthma attack. You may have to seek emergency care or go to the hospital.

It is important to treat asthma attacks quickly, especially in children. Babies and small children need to be watched closely during asthma attacks, and caregivers should seek medical help early during an attack. Your child's symptoms do not always reveal the severity of the attack. If your child does not improve soon after treatment for an attack, talk with a health professional.

• During asthma attacks, stay calm and soothe your child. This may help him or her relax and breathe more easily.
• Don't underestimate or overestimate how severe your child's asthma is. It often is hard to assess a baby's or small child's breathing difficulty. Seek medical care early for babies and small children with asthma symptoms.

Asthma attacks cannot be controlled by drinking large amounts of liquids or taking non-prescription medications such as antihistamines or cold remedies. But if you have asthma, you can take antihistamines for other problems, such as colds. Antihistamines will not make your asthma symptoms worse.

Complete the special treatment information form (PDF) (What is a PDF document?) to help you understand this treatment.

Citations

1. Gibson PG, Powell H (2004). Written action plans for asthma: An evidence-based review of key components. Thorax, 59(2): 94–99.