It lists the medicines your child needs to take every day to stay well, what to do if their asthma gets worse, and what to do in an asthma attack. Jun 04, 2014 cdc asthma asthma action plan apr 24, 2009 people with asthma should have an asthma action plan the asthma action plan shows your daily treatment, such as what kind. Electronic, fillable pdf versions of asthma action plans click below to open forms. The asthma action plan chosen should be appropriate for the persons age, educational status, language and culture. Asthma action plans by national asthma council australia. This colourful my asthma plan is designed especially for children age from six to 11. This brochure is a asthma selfmanagement action plan for adults to be completed by doctors together with their patients with asthma. Electronic pdf versions are available in full colour, black and white or a writable pdf. Merely noting the symptoms would not help to cure this disease if you do not know what actually you should take note of. In addition to the academy and dhmhs recommendation for using the asthma action plan, a study published in thorax by drs. It includes how to use a spacer, how to clean an inhaler, and actions to take for different stages of asthma from well, worse to worried.
Adapted from finger lakes asthma action plan and nhlbi revised 10. You can use it as a strategy to identify when your asthma may be flaring up and how to manage your asthma when it gets out of control. Breathe in and out normally for 4 breaths keeping your mouth on the spacer. The asthma action plan includes information related to treatment regimes and patient selfmanagement. Using a spacer if you use a metered dose inhaler mdi, a spacer will help to get the right dose of medicine into your lungs. Press down on puffer canister once to fire medication into spacer. An asthma action plan created by physician, educator and patient online collaboration with usability and visual design optimization. Asthma treatment plan student parent instructions the pacnj asthma treatment plan is designed to help everyone understand the steps necessary for the individual student to achieve the goal of controlled asthma. If you would like more information on illinois asthma program, please contact the illinois department of public health at 2177823300. If student improves to yellow zone, send student to doctor or contact doctor. Asthma action plan library national asthma council australia. The zones correspond to the colors of a traffic light.
For more information contact the asthma society of canada at. To download straight to your computer, right click and choose save target as. If student stays in red zone, begin emergency plan. Asthma action plan for older children childrens healthcare of atlanta. Every person with asthma needs to have a personalized asthma action plan.
Perform spirometry at baseline and at least every 1 to 2 years for patients 5 years of age. An asthma action plan aap is a written plan of action that uses 3 stoplight zones greenyellow red to help decide what treatment relating to symptoms or peak flow results is recommended to get and keep asthma under good control. Shareyour childs action plan with school, grandparents. Green zone doing well breathing is good no coughing, wheezing, chest tightness, or shortness of breath during the day or night, and able to do usual activities work, play, and exercise, and peak flow is more than. Asthma provider printed name and contact information. It is very important that you and your child follow the plan as written by your asthma health care provider.
Mar 01, 2016 providing this asthma education at the time of diagnosis and reinforcing it at all subsequent visits lead to better outcomes in terms of achieving the goals of asthma therapy, namely few symptoms, no limits on activity, rare exacerbations, and normal lung function. Asthma triggers try to stay away from or control these things. The 2012 revised dc asthma action plan fillintheblank pdf form is now available in english and spanish based on the national heart, lung, and blood institute s 2007 guidelines for the diagnosis and management of asthma. Asthma action plan community care of north carolina. I need to see my asthma nurse every six months parents get the most from your childs action plan make it easy for you and your family to find it when you need it take a photo and keep it on your mobile and your childs mobile if they have one stick a copy on your fridge door share your. To access the various versions of the asthma action plans, please utilize the links below.
Illinois department of public health asthma action plan. You can use the colors of a traffic light to help learn about your asthma medicines. It causes swelling and narrowing of the airways inside the lungs. Fill it in with your doctor so you can answer these questions. Exercise smoke, strong odors or spray mold colds respiratory infections chalk dustdust carpet pollen change in temperature animals dust mites tobacco smoke cockroaches. Action plans are particularly helpful in preventing multiple visits to the emergency room. This plan will help you know what to do when asthma is in control and when asthma symptoms start to act up. Before taking this form to your health care provider, complete the top left section with.
My asthma action plan times per day every day take only noas needed see below starting in yellow zone or before excercise times per day every day times per day every day 2 puffs 46 puffs 1 nebulizer treatment gargle or rinse mouth after use special instructions when i am doing well be careful ask for help asthma triggers check all that. My asthma action plan childrens healthcare of atlanta. And provide you with information on what action to take. Asthma action plan national heart, lung, and blood institute. Always give adrenaline autoinjector first, and then asthma reliever puffer if someone with known asthma and allergy to food, insects or. When this happens there can be coughing, a whistling sound when you breathe wheezing, chest tightness, and difficulty breathing. Asthma action plans may be based on symptoms with or without peak flow measurements. Connect with us 1200 first street, ne, washington, dc 20002 phone. Communication with your health care provider is an important part of using the asthma action plan. Perform skin or blood allergy tests for all patients with persistent asthma. These tools for asthma control were created following the evidencebased guidelines. This brochure is an asthma action plan for doctors to complete and give to child patients and their parentscaregivers.
To request a supply of hard copy asthma action plans, please fill out our online form or complete the order form pdf or word and submit it via email of fax. Developing an asthma action plan asthma health information. Asthma action plan for children age 618 child health bc. I give written authorization for the medications listed in the action plan to be administered in school by the nurse or other school members as appropriate. My asthma action plan name date doctor doctors phone number symptoms my breathing is normal. Asthma action plan asthma severity see reverse side asthma triggers identified things that make your asthma worse.
Child asthma action plan better breathing, better living name. This brochure provides an asthma action plan that will help you learn the steps to selfmanage your asthma so you can live a life as symptomfree as possible. Take this to your doctor here is your asthma action plan. Apr, 2020 the goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. Gibson and powell confirmed that using a written asthma action plan improves health outcomes for persons with asthma. An asthma action plan is a written series of steps and management techniques that should be used when a patient with asthma experiences worsening in symptoms of the condition. Asthma is getting worse cough, wheeze, chest tightness, or shortness of breath, or waking at night due to asthma, or can do some, but not all, usual activitiesorpeak flow. I should continue using my normal medications as directed by my doctor, and remeasure my peak flow every weeks months. Many written asthma action plans are available, as different action plans suit different people. Remember not to share your spacer with anyone else, and ask for a new one every year. An asthma action plan allows you and your healthcare provider to create a personalized program for managing your asthma.
Assess asthma control at every visit by selfadministered standardized test or verbal history. Using a spacer how to care for your spacer child asthma. Asthma action plan for children age 15 child health bc. An asthma management plan is a special plan that the doctor will make. Electronic, fillable pdf versions of asthma action plans. Our library includes some of the many different written asthma action plans available. Diagnosis and management 2015, translated action plans available in chinese and punjabi, and fillable pdf.