Asthma Action PlanGreen Zone: Well•Nosignsofasthma•Abletodonormalactivities•Noproblemswhilesleeping

•Peakflowabove:_______

*Rinsemouthafterthismedicine

Give these medicines every day:

MEDICINE: HOW MUCH: WHEN:

Yellow Zone: Watch Out!

Early Signs of Asthma:•Coldsymptoms•Coughingdayornight•Wheezingdayornight• Funnyfeelinginchest

•Myfirstsign:______________

•Peakflow:______________

Red Zone: EMERGENCY!

Late Signs of Asthma:•Tightchest•Breathinghardorfast•Usingneckorstomachmusclestobreathe

•Constantcoughing•Troubletalkingorwalking•Vomiting•Lipsornailsblue

•Peakflowbelow:_______

(above80%ofbest)

(50-80%ofbest)

(below50%ofbest)

Patient/Parent/Guardian Signature Date

RN/MD Signature Date

Phone number of Doctor or Nurse:

Day: __________________________

Night: _________________________

Original 1995. Revised 10/12. Copyright © 2012

First—give:

Albuterol 2-4puffsor1nebulizer 1-3timesinfirsthour

Call your Doctor or Nurse if not in Green Zone after first hour.

Next — if asthma is better after first hour, you may give:

Albuterol 2-4puffsor1nebulizer every4hoursasneeded

Call your Doctor or Nurse if:

Albuterolneededmoreoftenthanevery4hours.Albuterolneededevery4hoursformorethan1day.

Keep taking other Green Zone medicines.

First—givenow : Albuterol6puffsor1nebulizer

ANDcall your Doctor or Nurse.

Next — ifyoucannotreachyourDoctororNurseimmediately, give: Albuterol6puffsor1nebulizer

AND go to the nearest emergency room or call 911.

(oralsteroid)