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1.800.Einstein ²

Otolaryngology

  • An Asthma Action Plan for Your Child

    Name:                                Personal Best Peak Flow:               Date:                                    

    Provider’s Telephone:                                   After-hours Telephone:                                   

    Triggers: __________________________________________________________

    Personal Best Peak Flow: _____________________________________________

     

    Green Zone "GO!"

    Peak flow is greater than

                             (80%)

    See provider every ______ months.

     

    Symptoms:

    • No cough or wheeze

    • Breathing is good

    • Sleep through the night

    • Can work and play

     

    Asthma Medications

     

    Take your daily preventive medicines: 

                                        

    How much to take_______________

    When____________

     

    Take this medicine 5 minutes before exercise:

                                      

                                      

     

    Other medication(s):

                                        

                                        

     

    Yellow Zone "CAUTION"

    Peak flow is between

                            (50%) and

                            (80%)

    Call provider if in YELLOW ZONE

    for              hour(s).

     

    Symptoms:

    • Cough

    • Wheeze

    • Shortness of breath

    • Chest tightness

     

    Asthma Medications

     

    Continue taking your daily preventive medicines.

    Add quick-relief medicines for symptoms:

                                         

    How much?________________

     

    If you go back to the GREEN ZONE

    after one hour, continue to watch

    your symptoms.

     

    If your symptoms do not return to

    GREEN ZONE after one hour of treatment,

    take: ___                       

    How much?_________________

     

    Add                                   for            days:

                                         

                                       

     

    Red Zone "DANGER!"

    Peak flow is less than

                             (50%)

    Call Provider’s Office!

     

    Symptoms:

    • Medicine is not helping

    • Breathing is hard and fast

    • Nose opens wide

    • Constant coughing or wheezing

    • Can't talk well

    • Any severe symptoms

     

    Asthma Medications

     

    Take quick-relief :                           How much:          

    Add______________ How much           

     

    Go to the hospital or call 911 if you are still in the

    RED ZONE after 15 minutes and you have not

    reached your doctor.

    Call 911 if your child:

    • Is breathing hard or fast

    • Is sucking in chest or abdomen

    • Can’t walk or can’t talk

    • Has blue lips or fingers