If you or a loved one has asthma, you know the stress of an unexpected asthma attack. That’s why taking preventive measures against an attack is key. A helpful step is to create an asthma action plan with your physician.
“It’s important for individuals to understand what their symptoms are and what they have to do if they’re getting worse,” says pulmonary medicine specialist Nirosshan Thiruchelvam, MD. “It’s also important to work with your care provider to improve your symptoms rather than allowing them to get worse.”
To create an asthma action plan, you’ll need the right resources, steps and knowledge. The plan will prepare you in case of an attack, as well as improve your day-to-day life. This plan can serve as a tool for not only you as an individual with asthma, but also for your caregivers and physicians. For parents, it’s also an important resource for your child’s school nurse and teachers.
What’s in an asthma action plan?
According to the American Lung Association, an asthma action plan is a step-by-step worksheet that lays out ways to prevent your asthma from becoming too severe. It also includes what to do in case of an attack. You can create a plan for both adults and children, with special versions that you can create specifically for use in schools and preschools.
Your plan should also list your immunization history, including the dates you received your flu and COVID-19 vaccines.
Asthma plans usually include contact information and a list of medications that are divided into traffic colors or “zones” (usually color-coded in green, yellow and red). These zones help determine what steps to take depending on the severity of your symptoms. These zones represent “Go,” “Caution” and “Danger.”
“The action plan is important to bring you back to the green zone,” Dr. Thiruchelvam says. “So rather than getting worse, you’re getting better.”
Your asthma action plan should include important contact information, including your name, the name and phone number of your emergency contact, and your doctor’s information. It should also include the date your plan was created, so anyone reviewing will know how current it is.
Medications by zones
Go (green): The green zone lists the medications you take daily to control your asthma. This means that with these medications, you’re able to:
- Get a good night’s sleep.
- Breathe at a good rate without any coughing or wheezing.
- Work and play during the day.
The green zone will also list what medication you should take if you have exercise-induced asthma.
Caution (yellow): The yellow zone lists additional steps you should take, on top of continuing all of your green zone medications. Follow these steps if you have:
- The first signs of a cold.
- Exposure to an unknown trigger.
- Cough, mild wheezing or feelings of a tight chest.
- Coughing at night.
In addition to taking your yellow zone medications, you should call your asthma care provider.
Danger (red): If your asthma continues to worsen even after you’ve taken the medications outlined in your green and yellow zones, you enter the red zone of your asthma action plan. This section lists additional medications you should take when:
- Other medicine isn’t helping.
- Your breathing is hard and fast.
- You’re having trouble speaking
- Your nose is opening wide.
- In children, their ribs are showing.
In addition to taking the medications listed, in this stage of the plan, you (or whoever is following the plan on your behalf) should contact your doctor immediately, and if you can’t make contact, go directly to an emergency room.
How do you create your asthma action plan?
The different stages of your asthma plan make it clear what medications to use and what additional steps to take based on your symptoms. Your asthma plan takes any guesswork out of deciding what to do when you or someone you’re providing care for has an asthma attack. The plan is personalized to your needs.
Because a plan isn’t one-size-fits-all, you’ll fill in the different zones of your personal asthma plan when you see your physician. This can and should be updated during every office visit to monitor any improving or weakening symptoms.
“It’s going to be a living document, so it’s not going to be set in stone,” Dr. Thiruchelvam points out. “Your controller medication might be different. You know, things might change.”
Here’s some plan information that’ll look different for everyone:
- Personal best peak flow: Your peak flow is how fast you can push air out of your lungs when you blow out as hard and as fast as you can. Everyone’s peak flow is different. You can determine your personal best using a peak flow meter. Your personal best flow should be recorded in your plan, as well as your peak flows for each zone on the plan.
- Prescribed medicines: Your doctor will prescribe specific medicine to meet your needs for each type of symptom you may experience. These medicines (and your specific dose) should be listed by zone on your plan.
- Triggers: Note your triggers. Everyone has different triggers that could set off an attack, whether it be a change in weather or seasons, certain foods, dust, exercise or even emotional triggers.
How to read an asthma action plan
One section should include a list of symptoms to identify. Based on those, your doctor fills out the appropriate steps to take. Depending on the triggers, your symptoms and previous steps taken, each zone lists certain medications and actions to take.
“Individualized care is key,” says Dr. Thiruchelvam. “Especially when you’re treating asthma, there are two different paths. One is avoiding triggers and the other is treating the disease.”
Take these steps to follow your plan:
- Check if you’re having any symptoms and match them to the appropriate zone.
- Use a peak flow meter to check your peak flow and see if it aligns with the green, yellow or red zone.
- Take the appropriate medicine outlined by your doctor.
- If you’re in the yellow or red zone, follow the steps outlined and make a visit to either your asthma care provider or an emergency room.
Follow the 4:4:4 rule for children
An asthma action plan lays out steps to take in preparation for a possible attack. But the 4:4:4 rule is also important to know for children having an active attack. This shortcut will help you remember the specifics for helping a child use their inhaler during an attack. When a child is showing shortness of breath, tightness in their chest, wheezing or other severe symptoms of asthma, follow the 4:4:4 rule:
- Have the child sit upright.
- Give four puffs, one at a time, from their inhaler.
- Wait four minutes.
- If there’s no improvement, give another four puffs.
By creating an asthma action plan and knowing the 4:4:4 rule, you can be confident you’re prepared for a possible asthma attack. Keep this plan ready and available at home, at your physician’s office and at any school or daycare center for children.