Asthma Action Plan Guide
Complete guide to creating and following an asthma action plan for better control and emergency preparedness
An asthma action plan is a personalized written document that helps you manage your asthma daily and during attacks. It includes your triggers, medications (rescue and controller), peak flow zones, and when to seek emergency care. Following your action plan reduces attacks and improves quality of life.
Understanding Asthma
Asthma is a chronic inflammatory disease of the airways that causes recurring episodes of wheezing, breathlessness, chest tightness, and coughing. The airways are sensitive and react to various triggers by narrowing, producing excess mucus, and swelling.
Key Facts
- Prevalence: Over 25 million Americans have asthma, including 6 million children
- Types: Allergic asthma, non-allergic asthma, exercise-induced, occupational asthma
- Control is Possible: With proper management, most people can achieve good asthma control
- Individual Variability: Triggers and treatment responses vary person to person
The Importance of an Asthma Action Plan
An asthma action plan is a written document developed with your healthcare provider that tells you:
- What medications to take and when
- How to track your asthma control
- What triggers to avoid
- What to do when symptoms worsen
- When to seek emergency care
People with written action plans have:
- Fewer asthma attacks
- Less missed school/work
- Better quality of life
- Reduced emergency room visits
Creating Your Asthma Action Plan
The Zone System
Your action plan uses a traffic light system to help you monitor your asthma:
| Zone | Meaning | Peak Flow | Symptoms |
|---|---|---|---|
| Green | Good control | 80-100% of personal best | No symptoms, sleeping well |
| Yellow | Caution | 50-79% of personal best | Some symptoms, waking at night |
| Red | Medical alert | Below 50% of personal best | Severe symptoms, rescue not helping |
Green Zone: Daily Management
You're doing well if:
- No asthma symptoms during the day or night
- Can perform all normal activities
- Peak flow is 80% or higher of your personal best
- Need rescue inhaler less than twice per week
Your Plan:
- Continue taking controller medications as prescribed
- Take rescue inhaler 15-30 minutes before exercise if needed
- Avoid known triggers
- Continue regular monitoring
Yellow Zone: Caution
Warning signs include:
- Waking at night due to asthma
- Using rescue inhaler more than twice per week
- Peak flow 50-79% of personal best
- Mild cough, wheeze, or chest tightness
- Symptoms with activity that usually don't cause problems
Your Plan:
- Increase rescue inhaler use as directed
- May need to increase controller medication
- Avoid triggers
- Contact healthcare provider if symptoms don't improve in 24-48 hours
Red Zone: Medical Alert
Get help immediately if:
- Severe shortness of breath at rest
- Rescue inhaler not helping
- Peak flow below 50% of personal best
- Can't speak in full sentences
- Lips or fingernails turning blue
- Chest or neck muscles pulling in (retractions)
Your Plan:
- Call 911 or go to emergency room
- Take rescue inhaler every 20 minutes for up to 1 hour while waiting
- Stay upright, try to stay calm
Identifying Your Triggers
Common Asthma Triggers
| Category | Triggers | Avoidance Strategies |
|---|---|---|
| Allergens | Dust mites, pollen, pet dander, mold, cockroaches | Use allergen-proof covers, remove carpets, use HEPA filters, regular cleaning |
| Irritants | Smoke, air pollution, strong odors, chemicals | Avoid smoke, check air quality, use fragrance-free products |
| Respiratory Infections | Colds, flu, sinus infections | Get vaccinated, wash hands frequently, avoid sick contacts |
| Weather | Cold air, changes in temperature/humidity | Wear scarf over mouth in cold, exercise indoors when needed |
| Exercise | Physical exertion | Use pre-treatment, warm up gradually, cool down slowly |
| Emotions | Stress, strong emotions, laughing | Practice relaxation, manage stress |
| Medications | Aspirin, NSAIDs, beta-blockers | Discuss alternatives with your doctor |
| Foods | Sulfites, food allergies | Read labels, avoid known allergens |
Keeping a Trigger Diary
Track your symptoms and potential triggers:
| Date/Time | Symptoms | What you were doing | Possible triggers | Medications taken |
|---|---|---|---|---|
| Example: Mon 3pm | Cough, wheeze | Raking leaves | Pollen, dust | 2 puffs rescue |
Medication Management
Rescue Medications (Quick Relief)
Short-Acting Beta-Agonists (SABAs):
- Examples: Albuterol, Levalbuterol
- Onset: 5-15 minutes
- Duration: 4-6 hours
- Use: As needed for symptoms, before exercise
Proper Rescue Inhaler Use:
- Shake inhaler well
- Exhale completely
- Place mouthpiece between teeth, seal lips
- Press down and breathe in slowly
- Hold breath 10 seconds
- Wait 1 minute before second puff
- Use with spacer for better delivery
Controller Medications (Long-Term Control)
Inhaled Corticosteroids (ICS): The most effective long-term control medication.
| Medication | Dosing | Notes |
|---|---|---|
| Fluticasone | 1-2 puffs twice daily | Rinse mouth after use |
| Budesonide | 2 puffs twice daily | Can be used with nebulizer |
| Beclomethasone | 1-2 puffs twice daily | Qvar brand available |
| Mometasone | 2 puffs once daily | Asmanex brand |
Long-Acting Beta-Agonists (LABAs):
- Examples: Salmeterol, Formoterol
- Always used WITH inhaled corticosteroids
- Never use alone for asthma
Combination Inhalers:
| Combination | Dosing |
|---|---|
| Fluticasone/Salmeterol (Advair) | Twice daily |
| Budesonide/Formoterol (Symbicort) | Twice daily |
| Fluticasone/Vilanterol (Breo) | Once daily |
| Mometasone/Formoterol (Dulera) | Twice daily |
Other Controller Medications:
- Leukotriene Modifiers: Montelukast (Singulair) - oral tablet daily
- Theophylline: Oral medication, less commonly used now
- Biologics: For severe asthma (omalizumab, mepolizumab, etc.)
Peak Flow Monitoring
A peak flow meter measures how fast you can exhale. It helps detect airway narrowing before symptoms appear.
Finding Your Personal Best
- Measure peak flow for 2 weeks when asthma is well-controlled
- Take readings morning and evening, plus before and after rescue medication
- The highest reading is your personal best
Peak Flow Zones
| Zone | Range | Meaning |
|---|---|---|
| Green | 80-100% of best | Good control, continue usual medications |
| Yellow | 50-79% of best | Caution, may need treatment adjustment |
| Red | Below 50% of best | Medical alert, seek immediate care |
How to Use a Peak Flow Meter
- Move indicator to zero
- Stand up (or sit up straight)
- Take a deep breath
- Place mouthpiece in mouth, close lips
- Blow out as hard and fast as possible
- Read the number
- Repeat twice more, record the highest
Emergency Response Plan
Recognizing an Asthma Attack
Early Warning Signs:
- Increased cough, especially at night
- Feeling tired or weak with exercise
- Mild chest tightness
- Drop in peak flow
- Need for more rescue inhaler
Progressing Symptoms:
- Wheezing that doesn't improve with rescue inhaler
- Difficulty speaking in full sentences
- Breathing faster than normal
- Retractions (skin pulling between ribs or at neck)
- Anxiety or panic
Severe Emergency:
- Can't speak more than 1-2 words
- Lips or fingernails blue or gray
- Confusion or drowsiness
- Unconsciousness
Step-by-Step Emergency Response
At Home:
- Stay calm - Anxiety makes breathing worse
- Sit upright - Don't lie down
- Take rescue medication:
- 2-4 puffs with spacer
- Wait 4 minutes
- Repeat if no improvement
- Assess:
- If improving: Continue monitoring
- If not improving after 15 minutes: Call 911
- While waiting for help:
- Continue rescue inhaler every 20 minutes
- Stay upright
- Try to remain calm
Emergency Information Card
Keep a card with you that includes:
- Your name and emergency contact
- Asthma diagnosis and severity
- List of medications
- Healthcare provider contact
- Any allergies
Asthma in Daily Life
Exercise and Asthma
You CAN exercise with well-controlled asthma.
Tips:
- Use rescue inhaler 15-30 minutes before exercise
- Warm up for 10-15 minutes
- Breathe through your nose when possible
- Exercise indoors when air quality is poor
- Cool down gradually after exercise
Good Activities for Asthma:
- Swimming (warm, humid air)
- Walking
- Biking
- Yoga
- Team sports with rest periods
Travel with Asthma
Before You Go:
- Get a letter from your doctor listing medications
- Pack extra medications in carry-on
- Bring a copy of your action plan
- Research medical facilities at destination
During Travel:
- Keep medications accessible
- Maintain your regular schedule
- Be prepared for different climates/triggers
School and Work
For Parents of Children with Asthma:
- Provide school with action plan
- Ensure rescue inhaler is accessible
- Educate teachers about warning signs
- Plan for physical education and field trips
For Adults:
- Inform coworkers/supervisors about your asthma
- Keep rescue inhaler accessible
- Know workplace triggers and how to avoid them
When to Seek Help
See your doctor regularly if:
- Need rescue inhaler more than twice per week
- Wake at night due to asthma more than twice per month
- Refilling rescue inhaler more than twice per year
- Symptoms interfere with daily activities
Seek immediate care if:
- Rescue inhaler not helping
- Peak flow in red zone
- Can't speak in full sentences
- Lips or fingernails turning blue
- Severe anxiety or confusion
An asthma action plan puts you in control. Work with your healthcare provider to create a personalized plan, review it regularly, and share it with family, caregivers, and your healthcare team. With proper management, you can breathe easier and live fully.
Disclaimer: This content is for informational purposes only and does not constitute medical advice. Consult your healthcare provider for personalized guidance.