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Asthma Action Plan
For:

Doctor:

Doctor’s Phone Number

Hospital/Emergency Department Phone Number

GREEN ZONE

Doing Well

Date:

Take these long-term control medicines each day (include an anti-inflammatory).

No cough, wheeze, chest tightness, or
shortness of breath during the day or night
Can do usual activities

Medicine

How much to take

When to take it

❐ 2 or ❐ 4 puffs

5 minutes before exercise

And, if a peak flow meter is used,
Peak flow: more than
(80 percent or more of my best peak flow)
My best peak flow is:
Before exercise

YELLOW ZONE

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 activities

First

Add: quick-relief medicine—and keep taking your GREEN ZONE medicine.
(short-acting beta2-agonist)

Second

-OrPeak flow:
to
(50 to 79 percent of my best peak flow)

❐ 2 or ❐ 4 puffs, every 20 minutes for up to 1 hour
❐ Nebulizer, once

If your symptoms (and