Free Action plan template 20
Download the document to the computer for easy use
There are more pages to preview,Read on

Name:

Date:

Emergency Contact:

Relationship:

Cell phone:

Work phone:

Health Care Provider:

ASTHMA ACTION PLAN
GREEN ZONE:

Phone number:

Personal Best Peak Flow:

Take these medicines every day for control and maintenance:

Doing Well

Medicine

P No coughing, wheezing, chest
tightness, or difficulty breathing
P Can work, play, exercise, perform
usual activities without symptoms
OR
P Peak flow ____ to ____

How much to take

When and how often

(80% to 100% of personal best)

YELLOW ZONE:

CONTINUE your Green Zone medicines PLUS take these quick-relief medicines:

Caution/Getting Worse

P Coughing, wheezing, chest
tightness, or difficulty breathing
P Symptoms with daily activities,
work, play, and exercise
P Nighttime awakenings with
symptoms
OR
P Peak flow ____ to ____
(50% to 80% of personal best)

Medicine

How much to take

When and how often

Call your doctor if you have been in the Yellow Zone for more than 24 hours.
Also call your doctor if: