Asthma: Your Action Plan

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Medicine List

Controller medicine action plan

Fill in the blank spaces and boxes that apply for all sections.

  • Name of your controller medicine:
    • ____________________________________________
  • How much of this medicine do you take?
    • ____________________________________________
  • How often do you take this medicine?
    • ____________________________________________
  • Other instructions?
    • ____________________________________________

Quick-relief medicine action plan

  • Name of your quick-relief medicine:
    • ____________________________________________
  • How much of this medicine do you take?
    • ____________________________________________
  • How often do you take this medicine?
    • ____________________________________________

Asthma Zones

GREEN ZONE: This is where you want to be!

Green zone symptoms

  • You have no shortness of breath or chest tightness. You are not coughing or wheezing.
  • You can do all of your usual activities.
  • You sleep well at night.

Green zone peak flow (if you use a peak flow meter)

  • ______ or more (80% or more of your personal best)

Green zone actions (Check the boxes and fill in the blank spaces that apply.)

[ ] You take your controller medicine(s) every day.

[ ] You are staying away from your asthma triggers.

[ ] You take quick-relief medicine (called _____________________) ______ minutes before exercise.

YELLOW ZONE: Your asthma is getting worse.

Yellow zone symptoms

  • You are short of breath or have chest tightness. You are coughing or wheezing.
  • You have symptoms that keep you up at night.
  • You can do some, but not all, of your usual activities.

Yellow zone peak flow (if you use a peak flow meter)

  • ______ to ______ (50% to 79% of your personal best)

Yellow zone actions (Check the boxes and fill in the blank spaces that apply.)

[ ] Take _____ puff(s) of quick-relief medicine called ______________________. Repeat _____ times.

[ ] If your symptoms don't get better or your peak flow has not returned to the green zone in 1 hour, then:

  • [ ] Take _____ puff(s) of medicine called ______________________. Take it ____ times a day.
  • [ ] Begin or increase treatment with corticosteroid pills. Take ______ mg of medicine called ____________________________ every __________.
  • [ ] Call your doctor at this number: ____________________.

RED ZONE: Danger!

Red zone symptoms

  • You are very short of breath.
  • You can't do your usual activities.
  • Quick-relief medicine doesn't help. Or your symptoms don't get better after 24 hours in the yellow zone.

Red zone peak flow (if you use a peak flow meter)

  • Less than _______ (less than 50% of your personal best)

Red zone actions (Check the boxes and fill in the blank spaces that apply.)

[ ] Take _____ puff(s) of quick-relief medicine called ____________________________. Repeat ______ times.

[ ] Begin or increase treatment with corticosteroid pills. Take ________ mg now.

[ ] Call your doctor at this number: _________________. If you can't contact your doctor, go to the emergency department. Call 911 or ___________________.

[ ] Other numbers you might call are: ___________________________________.

When should you call for help?

Call 911 anytime you think you may need emergency care. For example, call if:

  • You have severe trouble breathing.

Call your doctor now or seek immediate medical care if:

  • You are in the red zone of your asthma action plan.
  • You've used your quick-relief medicine but are still having trouble breathing.
  • You cough up blood.
  • You have new or worse trouble breathing.
  • You cough up dark brown or bloody mucus (sputum).

Watch closely for changes in your health, and be sure to contact your doctor if:

  • You need to use quick-relief medicine more than 2 days each week within a month (unless it's just for exercise).
  • Your coughing and wheezing get worse.

Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

Where can you learn more?

Go to https://www.healthwise.net/patientEd

Enter H178 in the search box to learn more about "Asthma: Your Action Plan".




The Health Encyclopedia contains general health information. Not all treatments or services described are covered benefits for Kaiser Permanente members or offered as services by Kaiser Permanente. For a list of covered benefits, please refer to your Evidence of Coverage or Summary Plan Description. For recommended treatments, please consult with your health care provider.