They comprise of either 3 or 4 stages depending on patient and health professionals. A written asthma action plan encourages selfmanagement of asthma. People with asthma should have an asthma action plan. To download straight to your computer, right click and choose save target as. Work with your health care provider to create a plan that works for you. Asthma action plan you can use the colors of a traffic light to help learn about your asthma medicines. The goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. Then decide with your doctor what steps you will take. These tools for asthma control were created following the evidencebased guidelinesexternal icon published by the national institutes of health.
Green use these medicines every day to prevent asthma attacks. You can use it as a strategy to identify when your asthma may be flaring up and how to manage your asthma. Asthma action plan, for children 6 years or older, continued doctor doctors phone number. Maintaining good daytoday asthma control is the key to keeping symptoms at bay and preventing asthma attacks. Written asthma action plans are one of the most effective asthma interventions available. This guide suggests things you can do to avoid your asthma triggers.
Adapted from finger lakes asthma action plan and nhlbi revised 10. It is important make an asthma action plan that works well for you. Use the schoolaged asthma action plan, asthma action plan for home and school that includes language for schoolaged children to selfcarry their asthma. This plan has information and instructions on how to manage your asthma. Asthma action plan engpdf asthma and allergy foundation. Clinical guideline for the diagnosis, evaluation, and management of adults and children with asthma 2011 pdf asthma action plan. An asthma action plan helps the person with asthma andor their carer recognise worsening asthma and gives clear instructions on what to do in response. Take a copy of your written asthma action plan to your school nurse. A practice personalised asthma action plan paap was developed by the author, based on the existing evidence base, for use in a single general practice setting. Illinois department of public health asthma action plan. Work with your health care provider to create a plan for your child. If you do not have adobe acrobat reader on your computer, it can be downloaded directly from adobes web site, without charge, by clicking the button to the right. The group of 8 g8 of the worlds wealthiest countries. Many people with asthma are allergic to the dried droppings and remains of cockroaches.
Name asthma action plan, for children 6 years or older. School health forms and action plans schoolage health and. If a spray is used to kill roaches, stay out of the room until the odor. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. Asthma action plan pdf fill out and sign printable pdf. Green zone doing well breathing is good no coughing, wheezing, chest tightness, or shortness of breath during the day or night, and able to do usual activities work, play, and exercise, and peak flow is more than. Take a photograph of it and keep it on your phone you can check what to do if your asthma. Work with your health care provider to create a plan. All subjects received evaluation and education for asthma before being randomly allocated to receive no action plan, a symptombased action plan, or a peak flowmeter and a peak flowbased action plan. Asthma action plans asthma initiative of michigan aim.
Asthma action plan check all items that trigger your asthma and things that could make your asthma worse. Every person living with asthma should have an asthma action plan. My asthma action plan times per day every day take only noas needed see below starting in yellow zone or before excercise times per day every day times per day every day 2 puffs 46 puffs 1 nebulizer treatment gargle or rinse mouth after use special instructions when i am doing well be careful ask for help asthma triggers check all that. Stay informed with the latest updates on coronavirus covid19. Virginia asthma action plan asthma action plans assist you and your child in managing their asthma. If any of the above symptoms are present, call your local emergency service immediately. If you do not have an asthma action plan, download and print this form.
I should continue using my normal medications as directed by my doctor, and remeasure my peak flow every weeks months. Everyone with asthma should have a written asthma action plan. To request a supply of hard copy asthma action plans, please fill out our online form or complete the order form pdf. Asthma action plan name school dob health care provider providers phone parentresponsible person parents phone additional emergency contact contact phone asthma severity see reverse side asthma triggers identified things that make your asthma. Action plans are based on your childs asthma symptoms and may include hisher personal best peak. These plans complement the childs asthma management plan, whether it be nacs asthma action plan, or asthma australias asthma care plan in an education and care setting. This brochure provides an asthma action plan that will help you learn the steps to selfmanage your asthma so you can live a life as symptomfree as possible.
I need to see my asthma nurse every six months parents get the most from your childs action plan make it easy for you and your family to find it when you need it take a photo and keep it on your mobile and your childs mobile if they have one stick a copy on your fridge door share your. They comprise of either 3 or 4 stages depending on patient and health professionals preference. Communication with your health care provider is an important part of using the asthma action plan. Asthma control means the extent to which the effects of asthma can be seen, or have been reduced or removed by treatment.
To be completed by parentguardian and student student asthma action card continued student name. Merely noting the symptoms would not help to cure this disease if you do not know what actually you should take note of. These should be excluded in the students environment as much as possible. Asthma action plan name school dob health care provider providers phone parentresponsible person parents phone additional emergency contact contact phone asthma severity see reverse side asthma triggers identified things that make your asthma worse. Asthma action plans respiratory health association. Action plans are particularly helpful in preventing multiple visits to the emergency room. Intermittent mild persistent moderate persistent severe persistent. It is very important that you and your child follow the plan as written by your asthma health care provider. For more information on asthma, please visit the national heart, lung and blood institute at. Asthma action plan for adults american lung association. Take your asthma action plan to your school, childcare provider and your home. My asthma action plan name date doctor doctors phone number symptoms my breathing is normal. Create an asthma action plan american lung association.
To access the various versions of the asthma action plans, please utilize the links below. Asthma action plans also tell school and other caregivers about your childs asthma. If student improves to yellow zone, send student to doctor or contact doctor. This is the asthma action plan for dc public schools provided by the department of health. Have the following written down and kept close at hand in case of an emergency. Asthma action plans are written documents developed by you and your health care provider, listing customized steps to prevent and handle an asthma. Asthma action plan national heart, lung, and blood. More than ever, investing in nutrition is seen as a key development priority to benefit global welfare. Asthma action plan provider instructions at initial presentation, determine the level of asthma severity level of severity is determined by both impairment and risk and is assigned to the most.
It has sections for information about medicines, how to know when your symptoms get worse and what to do in an emergency. My asthma action plan childrens healthcare of atlanta. Take a photograph of it and keep it on your phone you can check what to do if your asthma gets worse. Your goal is to prevent and control your asthma attacks. Asthma action plan this information is for general purposes and is not intended to replace the advice of a qualified health professional. With the help of your doctor, use this plan to write down how to manage your asthma. Fill out, securely sign, print or email your asthma action plan pdf asthma and allergy foundation of america aafa instantly with signnow. A list of the persons triggers and how to avoid them, instructions for taking asthma medicine, information on what to do during an asthma episode, instructions on when to call a doctor, and. Asthma action plan and informational materials asthma clinical guideline tool. Be sure to include the three zones created by the national institutes of healthexternal icon in your plan. Put a check next to the triggers that you know make your asthma worse and ask your doctor to help you find out if you have other triggers as well. If student stays in red zone, begin emergency plan.
The colors of a traffic light will help you use your asthma. The process of developing a written asthma action plan is important, as this should be a discussion of the persons individual asthma and its management. Use poison baits, powders, gels, or paste for example, boric acid. In response to the release of the epr3 guidelines, ramp, along with our clinical partners, worked on a revision to our asthma action plans. Electronic, fillable pdf versions of asthma action plans.
There are many different asthma action plan formats. Coordinated federal action plan to reduce racial and. Intermittent mild persistent moderate persistent severe persistent heshe has had many or severe asthma attacksexacerbations school staff. This could include teachers, school nurses, and after school care staff. For more information contact the asthma society of canada at. Coordinated federal action plan to reduce racial and ethnic asthma disparities in this plan, federal agencies propose to build on the strengths and lessons learned from past and existing federal asthma programs, combine efforts among federal programs at the community level, and develop collaborative strategies to fill knowledge gaps within. Before taking this form to your health care provider, complete the top left section with.
Massachusetts asthma action plan personal best peak flow. Date hospitalemergency department phone number green zone doing well no cough, wheeze, chest. My written asthma action plan helps me judge how well i am and know what i need to do if im not. A written asthma action plan, developed jointly by the health care provider and the patient, will help the patient manage his or her asthma. An asthma action plan is an important tool to share with caregivers of children with asthma, including daycare providers, schools and aftercare programs.
An asthma action plan allows you and your healthcare provider to create a personalized program for managing your asthma. Green zone doing well breathing is good no coughing, wheezing, chest tightness, or. This brochure is a asthma selfmanagement action plan for adults to be completed by doctors together with their patients with asthma. Ask your doctor questions talk about concerns, including medication side effects. Read our tips on getting the best from a childs asthma action plan.
Webonly publications this item is only available online for download and selfprinting. Asthma action plan library national asthma council australia. Respira bien no tiene tos ni sibilancia puede trabajar y jugar. Asthma action plan national heart, lung, and blood institute. English pdf spanish pdf asthma triggers at home and in the workplace.
Each asthma patients experience with asthma may be different but our simple action plan templates are very versatile to deal with any kind of asthma. The pacnj asthma treatment plan is designed to help everyone understand the steps necessary for the individual student to achieve the goal of controlled asthma. Asthma action plans national asthma council australia. The illinois department of public health idph regulates the installation of all.
Asthma action plan in word and pdf formats toggle navigation. Electronic, fillable pdf versions of asthma action plans click below to open forms. Our library includes some of the many different written asthma action plans available. We eagerly look forward to the continued evolution of the plan over time. Follow the yellow and red zone plans for rescue medicines according to asthma symptoms. Malfunctioning or improperly constructed and maintained private sewage disposal systems can pose serious health hazards.