An asthma action plan should include some basic details, to begin with. This test should be done by your healthcare provider at least once a year. Achieving and maintaining asthma control requires providing. This colourful my asthma plan is designed especially for children age from six to 11. If you or someone you are responsible for has asthma, ask about developing an asthma action plan with your doctor. Everyone with asthma needs his or her own asthma action plan. Reliever medicine should only be used if your child has asthma symptoms or as directed by your gp or asthma nurse. An asthma action plan aap is a written plan that outlines how to manage your childs asthma. Green, yellow, red the color codes on your childs asthma action plan help you stay alert for asthma attacks and take the right steps to treat them. Minnesota department of health asthma action plans in pdf child or adult. If i am not back in the green zone within one hour, then i should.
Help your child manage his or her asthma by staying organized. Children who are old enough to understand why youre setting up the plan may be able to help create it. It includes how to use a spacer, how to clean an inhaler, and actions to take for different stages of asthma from well, worse to worried. Develop written asthma action plan initiate medication. Advice to achieve and maintain good control for children and. Asthma action plan library national asthma council australia. Albuterol is not helping within 1520 minutes call your asthma provider breathing is hard and fast ribs show when breathing cant sleep or play because of coughing or wheezing. Recognize early signs, symptoms, and pef measures that indicate worsening asthma. Make an appointment with your asthma care provider within two days of an er visit or hospitalization.
Asthma action plan national heart, lung, and blood institute. Every person with asthma should have an asthma action plan aap in writing. Then decide with your doctor what steps you will take. We distribute aaps to patients in the inpatient and outpatient settings. A copy of the plan should be with your childs school, day care center, babysitter, coach, grandparent and anyone else that helps take care of your child. 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. Asthma action plan for children age 15 british columbia. You and your hcp will write an action plan that you will follow to treat your symptoms and improve your breathing. Our library includes some of the many different written asthma action plans available. Acute asthma wheeze personal asthma action plan respiratory. 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. An asthma action plan, sometimes called asthma management plan, is a form used to keep track of medications, remind you what your peak flow is, and indicate what steps to take if you find yourself having an asthma attack. Asthma action plans also tell school and other caregivers about your child s asthma. 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.
It lists the medicines your child needs to take every day to stay well, what to do if their asthma gets worse, and what to do in an asthma attack. Written asthma action plans are one of the most effective asthma interventions available. Asthma action plan and informational materials asthma clinical guideline tool. Your goal is to prevent and control your asthma attacks. My asthma action plan childrens healthcare of atlanta. 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. This form, when completed by health care providers, gives parents and school personnel a written asthma management plan for children. Symptoms are same or worse after 24 hours in the yellow zone or very short of breath or quickrelief asthma medicines have not helped or cannot. 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.
Shows your childs daily treatment, such as what kind of medicines to take and when to take them. Apr, 2020 everyone with asthma needs his or her own asthma action plan. This brochure is an asthma action plan for doctors to complete and give to child patients and their parentscaregivers. Shareyour childs action plan with school, grandparents. Diagnosis and management 2015, translated action plans available in chinese and punjabi, and fillable pdf. This guide suggests things you can do to avoid your asthma triggers. Once you are diagnosed with asthma, it is very important that you work closely with your hcp to control your asthma.
Green use these medicines every day to prevent asthma attacks. Get copies of common action plan templates on our sensitive choice website. If you cannot contact your doctor, go directly to the emergency room. Asthma action plan you can use the colors of a traffic light to help learn about your asthma medicines. It identifies personal best peak flow, levels of symptom severity, and appropriate patient action. Clinical guideline for the diagnosis, evaluation, and management of adults and children with asthma 2011 pdf asthma action plan. Aug 28, 2019 because people experience asthma differently, youll need to work with the doctor to make a customized plan for your child. Asthma has a genetic component but this does not mean that the children of a person with asthma will also have asthma. If your child doesnt have an asthma action plan, talk to his doctor about getting one. This plan will be shared with school staff who care for my child. These documents are typically aimed toward children who may have trouble managing their conditions. Every person with asthma needs to have a personalized asthma action plan. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. Work with your health care provider to create a plan for your child.
They do however have an increased risk of developing asthma compared to children with parents who do not have asthma. The goal of this asthma care quick reference guide is to help clinicians provide quality care to people who. Asthma action plan, for children 6 years or older, continued doctor doctors phone number. Written asthma action plans are one of the most effective asthma management tools available.
Asthma resources for professionals childrens hospital. Asthma action plan for children age 618 child health bc. 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. Allergens animal dander some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. Name asthma action plan, for children 6 years or older.
Work with your health care provider to create a plan that works for you. San francisco bay area regional asthma management plan. Both the asthma provider and the parent feel that the child may carry and selfadminister their inhalers. A printable version of the children asthma action plan and discharge plan from the asthma model of care keywords. Ask your healthcare provider to complete an asthma action plan to tell you what to do daily and what to do in case of an asthma flareup. Be sure to include the three zones created by the national institutes of healthexternal icon in your plan. Provider instructions for asthma action plan children ages 05 determine the level of asthma severity see table 1 fill in medications fill in medications appropriate to that level see table 1 and include instructions, such as shake well before using use with spacer.
Asthma action plan for children age 15 child health bc. Washington state asthma plan 2016 about the asthma plan this updated version of the washington state asthma plan reflects the current landscape of asthma care and management in washington. Asthma action plan asthma severity see reverse side asthma triggers identified. For more information contact the asthma society of canada at. Pdf core asthma education messages pdf developed by children s hospital of philadelphia asthma initiative.
Red stop green feel good yellow slow down green zone feel great no cough or wheeze can play can sleep red zone sinking in at ribs or neck. Call your asthma provider breathing is hard and fast ribs show when breathing cant sleep or play because of. An asthma action plan should have information that details the course of action when such asthma aggravations occur. Asthma care quick reference national heart, lung, and. An asthma action plan is a printed form with specific instructions based on childs names asthma that tells when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room. Asthma action plans are written documents developed by you and your health care provider, listing customized steps to prevent and handle an asthma episode. Asthma action plans division of disease prevention mecdc. Asthma action plan asthma australia nations peak consumer.
You can use it as a strategy to identify when your asthma may be flaring up and how to manage your asthma when it gets out of control. The washington asthma initiative and the washington state department of health support the plan. Using a written asthma action plan can significantly reduce the risk of asthma symptoms and an asthma attack for children. Cdcs national asthma control program created this set of videos to help children with asthma and their families and caregivers learn how to use an asthma inhaler. Adapted from naepp by childrens national medical center coordinated by the national capital asthma coalition this publication was supported in part by a grant from the dc department of health asthma c o nt rlp ga m,w ihf uds p v eby a n 5u 9eh3 24 08. Does your child have any of the following symptoms when they seem well. This could include teachers, school nurses, and after school care staff. Asthma action plans also tell school and other caregivers about your childs asthma. With a written asthma action plan, its easier for you to measure whether your childs asthma is. Nac aap colour nac aap black and white an aap provides clear information and instructions for managing your asthma. Asthma action plans division of disease prevention. Ribs show in children medicine how much how oftenwhen get help from a doctor now. It will help them understand how to recognize and handle an asthma attack. Download national asthma council asthma action plan pdf.
It contains student medication administration authorization. Adapted from finger lakes asthma action plan and nhlbi revised 10. An asthma action plan allows you and your healthcare provider to create a personalized program for managing your asthma. Asthma action plans respiratory health association. English pdf spanish pdf asthma triggers at home and in the workplace. Asthma action plan for older children childrens healthcare of atlanta.
National health and safety performance standards appendix m special care plan for a child with asthma continued if more columns are needed for medication or equipment instruction, copy this page. Maintaining good daytoday asthma control is the key to keeping symptoms at bay and preventing asthma attacks. Asthma action plan name date of birth gradeteacher. An asthma action plan is a written document that teaches people how to control ones asthma during emergency situations. Home care develop a written asthma action plan see patient education for selfmanagement, page 3.
Provider instructions for asthma action plan children ages 05 determine the level of asthma severity see table 1 fill in medications fill in medications appropriate to that level see table 1 and include instructions, such as shake well before using use with spacer, and rinse mouth after using. Here is a sample asthma action plan you can use for students in school. Asthma action plan and discharge plan for children wa health. Every person living with asthma should have an asthma action plan. Connecticut department of health asthma action plans in pdf and word formats. Acute respiratory paediatric working group of the wa child and youth health network and respiratory health network subject. This asthma action plan is adapted from the asthma action plan created by the national institutes of health. 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. Date hospitalemergency department phone number green zone doing well no cough, wheeze, chest tightness, or shortness of breath during the day or night can do usual activities and, if a peak flow meter is used, peak flow. 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. Well no signs of asthma able to do normal activities no problems while sleeping peak flow above. Nicotine replacement therapy prescription pdf asthma knowledge quiz pdf. Asthma action plans national asthma council australia.
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