My asthma action plan name date doctor doctors phone number symptoms. Global initiative for asthma global initiative for. Previous studies have investigated suboptimal paap implementation but more insight is needed into barriers to their use from the perspective of professionals, patients and primary care. Personal asthma action plans paaps have been guideline recommended for years, but consistently underissued by health professionals and underutilised by patients. This asthma action plan is adapted from the asthma action plan created by the national institutes of health. Asthma action plan in word and pdf formats toggle navigation. These should be excluded in the students environment as much as possible. Asthma symptom control means how often in the last four weeks you had asthma symptoms, used your reliever. Written asthma action plans are part of effective asthma selfmanagement. An asthma action plan is an important tool to share with caregivers of children with asthma, including daycare providers, schools and aftercare programs. Breathing is good no cough or wheeze sleep through the night. Allergens animal dander some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. Call our friendly helpline nurses mondayfriday, 9am5pm 0300 222 5800. The date when the sample action plan was originally issued should also be included.
And with that, we give you simple steps on how you can create your own personal action plan that can help you get started with your own. Melissa martin asthma action plan personal best peak flow. Everyones asthma is different, so your best peak flow may be different from the average number for someone of your height, weight and gender. Cough, wheeze, chest tightness, or shortness of breath, or. 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 do usual activities work, play peak flow meter if used. Work with your health care provider to create a plan that works for you. The colors of a traffic light will help you use your asthma medicines. Red zone below 50 percent of your personal best number signals a medical emergency. Your mvp asthma action plan personal best peak flow. Once you are diagnosed with asthma, it is very important that you work closely with your hcp to control your asthma. Your healthcare provider, together with you and your caregivers, will develop an asthma action plan for you based on your personal best peak flow.
Although parents of children with asthma do not need a written asthma action plan, they do need to know what to do if their child has an increase in asthma symptoms. Once you have created one with your gp or asthma nurse, it. Connecticut department of health asthma action plans in pdf and word. Randomised controlled trials published between 1960. Peak flow to 80% to 100% of your personal best peak flow to 60% to 80% of your personal best peak flow to less than 60% of your personal best title. Your goal is to prevent and control your asthma attacks. Then decide with your doctor what steps you will take. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. Your action plan is a personal guide to help you stay on top of your asthma. The action plan would include the treatment that the patient is taking for his asthma such as the type of medication he takes and the frequency he observes in taking them, a plan on how he can.
Illinois department of public health asthma action plan. Call our friendly helpline nurses mondayfriday, 9am5pm 0300 222 5800 uk your written asthma action plan can help you stay on top of your asthma. Our goals include improving diagnoses, management and prevention of asthma by stimulating research, and providing evidencebased educational resources for worldwide use. Asthma action plan national heart, lung, and blood institute. If you use a peak flow meter, the action plan will also tell you when low peak flow readings signal that an asthma attack has become an emergency. 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. Personal asthma action plan advice to achieve and maintain good control for children and young people over 2 years old this is the asthma personal asthma action plan for only completed sections apply to the above child young person. Asthma action plan, for children 6 years or older, continued doctor doctors phone number. Action for anaphylaxis elling of lips, face, eyessw tingling mouth es or weltshiv bdominal pain, vomiting a these are signs of anaphylaxis for insect allergy always give adrenaline autoinjector first, and then asthma reliever puffer if someone with known asthma and allergy. Asthma action plan library national asthma council australia. An asthma action plan can also help reduce a patients need for medical emergency treatment because the written simple plan can help diminish the symptoms. Name asthma action plan, for children 6 years or older. Set a timeline it is important for you to determine a timeline for when you will be able to execute your action plan.
Asthma action plan asthma severity see reverse side asthma triggers identified things that make your asthma worse. An asthma action plan can help you pinpoint the signs that your condition is worsening. How to keep your asthma under control asthma is a chronic disease. Action plans were defined as written or electronic. Take a photograph of it and keep it on your phone you can check what to do if your asthma gets worse. You must take your quickrelief medicine right away. Other medicines and devices eg spacers i use for my asthma every day. This will help you stay on top of the symptoms when they first appear, lessening the chance for the asthma to get in the way of your daily life.
Remember that it is very important to remain on your maintenance medication, even if you are having no symptoms of asthma. Providing this asthma education at the time of diagnosis and reinforcing it at all subsequent visits lead to better outcomes in terms of achieving the goals of asthma therapy, namely few symptoms, no limits on activity, rare exacerbations, and normal lung function. Everyone with asthma needs his or her own asthma action plan. 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. Shareyour childs action plan with school, grandparents. You and your hcp will write an action plan that you will follow to treat your symptoms and improve your breathing.
While there may be personal action plan examples that we have provided above, you might still want to create a personal action plan from scratch. The patients name, their doctors contact details should be specified as well as the patients emergency contact. This guide suggests things you can do to avoid your asthma triggers. Asthma control means the extent to which the effects of asthma can be seen, or have been reduced or removed by treatment. The vicious cycle of personalised asthma action plan. 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. This step is what makes your personal action plan and action plan. To be completed by parentguardian and student student asthma action card continued student name. An asthma action plan is your personal guide to manage your asthma when it gets out of control. Apr, 2020 everyone with asthma needs his or her own asthma action plan. Acute asthma and wheeze personal action plan healthy london.
Refer to your asthma action plan to monitor your asthma and get advanced warning of flareups. And, it helps you know what to do when you have symptoms. 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. An asthma action plan, also known as an asthma management plan, is a detailed plan that an asthma patient should make with the help of his doctor to help him control his condition. Adult asthma action plan 16 years and older the goal of asthma treatment is to live a healthy, active life. Asthma uk research shows that using an asthma action plan is one of the best ways to look after your childs asthma. Many people with asthma are allergic to the dried droppings and remains of cockroaches. Take your asthma controller medications even when you are feeling well. I give permission for the medicines listed in the action plan to be administered in school by the nurse or other school staff as appropriate. Asthma uk asthma uks your asthma and my asthma materials have been developed to help people with asthma to self manage and take better control of their asthma. I hereby authorise medications specified on this plan to be administered according to the plan signed. My written asthma action plan helps me judge how well i am and know what i need to do if im not. Asthma action plan what to look out for asthma medicines preventers your.
Creation of a primary care personal asthma action plan. Your asthma action plan needs to be based on your personal best peak flow number. Since not everyone knows how to treat asthma, you can use the action plan for proper guidance. Your personalised asthma action plan has all the information and tips you need to stay well. Acute asthma wheeze personal asthma action plan advice to achieve and maintain good control for children and young people over 1 year old this is the asthma wheeze personal asthma action plan for only completed sections apply to the above child young person. Create an asthma action plan american lung association. National guidelines recommend that all patients with asthma are offered a personal asthma action plan paap, which contains potentially lifesaving information should a patient experience a decline in symptoms. If you would like more information on illinois asthma program, please contact the illinois department of public health at 2177823300. Symbicort turbohaler your dose if i need more than 12 symbicort turbohaler inhalations in a single day. Read our tips on getting the best from a childs asthma action plan. Breathing is good no cough or wheeze can work and play sleeps well at. An asthma action plan should have information that details the course of action when such asthma aggravations occur. Your asthma action plan fill this in with your gp or nurse the stepbystep guide that helps you stay on top of your asthma name and date.
You personal best is important because it provides a gauge to know if you are healthy, having a minor asthma episode, or having a severe asthma episode. Our written asthma action plans are free to download, and using one will significantly cut your risk of an asthma attack. Your doctor may need to change your asthma action plan. The action plan may have a place for you to list your asthma triggers and notes on how to avoid them. Significance to disparitiesanalysis of the 20062007 child asthma callback survey showed that there were no racialethnic disparities for asthma action plan receipt. Be sure to include the three zones created by the national institutes of healthexternal icon in your plan.
You should understand what asthma is and how simple monitoring and early treatment can help prevent asthma attacks. Oct 21, 2015 personal asthma action plans paaps have been guideline recommended for years, but consistently underissued by health professionals and underutilised by patients. Asthma action plan health library unitedhealthcare. Select the one that is best for you, print a copy and fill in the information requested. An asthma action plan should include some basic details, to begin with. To find out your personal best peak flow number, take peak flow readings. Previous studies have investigated suboptimal paap implementation but more insight is needed into barriers to their use from the perspective of professionals, patients and primary care teams. When can personal best peak flow be determined for asthma. Advice to achieve and maintain good control for children and young people.
The global initiative for asthma gina strives to increase awareness of asthma among health professionals, health authorities, and the general public. Minnesota department of healths interactive asthma action plan is a computerbased program that uses information entered by the healthcare provider to create a personalized plan for each patient. Use the schoolaged asthma action plan, asthma action plan for home and school that includes language for schoolaged children to selfcarry their asthma inhaler in school. For more information on asthma, please visit the national heart, lung and blood. Name date next asthma checkup due doctors contact details emergency contact details name phone relationship asthma action plan take this asthma action plan with you when you visit your doctor. Identify your asthma triggers and learn to avoid them. To investigate how best to encourage health professionals to promote, and for people with asthma to use, asthma action plans. Our library includes some of the many different written asthma action plans available. Right after doing a reverse goal setting, you can now easily determine a stepbystep map for your personal action plan strategy. Use the action plan to recognize the signs of rapidly worsening asthma. At subsequent asthma visits, time spent updating an asthma action plan could be better spent reinforcing asthma education and answering questions. I consent to communication between the prescribing health care provider or clinic, the school nurse, the school medical advisor and school.