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MY ASTHMA ACTION PLAN Date Name Next of kin Next of kin s contact number Green Zone Everyday Asthma Care Orange Zone When I am feeling unwell Red Zone When I am having an asthma attack ASSESSMENT ASSESSMENT ASSESSMENT My asthma is controlled I have no cough wheeze shortness of breath or chest tightness I can exercise without asthma symptoms My asthma symptoms do not wake me at night I do not need to take days off school college or work I use my reliever inhaler twice a week or less over the age of 6 years I use my reliever inhaler once a week or less under the age 6 years My peak flow is between and 80 100 of my personal best ACTION ACTION Controller inhaler Emergency contact number for example GP or out of hours Doctor When my asthma is controlled I take my controller medication everyday Name An Asthma Action Plan is your personal guide to manage your asthma when it gets out of control It will help you to recognise these asthma symptoms COUGH WHEEZE CHEST TIGHTNESS SHORTNESS OF BREATH and provide you with information on what action to take This Asthma Action Plan is yours so use it don t lose it My asthma symptoms include one or all of the following cough wheeze shortness of breath or chest tightness I have symptoms with exercise My asthma symptoms wake me at night I need to take days off school college or work due to asthma symptoms I am taking my reliever inhaler more than twice a week over the age of 6 years I am taking my reliever inhaler more than once a week under the age of 6 years My peak flow is dropping I feel like I have a cold or flu Colour Number of puffs in the morning Controller inhaler When I am feeling unwell I take my medication like this Name Colour Name minute Use a spacer if available Reliever inhaler Colour Number of puffs I should always carry my reliever inhaler I take two puffs of my reliever inhaler before exercise if needed When I am well I also take my other medication I always use a spacer with my inhaler if I have one 1 Stay calm Sit up straight do not lie down 3 Take one puff of your reliever inhaler blue every I always rinse my mouth after I take my controller inhaler I take my reliever inhaler if I wheeze cough have chest tightness or I am finding it difficult to breathe Follow the 5 steps below If you are worried or not improving at any stage CALL 999 112 2 Take slow steady breaths Number of puffs at night Reliever inhaler ACTION THIS IS AN EMERGENCY ACT NOW Number of puffs in the morning Number of puffs at night My asthma symptoms are getting worse and I have increased cough wheeze shortness of breath or chest tightness My reliever inhaler gives little or no relief I find it difficult to talk or walk I find it difficult to breathe I have blue lips or fingernails My peak flow is dropping further The attack came on suddenly I am breathing fast and using my tummy and neck muscles Name People over 6 years can take up to 10 puffs in 10 minutes Colour Number of puffs If I am not improving and I have been prescribed Prednisolone tablets steroid tablets to keep at home I should start taking them Yes No If I continue to feel unwell and I am not improving or I am concerned I contact the GP Nurse out of hours Doctor Emergency Department I always use a spacer with my inhaler if I have one Children under 6 years can take up to 6 puffs in 10 minutes 4 Call 112 or 999 if your symptoms do not improve after 10 minutes 5 Repeat step 3 if an ambulance has not arrived in 10 minutes It is safe to take additional puffs of your blue inhaler during an acute asthma attack I always use a spacer with my inhaler if I have one
COVER My Asthma Medicine My daily controller medication My controller inhaler is Colour My other controller medication is Colour My nasal treatment is Make your asthma action plan work for you My allergy treatment is Why do I need controller medication My controller medication benefits my lungs by reducing inflammation swelling and mucus I need to take my controller every day even when I am well Put your Asthma Action Plan where you and your family can easily find it Save a photo of your Asthma Action Plan on your phone or keep a copy in your bag or car Share a copy of your Asthma Action Plan with family members friends and care givers Check your Asthma Action Plan regularly My reliever medications My reliever inhaler is Colour Why do I need reliever medication My reliever works quickly to make breathing easier by opening up my airway I will always carry my reliever inhaler with me My personal best peak flow if over 6 years of age is Always bring your Asthma Action Plan with you to healthcare appointments and Emergency Department visits Remember to attend for an asthma review at least once a year and have your inhaler technique checked You can help your asthma by Staying active and taking exercise for at least 20 minutes each day ASTHMA Maintaining a healthy weight Quitting smoking and avoiding smokey environments For help to quit smoking call the QUITline on 1800 201 203 or visit www quit ie My asthma triggers are ASTHMA ADVICELINE 1800 Monday Friday 9am 5pm YOUR ACTION PLAN 44 54 64 Beacon Hospital Sandyford Dublin 18 D18 AK68 Tel 01 293 6600 www beaconhospital ie THIS IS MODERN MEDICINE Version 1 01 2022