CHILD AND ADULT / ASTHMA ACTION PLAN _ / PAGE ONE
This plan will help you control your asthma, provide you with a summary of your medications, and help you remember what to do during an asthma episode. Please keep a copy with you at all times. Our goal is for you to:
ü Be active without having asthma symptoms, including exercise or sports.ü Sleep through the night without having asthma symptoms
ü Prevent asthma episodes or attacks
ü Have the best possible peak flow
ü Avoid side effects from medications / Hospital Name
ADDRESS
City State Zip
Phone number Hospital
RESCUE: 911
This plan is based on PEAK FLOW monitoring. You should do this twice a week if your asthma is well controlled but twice a day (a.m. & p.m.) if not or when you are symptomatic. Measure your peak flow before and after any inhaled medications. Always take the best of 3 consistent readings. If you have not taken at least 2 weeks to measure your peak flow at least 2x/day to determine your personal best peak flow, talk with Dr. Wallace.
Established Dx. Abdominal pain/54./789.0Acne/89/706.1Allergic Rhinitis, mites/molds/305/477.8Allergic Rhinitis,pollen/279/477.0Anaphylactic Rxnot food/002/995.0Anaphalactic Rxn, food unspec/540/995.60Angioedema/003/995.1Arthralgia/004/719.4Arthritis,Subacute/005/716.9Asthma w/COPD/140/493.2Asthma,Ext/138/493.00Asthma,Ext w/Status/141/493.01Asthma,Int/139/493.10Asthma Int w/Status/142/493.11Asthma,Unsp/006/493.90Asthma,Unspec w/Status/007/493.91Atopic Dermatitis/008/691.8Blood Pressure,Elevat/180/796.2Bronchitis/acute/009/466.0Bronchitis Acute w/COPD/135/491.21Bronchitis,Chronic,Unspec/010/491.90Bronchitis,Chroni w/COPD/136/491.20Bronchitis Chronic Simple/137/491.00 Candidiasis,Oral/110/112.0Cerumen,impaction/011/380.4Conjunctivitis,Acute/013/372.0Conjunctivitis.Allergic/014/372.14COPD/015/496.0Cough/016/786.2Dermatitis,Contact/017/692.9Diarrhea/090/008.8Drug Allergy/018/995.2Dyspnea/258/786.09Eczema/019/692.9Epistaxis/086/784.7Fatigue/021/780.7Fever/022/780.6Food Allergy/023/693.1Gastroenteritis/024/009.0Gastroesophageal Reflux/345/530.81Headache,unspec/025/784.0Hoarseness&Other Voice Dist./104/784.49Hyperlipidemia.Mixed/69/272.2Hypertension/26/401.9Hypertrophic T&A's/027/474.1Hypothyroidism,Unspec/086/244.9 Immune Disorder,Other/028/279.3Infection,Resp w/flu/029/487.1Latex Allergy/563/989.82Laryngitis,Acute/030/464.0Lymphadenopathy/031/785.6Lymphadenitis/032/683Migraine/033/346.9Nasal Septal Deviation/034/470.0Non-Allergic Rhinitis/035/472.0Otitis Externa/036/380.1Otitis Media/037/382.9Otitis Serous/038/381.1Pharyngitis/039/462Polyps,nasal/041/471.9Pruritis/042/698.9Rash,unspec./043/782.1Reaction,Drug/101/995.2Reflux Esphoagitis/469/530.11Resp Infection/Chronic/044/519.8Rosacea/151/695.3 Seborrhea/045/690.0Shortness of Breath/060/786.09Sinusistis,Acute/046/461.9Sinusitis, Chronic/047/473.9Sore Throat/091/462.0Stomatitis,Oral Aphepeous/213/528.2Tonsilitis/49/463.0URI,Acute/049/465.9Urticaria, Allergic/82/708.0 Urticaria Cholinergic/159/708.5Urticaria Chronic/294/708.8Urticaria,Dermagraphic/292/708.3Urticaria, Idiopathic/065/708.1Urticaria,unspecified/050/708.9Venomous Sting Rx./051/989.5Weight Loss/052/783.2Wheeze/327/786.09 / Drug Allergies: / Ht.Abdominal pain/54./789.0Acne/89/706.1Allergic Rhinitis, mites/molds/305/477.8Allergic Rhinitis,pollen/279/477.0Anaphylactic Rxnot food/002/995.0Anaphalactic Rxn, food unspec/540/995.60Angioedema/003/995.1Arthralgia/004/719.4Arthritis,Subacute/005/716.9Asthma w/COPD/140/493.2Asthma,Ext/138/493.00Asthma,Ext w/Status/141/493.01Asthma,Int/139/493.10Asthma Int w/Status/142/493.11Asthma,Unsp/006/493.90Asthma,Unspec w/Status/007/493.91Atopic Dermatitis/008/691.8Blood Pressure,Elevat/180/796.2Bronchitis/acute/009/466.0Bronchitis Acute w/COPD/135/491.21Bronchitis,Chronic,Unspec/010/491.90Bronchitis,Chroni w/COPD/136/491.20Bronchitis Chronic Simple/137/491.00 Candidiasis,Oral/110/112.0Cerumen,impaction/011/380.4Conjunctivitis,Acute/013/372.0Conjunctivitis.Allergic/014/372.14COPD/015/496.0Cough/016/786.2Dermatitis,Contact/017/692.9Diarrhea/090/008.8Drug Allergy/018/995.2Dyspnea/258/786.09Eczema/019/692.9Epistaxis/086/784.7Fatigue/021/780.7Fever/022/780.6Food Allergy/023/693.1Gastroenteritis/024/009.0Headache,unspec/025/784.0Hoarseness&Other Voice Dist./104/784.49Hyperlipidemia.Mixed/69/272.2Hypertension/26/401.9Hypertrophic T&A's/027/474.1Hypothyroidism,Unspec/086/244.9Gastroesophageal Reflux/345/530.81 Immune Disorder,Other/028/279.3Infection,Resp w/flu/029/487.1Latex Allergy/563/989.82Laryngitis,Acute/030/464.0Lymphadenopathy/031/785.6Lymphadenitis/032/683Migraine/033/346.9Nasal Septal Deviation/034/470.0Non-Allergic Rhinitis/035/472.0Otitis Externa/036/380.1Otitis Media/037/382.9Otitis Serous/038/381.1Pharyngitis/039/462Polyps,nasal/041/471.9Pruritis/042/698.9Rash,unspec./043/782.1Reaction,Drug/101/995.2Reflux Esphoagitis/469/530.11Resp Infection/Chronic/044/519.8Rosacea/151/695.3 Seborrhea/045/690.0Shortness of Breath/060/786.09Sinusistis,Acute/046/461.9Sinusitis, Chronic/047/473.9Sore Throat/091/462.0Stomatitis,Oral Aphepeous/213/528.2Tonsilitis/49/463.0URI,Acute/049/465.9Urticaria, Allergic/82/708.0 Urticaria Cholinergic/159/708.5Urticaria Chronic/294/708.8Urticaria,Dermagraphic/292/708.3Urticaria, Idiopathic/065/708.1Urticaria,unspecified/050/708.9Venomous Sting Rx./051/989.5Weight Loss/052/783.2Wheeze/327/786.09 / Wt.
Abdominal pain/54./789.0Acne/89/706.1Allergic Rhinitis, mites/molds/305/477.8Allergic Rhinitis,pollen/279/477.0Anaphylactic Rxnot food/002/995.0Anaphalactic Rxn, food unspec/540/995.60Angioedema/003/995.1Arthralgia/004/719.4Arthritis,Subacute/005/716.9Asthma w/COPD/140/493.2Asthma,Ext/138/493.00Asthma,Ext w/Status/141/493.01Asthma,Int/139/493.10Asthma Int w/Status/142/493.11Asthma,Unsp/006/493.90Asthma,Unspec w/Status/007/493.91Atopic Dermatitis/008/691.8Blood Pressure,Elevat/180/796.2Bronchitis/acute/009/466.0Bronchitis Acute w/COPD/135/491.21Bronchitis,Chronic,Unspec/010/491.90Bronchitis,Chroni w/COPD/136/491.20Bronchitis Chronic Simple/137/491.00 Candidiasis,Oral/110/112.0Cerumen,impaction/011/380.4Conjunctivitis,Acute/013/372.0Conjunctivitis.Allergic/014/372.14COPD/015/496.0Cough/016/786.2Dermatitis,Contact/017/692.9Diarrhea/090/008.8Drug Allergy/018/995.2Dyspnea/258/786.09Eczema/019/692.9Epistaxis/086/784.7Fatigue/021/780.7Fever/022/780.6Food Allergy/023/693.1Gastroenteritis/024/009.0Headache,unspec/025/784.0Hoarseness&Other Voice Dist./104/784.49Hyperlipidemia.Mixed/69/272.2Hypertension/26/401.9Hypertrophic T&A's/027/474.1Hypothyroidism,Unspec/086/244.9Gastroesophageal Reflux/345/530.81 Immune Disorder,Other/028/279.3Infection,Resp w/flu/029/487.1Latex Allergy/563/989.82Laryngitis,Acute/030/464.0Lymphadenopathy/031/785.6Lymphadenitis/032/683Migraine/033/346.9Nasal Septal Deviation/034/470.0Non-Allergic Rhinitis/035/472.0Otitis Externa/036/380.1Otitis Media/037/382.9Otitis Serous/038/381.1Pharyngitis/039/462Polyps,nasal/041/471.9Pruritis/042/698.9Rash,unspec./043/782.1Reaction,Drug/101/995.2Reflux Esphoagitis/469/530.11Resp Infection/Chronic/044/519.8Rosacea/151/695.3 Seborrhea/045/690.0Shortness of Breath/060/786.09Sinusistis,Acute/046/461.9Sinusitis, Chronic/047/473.9Sore Throat/091/462.0Stomatitis,Oral Aphepeous/213/528.2Tonsilitis/49/463.0URI,Acute/049/465.9Urticaria, Allergic/82/708.0 Urticaria Cholinergic/159/708.5Urticaria Chronic/294/708.8Urticaria,Dermagraphic/292/708.3Urticaria, Idiopathic/065/708.1Urticaria,unspecified/050/708.9Venomous Sting Rx./051/989.5Weight Loss/052/783.2Wheeze/327/786.09 / Home Meter Mini WrightAccessAstechPersonel Best Mini WrightPersonal BestAccess
Abdominal pain/54./789.0Acne/89/706.1Allergic Rhinitis, mites/molds/305/477.8Allergic Rhinitis,pollen/279/477.0Anaphylactic Rxnot food/002/995.0Anaphalactic Rxn, food unspec/540/995.60Angioedema/003/995.1Arthralgia/004/719.4Arthritis,Subacute/005/716.9Asthma w/COPD/140/493.2Asthma,Ext/138/493.00Asthma,Ext w/Status/141/493.01Asthma,Int/139/493.10Asthma Int w/Status/142/493.11Asthma,Unsp/006/493.90Asthma,Unspec w/Status/007/493.91Atopic Dermatitis/008/691.8Blood Pressure,Elevat/180/796.2Bronchitis/acute/009/466.0Bronchitis Acute w/COPD/135/491.21Bronchitis,Chronic,Unspec/010/491.90Bronchitis,Chroni w/COPD/136/491.20Bronchitis Chronic Simple/137/491.00 Candidiasis,Oral/110/112.0Cerumen,impaction/011/380.4Conjunctivitis,Acute/013/372.0Conjunctivitis.Allergic/014/372.14COPD/015/496.0Cough/016/786.2Dermatitis,Contact/017/692.9Diarrhea/090/008.8Drug Allergy/018/995.2Dyspnea/258/786.09Eczema/019/692.9Epistaxis/086/784.7Fatigue/021/780.7Fever/022/780.6Food Allergy/023/693.1Gastroenteritis/024/009.0Headache,unspec/025/784.0Hoarseness&Other Voice Dist./104/784.49Hyperlipidemia.Mixed/69/272.2Hypertension/26/401.9Hypertrophic T&A's/027/474.1Hypothyroidism,Unspec/086/244.9Gastroesophageal Reflux/345/530.81 Immune Disorder,Other/028/279.3Infection,Resp w/flu/029/487.1Latex Allergy/563/989.82Laryngitis,Acute/030/464.0Lymphadenopathy/031/785.6Lymphadenitis/032/683Migraine/033/346.9Nasal Septal Deviation/034/470.0Non-Allergic Rhinitis/035/472.0Otitis Externa/036/380.1Otitis Media/037/382.9Otitis Serous/038/381.1Pharyngitis/039/462Polyps,nasal/041/471.9Pruritis/042/698.9Rash,unspec./043/782.1Reaction,Drug/101/995.2Reflux Esphoagitis/469/530.11Resp Infection/Chronic/044/519.8Rosacea/151/695.3 Seborrhea/045/690.0Shortness of Breath/060/786.09Sinusistis,Acute/046/461.9Sinusitis, Chronic/047/473.9Sore Throat/091/462.0Stomatitis,Oral Aphepeous/213/528.2Tonsilitis/49/463.0URI,Acute/049/465.9Urticaria, Allergic/82/708.0 Urticaria Cholinergic/159/708.5Urticaria Chronic/294/708.8Urticaria,Dermagraphic/292/708.3Urticaria, Idiopathic/065/708.1Urticaria,unspecified/050/708.9Venomous Sting Rx./051/989.5Weight Loss/052/783.2Wheeze/327/786.09 / Best Home
Abdominal pain/54./789.0Acne/89/706.1Allergic Rhinitis, mites/molds/305/477.8Allergic Rhinitis,pollen/279/477.0Anaphylactic Rxnot food/002/995.0Anaphalactic Rxn, food unspec/540/995.60Angioedema/003/995.1Arthralgia/004/719.4Arthritis,Subacute/005/716.9Asthma w/COPD/140/493.2Asthma,Ext/138/493.00Asthma,Ext w/Status/141/493.01Asthma,Int/139/493.10Asthma Int w/Status/142/493.11Asthma,Unsp/006/493.90Asthma,Unspec w/Status/007/493.91Atopic Dermatitis/008/691.8Blood Pressure,Elevat/180/796.2Bronchitis/acute/009/466.0Bronchitis Acute w/COPD/135/491.21Bronchitis,Chronic,Unspec/010/491.90Bronchitis,Chroni w/COPD/136/491.20Bronchitis Chronic Simple/137/491.00 Candidiasis,Oral/110/112.0Cerumen,impaction/011/380.4Conjunctivitis,Acute/013/372.0Conjunctivitis.Allergic/014/372.14COPD/015/496.0Cough/016/786.2Dermatitis,Contact/017/692.9Diarrhea/090/008.8Drug Allergy/018/995.2Dyspnea/258/786.09Eczema/019/692.9Epistaxis/086/784.7Fatigue/021/780.7Fever/022/780.6Food Allergy/023/693.1Gastroenteritis/024/009.0Headache,unspec/025/784.0Hoarseness&Other Voice Dist./104/784.49Hyperlipidemia.Mixed/69/272.2Hypertension/26/401.9Hypertrophic T&A's/027/474.1Hypothyroidism,Unspec/086/244.9Gastroesophageal Reflux/345/530.81 Immune Disorder,Other/028/279.3Infection,Resp w/flu/029/487.1Latex Allergy/563/989.82Laryngitis,Acute/030/464.0Lymphadenopathy/031/785.6Lymphadenitis/032/683Migraine/033/346.9Nasal Septal Deviation/034/470.0Non-Allergic Rhinitis/035/472.0Otitis Externa/036/380.1Otitis Media/037/382.9Otitis Serous/038/381.1Pharyngitis/039/462Polyps,nasal/041/471.9Pruritis/042/698.9Rash,unspec./043/782.1Reaction,Drug/101/995.2Reflux Esphoagitis/469/530.11Resp Infection/Chronic/044/519.8Rosacea/151/695.3 Seborrhea/045/690.0Shortness of Breath/060/786.09Sinusistis,Acute/046/461.9Sinusitis, Chronic/047/473.9Sore Throat/091/462.0Stomatitis,Oral Aphepeous/213/528.2Tonsilitis/49/463.0URI,Acute/049/465.9Urticaria, Allergic/82/708.0 Urticaria Cholinergic/159/708.5Urticaria Chronic/294/708.8Urticaria,Dermagraphic/292/708.3Urticaria, Idiopathic/065/708.1Urticaria,unspecified/050/708.9Venomous Sting Rx./051/989.5Weight Loss/052/783.2Wheeze/327/786.09 / Best Office
Abdominal pain/54./789.0Acne/89/706.1Allergic Rhinitis, mites/molds/305/477.8Allergic Rhinitis,pollen/279/477.0Anaphylactic Rxnot food/002/995.0Anaphalactic Rxn, food unspec/540/995.60Angioedema/003/995.1Arthralgia/004/719.4Arthritis,Subacute/005/716.9Asthma w/COPD/140/493.2Asthma,Ext/138/493.00Asthma,Ext w/Status/141/493.01Asthma,Int/139/493.10Asthma Int w/Status/142/493.11Asthma,Unsp/006/493.90Asthma,Unspec w/Status/007/493.91Atopic Dermatitis/008/691.8Blood Pressure,Elevat/180/796.2Bronchitis/acute/009/466.0Bronchitis Acute w/COPD/135/491.21Bronchitis,Chronic,Unspec/010/491.90Bronchitis,Chroni w/COPD/136/491.20Bronchitis Chronic Simple/137/491.00 Candidiasis,Oral/110/112.0Cerumen,impaction/011/380.4Conjunctivitis,Acute/013/372.0Conjunctivitis.Allergic/014/372.14COPD/015/496.0Cough/016/786.2Dermatitis,Contact/017/692.9Diarrhea/090/008.8Drug Allergy/018/995.2Dyspnea/258/786.09Eczema/019/692.9Epistaxis/086/784.7Fatigue/021/780.7Fever/022/780.6Food Allergy/023/693.1Gastroenteritis/024/009.0Headache,unspec/025/784.0Hoarseness&Other Voice Dist./104/784.49Hyperlipidemia.Mixed/69/272.2Hypertension/26/401.9Hypertrophic T&A's/027/474.1Hypothyroidism,Unspec/086/244.9Gastroesophageal Reflux/345/530.81 Immune Disorder,Other/028/279.3Infection,Resp w/flu/029/487.1Latex Allergy/563/989.82Laryngitis,Acute/030/464.0Lymphadenopathy/031/785.6Lymphadenitis/032/683Migraine/033/346.9Nasal Septal Deviation/034/470.0Non-Allergic Rhinitis/035/472.0Otitis Externa/036/380.1Otitis Media/037/382.9Otitis Serous/038/381.1Pharyngitis/039/462Polyps,nasal/041/471.9Pruritis/042/698.9Rash,unspec./043/782.1Reaction,Drug/101/995.2Reflux Esphoagitis/469/530.11Resp Infection/Chronic/044/519.8Rosacea/151/695.3 Seborrhea/045/690.0Shortness of Breath/060/786.09Sinusistis,Acute/046/461.9Sinusitis, Chronic/047/473.9Sore Throat/091/462.0Stomatitis,Oral Aphepeous/213/528.2Tonsilitis/49/463.0URI,Acute/049/465.9Urticaria, Allergic/82/708.0 Urticaria Cholinergic/159/708.5Urticaria Chronic/294/708.8Urticaria,Dermagraphic/292/708.3Urticaria, Idiopathic/065/708.1Urticaria,unspecified/050/708.9Venomous Sting Rx./051/989.5Weight Loss/052/783.2Wheeze/327/786.09
Major Inhalant Allergen:
Food Allergens to avoid:
Common Triggers for many asthmatics: Viral infections, exercise, laugh/cough, smoke, perfume, pollution, cold air or weather changes, stress, and allergen exposure.
· Follow your GREEN ZONE plan every day to keep most asthma symptoms from starting. Recognize your symptoms of an asthma episode and act quickly to stop them.
· Follow your YELLOW ZONE plan to stop asthma symptoms and keep an asthma episode from getting serious.
· Follow your RED ZONE plan to take care of a serious episode. THIS IS AN EMERGENCY PLAN!
GREEN ZONE: 80-100% of Personal Best: . Check Peak flow 2x/week.
DAILY PLAN TO KEEP ASTHMA SYMPTOMS UNDER CONTROLTAKE MEDICATIONS EVEN IF YOU HAVE NO SYMPTOMS / GREEN ZONE:
1 Alupent Solution NebulizedAtrovent Solution NebulizedAlbuterol Solution NEBTornalate Sol. 0.75cc /2cc Saline Neb.Tornalate Sol. 1.5cc/ 2cc Saline Neb.Proventil/Ventolin /Saline Premixed Neb.Proventil/Ventolin Sol, 0.25cc/1 Intal NebulizedProventil/Ventolin Sol. 0.35cc/ 1 Intal NebulizedProventil/Ventolin Sol, 0.5cc/1 Intal NebProventil/Ventolin Sol. 0.25cc/ 2cc SalineProventil/Ventolin Sol. 0.35cc/ 2cc SalineProventil/Ventolin Sol. 0.5cc/ 2cc SalineProventil/Ventolin Sol. 1cc/ 2cc SalineProventil/Ventolin Sol, 1cc/ Saline 2cc NebMaxair Autohaler 1spMaxair Autohaler 1-2spMaxair Autohaler 2spMaxair Autohaler 4spProventil HFA MDIProventil/Ventolin MDI Ventolin MDISerevent MDI 1 spraySerevent MDI 2 spray AeroBid MDIAtrovent MDIAtrovent Solution NEBAzmacort MDIBeclovent MDIFloVent 44mcgFloVent 110mcgFlovent 220mcgIntal MDIIntal Solution NEBTiladeTornalate MDISerevent MDIVanceril MDIVanceril DS MDI Proventil SyrupSlo-bid GyrocapsTheodur SprinklesVentolinSyrupAccolate 20mg Uniphyl 400mg Uni-dur 600mg Uni-dur 400mg Proventil Repetabs 8mg Proventil Repetabs 4mgTheodur 450mg Theodur 300mg Theo-24 100mg Theodur 200mg Theodur 100mg Theo-24 400mg Theo-24 300mg Theo-24 200mg 1-2 sp every 4-6hrs.1-2 sprays every 6 hrs.2 sprays every 6 hrs.3 sp every 6hr4 sp every 6hr1 sprays every 12 hrs.1-2 sprays every 12 hrs.2 sprays every 12 hrs.3 sprays every 12 hrs.4 sprays every 12 hrs5 sprays every 12 hrs.6 sprays 3 x/day1-sp every 4-6hr 1-2 sp evey 4 hr2 sp every 4 hr2 sp 2x/day1sp1-2sp2sp3 sp4 sp5 sp6 sp ampmam & pmdailybedtime2x/day3x/day4x/day5x/day6x/dayevery 1-3hrevery 2hrevery 3hrevery 4hrevery 5hrevery 6hr3very 4-6hrevery 8 hrevery 12 hr1 1/2 daily2 daily2 every 12 hr as needed (CONTROLLER) / NO SIGNS OR SYMTPOMS OF ASTHMA
2 Alupent Solution NebulizedAtrovent Solution NebulizedAlbuterol Solution NEBTornalate Sol. 0.75cc /2cc Saline Neb.Tornalate Sol. 1.5cc/ 2cc Saline Neb.Proventil/Ventolin /Saline Premixed Neb.Proventil/Ventolin Sol, 0.25cc/1 Intal NebulizedProventil/Ventolin Sol. 0.35cc/ 1 Intal NebulizedProventil/Ventolin Sol, 0.5cc/1 Intal NebProventil/Ventolin Sol. 0.25cc/ 2cc SalineProventil/Ventolin Sol. 0.35cc/ 2cc SalineProventil/Ventolin Sol. 0.5cc/ 2cc SalineProventil/Ventolin Sol. 1cc/ 2cc SalineProventil/Ventolin Sol, 1cc/ Saline 2cc NebMaxair Autohaler 1spMaxair Autohaler 1-2spMaxair Autohaler 2spMaxair Autohaler 4spProventil HFA MDIProventil/Ventolin MDI Ventolin MDISerevent MDI 1 spraySerevent MDI 2 spray AeroBid MDIAtrovent MDIAtrovent Solution NEBAzmacort MDIBeclovent MDIFloVent 44mcgFloVent 110mcgFlovent 220mcgIntal MDIIntal Solution NEBTiladeTornalate MDISerevent MDIVanceril MDIVanceril DS MDI Proventil SyrupSlo-bid GyrocapsTheodur SprinklesVentolinSyrupAccolate 20mg Uniphyl 400mg Uni-dur 600mg Uni-dur 400mg Proventil Repetabs 8mg Proventil Repetabs 4mgTheodur 450mg Theodur 300mg Theo-24 100mg Theodur 200mg Theodur 100mg Theo-24 400mg Theo-24 300mg Theo-24 200mg 1-2 sp every 4-6hrs.1-2 sprays every 6 hrs.2 sprays every 6 hrs.3 sp every 6hr4 sp every 6hr1 sprays every 12 hrs.1-2 sprays every 12 hrs.2 sprays every 12 hrs.3 sprays every 12 hrs.4 sprays every 12 hrs5 sprays every 12 hrs.6 sprays 3 x/day1-sp every 4-6hr 1-2 sp evey 4 hr2 sp every 4 hr2 sp 2x/day1sp1-2sp2sp3 sp4 sp5 sp6 sp ampmam & pmdailybedtime2x/day3x/day4x/day5x/day6x/dayevery 1-3hrevery 2hrevery 3hrevery 4hrevery 5hrevery 6hr3very 4-6hrevery 8 hrevery 12 hr1 1/2 daily2 daily2 every 12 hr as needed(CONTROLLER) / · Breathing is good
·
3 Alupent Solution NebulizedAtrovent Solution NebulizedAlbuterol Solution NEBTornalate Sol. 0.75cc /2cc Saline Neb.Tornalate Sol. 1.5cc/ 2cc Saline Neb.Proventil/Ventolin /Saline Premixed Neb.Proventil/Ventolin Sol, 0.25cc/1 Intal NebulizedProventil/Ventolin Sol. 0.35cc/ 1 Intal NebulizedProventil/Ventolin Sol, 0.5cc/1 Intal NebProventil/Ventolin Sol. 0.25cc/ 2cc SalineProventil/Ventolin Sol. 0.35cc/ 2cc SalineProventil/Ventolin Sol. 0.5cc/ 2cc SalineProventil/Ventolin Sol. 1cc/ 2cc SalineProventil/Ventolin Sol, 1cc/ Saline 2cc NebMaxair Autohaler 1spMaxair Autohaler 1-2spMaxair Autohaler 2spMaxair Autohaler 4spProventil HFA MDIProventil/Ventolin MDI Ventolin MDISerevent MDI 1 spraySerevent MDI 2 spray AeroBid MDIAtrovent MDIAtrovent Solution NEBAzmacort MDIBeclovent MDIFloVent 44mcgFloVent 110mcgFlovent 220mcgIntal MDIIntal Solution NEBTiladeTornalate MDISerevent MDIVanceril MDIVanceril DS MDI Proventil SyrupSlo-bid GyrocapsTheodur SprinklesVentolinSyrupAccolate 20mg Uniphyl 400mg Uni-dur 600mg Uni-dur 400mg Proventil Repetabs 8mg Proventil Repetabs 4mgTheodur 450mg Theodur 300mg Theo-24 100mg Theodur 200mg Theodur 100mg Theo-24 400mg Theo-24 300mg Theo-24 200mg 1-2 sp every 4-6hrs.1-2 sprays every 6 hrs.2 sprays every 6 hrs.3 sp every 6hr4 sp every 6hr1 sprays every 12 hrs.1-2 sprays every 12 hrs.2 sprays every 12 hrs.3 sprays every 12 hrs.4 sprays every 12 hrs5 sprays every 12 hrs.6 sprays 3 x/day1-sp every 4-6hr 1-2 sp evey 4 hr2 sp every 4 hr2 sp 2x/day1sp1-2sp2sp3 sp4 sp5 sp6 sp ampmam & pmdailybedtime2x/day3x/day4x/day5x/day6x/dayevery 1-3hrevery 2hrevery 3hrevery 4hrevery 5hrevery 6hr3very 4-6hrevery 8 hrevery 12 hr1 1/2 daily2 daily2 every 12 hr as needed(CONTROLLER) / · No early warning signs or asthma
4 Alupent Solution NebulizedAtrovent Solution NebulizedAlbuterol Solution NEBTornalate Sol. 0.75cc /2cc Saline Neb.Tornalate Sol. 1.5cc/ 2cc Saline Neb.Proventil/Ventolin /Saline Premixed Neb.Proventil/Ventolin Sol, 0.25cc/1 Intal NebulizedProventil/Ventolin Sol. 0.35cc/ 1 Intal NebulizedProventil/Ventolin Sol, 0.5cc/1 Intal NebProventil/Ventolin Sol. 0.25cc/ 2cc SalineProventil/Ventolin Sol. 0.35cc/ 2cc SalineProventil/Ventolin Sol. 0.5cc/ 2cc SalineProventil/Ventolin Sol. 1cc/ 2cc SalineProventil/Ventolin Sol, 1cc/ Saline 2cc NebMaxair Autohaler 1spMaxair Autohaler 1-2spMaxair Autohaler 2spMaxair Autohaler 4spProventil HFA MDIProventil/Ventolin MDI Ventolin MDISerevent MDI 1 spraySerevent MDI 2 spray AeroBid MDIAtrovent MDIAtrovent Solution NEBAzmacort MDIBeclovent MDIFloVent 44mcgFloVent 110mcgFlovent 220mcgIntal MDIIntal Solution NEBTiladeTornalate MDISerevent MDIVanceril MDIVanceril DS MDI Proventil SyrupSlo-bid GyrocapsTheodur SprinklesVentolinSyrupAccolate 20mg Uniphyl 400mg Uni-dur 600mg Uni-dur 400mg Proventil Repetabs 8mg Proventil Repetabs 4mgTheodur 450mg Theodur 300mg Theo-24 100mg Theodur 200mg Theodur 100mg Theo-24 400mg Theo-24 300mg Theo-24 200mg 1-2 sp every 4-6hrs.1-2 sprays every 6 hrs.2 sprays every 6 hrs.3 sp every 6hr4 sp every 6hr1 sprays every 12 hrs.1-2 sprays every 12 hrs.2 sprays every 12 hrs.3 sprays every 12 hrs.4 sprays every 12 hrs5 sprays every 12 hrs.6 sprays 3 x/day1-sp every 4-6hr 1-2 sp evey 4 hr2 sp every 4 hr2 sp 2x/day1sp1-2sp2sp3 sp4 sp5 sp6 sp ampmam & pmdailybedtime2x/day3x/day4x/day5x/day6x/dayevery 1-3hrevery 2hrevery 3hrevery 4hrevery 5hrevery 6hr3very 4-6hrevery 8 hrevery 12 hr1 1/2 daily2 daily2 every 12 hr as needed / · Normal Activity and sleep
5 Alupent Solution NebulizedAtrovent Solution NebulizedAlbuterol Solution NEBTornalate Sol. 0.75cc /2cc Saline Neb.Tornalate Sol. 1.5cc/ 2cc Saline Neb.Proventil/Ventolin /Saline Premixed Neb.Proventil/Ventolin Sol, 0.25cc/1 Intal NebulizedProventil/Ventolin Sol. 0.35cc/ 1 Intal NebulizedProventil/Ventolin Sol, 0.5cc/1 Intal NebProventil/Ventolin Sol. 0.25cc/ 2cc SalineProventil/Ventolin Sol. 0.35cc/ 2cc SalineProventil/Ventolin Sol. 0.5cc/ 2cc SalineProventil/Ventolin Sol. 1cc/ 2cc SalineProventil/Ventolin Sol, 1cc/ Saline 2cc NebMaxair Autohaler 1spMaxair Autohaler 1-2spMaxair Autohaler 2spMaxair Autohaler 4spProventil HFA MDIProventil/Ventolin MDI Ventolin MDISerevent MDI 1 spraySerevent MDI 2 spray AeroBid MDIAtrovent MDIAtrovent Solution NEBAzmacort MDIBeclovent MDIFloVent 44mcgFloVent 110mcgFlovent 220mcgIntal MDIIntal Solution NEBTiladeTornalate MDISerevent MDIVanceril MDIVanceril DS MDI Proventil SyrupSlo-bid GyrocapsTheodur SprinklesVentolinSyrupAccolate 20mg Uniphyl 400mg Uni-dur 600mg Uni-dur 400mg Proventil Repetabs 8mg Proventil Repetabs 4mgTheodur 450mg Theodur 300mg Theo-24 100mg Theodur 200mg Theodur 100mg Theo-24 400mg Theo-24 300mg Theo-24 200mg 1-2 sp every 4-6hrs.1-2 sprays every 6 hrs.2 sprays every 6 hrs.3 sp every 6hr4 sp every 6hr1 sprays every 12 hrs.1-2 sprays every 12 hrs.2 sprays every 12 hrs.3 sprays every 12 hrs.4 sprays every 12 hrs5 sprays every 12 hrs.6 sprays 3 x/day1-sp every 4-6hr 1-2 sp evey 4 hr2 sp every 4 hr2 sp 2x/day1sp1-2sp2sp3 sp4 sp5 sp6 sp ampmam & pmdailybedtime2x/day3x/day4x/day5x/day6x/dayevery 1-3hrevery 2hrevery 3hrevery 4hrevery 5hrevery 6hr3very 4-6hrevery 8 hrevery 12 hr1 1/2 daily2 daily2 every 12 hr as needed
6 Alupent Solution NebulizedAtrovent Solution NebulizedAlbuterol Solution NEBTornalate Sol. 0.75cc /2cc Saline Neb.Tornalate Sol. 1.5cc/ 2cc Saline Neb.Proventil/Ventolin /Saline Premixed Neb.Proventil/Ventolin Sol, 0.25cc/1 Intal NebulizedProventil/Ventolin Sol. 0.35cc/ 1 Intal NebulizedProventil/Ventolin Sol, 0.5cc/1 Intal NebProventil/Ventolin Sol. 0.25cc/ 2cc SalineProventil/Ventolin Sol. 0.35cc/ 2cc SalineProventil/Ventolin Sol. 0.5cc/ 2cc SalineProventil/Ventolin Sol. 1cc/ 2cc SalineProventil/Ventolin Sol, 1cc/ Saline 2cc NebMaxair Autohaler 1spMaxair Autohaler 1-2spMaxair Autohaler 2spMaxair Autohaler 4spProventil HFA MDIProventil/Ventolin MDI Ventolin MDISerevent MDI 1 spraySerevent MDI 2 spray AeroBid MDIAtrovent MDIAtrovent Solution NEBAzmacort MDIBeclovent MDIFloVent 44mcgFloVent 110mcgFlovent 220mcgIntal MDIIntal Solution NEBTiladeTornalate MDISerevent MDIVanceril MDIVanceril DS MDI Proventil SyrupSlo-bid GyrocapsTheodur SprinklesVentolinSyrupAccolate 20mg Uniphyl 400mg Uni-dur 600mg Uni-dur 400mg Proventil Repetabs 8mg Proventil Repetabs 4mgTheodur 450mg Theodur 300mg Theo-24 100mg Theodur 200mg Theodur 100mg Theo-24 400mg Theo-24 300mg Theo-24 200mg 1-2 sp every 4-6hrs.1-2 sprays every 6 hrs.2 sprays every 6 hrs.3 sp every 6hr4 sp every 6hr1 sprays every 12 hrs.1-2 sprays every 12 hrs.2 sprays every 12 hrs.3 sprays every 12 hrs.4 sprays every 12 hrs5 sprays every 12 hrs.6 sprays 3 x/day1-sp every 4-6hr 1-2 sp evey 4 hr2 sp every 4 hr2 sp 2x/day1sp1-2sp2sp3 sp4 sp5 sp6 sp ampmam & pmdailybedtime2x/day3x/day4x/day5x/day6x/dayevery 1-3hrevery 2hrevery 3hrevery 4hrevery 5hrevery 6hr3very 4-6hrevery 8 hrevery 12 hr1 1/2 daily2 daily2 every 12 hr as needed(QUICK RELIEF)
EXERCISE ASTHMA: If you usually experience asthma symptoms with exercise, use your QUICK RELIEF MEDICATION 15 minutes before exercise.
CHILD AND ADULT / ASTHMA ACTION PLAN / PAGE 2
YELLOW ZONE: 60-80% of Personal Best
1. USE YOUR QUICK RELIEF MEDICATION Alupent Solution NebulizedAtrovent Solution NebulizedAlbuterol Solution NEBSerevent MDI 1 spraySerevent MDI 2 sprayTornalate Sol. 0.75cc /2cc Saline Neb.Tornalate Sol. 1.5cc/ 2cc Saline Neb.Proventil/Ventolin /Saline Premixed Neb.Proventil/Ventolin Sol, 0.25cc/1 Intal NebulizedProventil/Ventolin Sol. 0.35cc/ 1 Intal NebulizedProventil/Ventolin Sol, 0.5cc/1 Intal NebProventil/Ventolin Sol. 0.25cc/ 2cc SalineProventil/Ventolin Sol. 0.35cc/ 2cc SalineProventil/Ventolin Sol. 0.5cc/ 2cc SalineProventil/Ventolin Sol. 1cc/ 2cc SalineProventil/Ventolin Sol, 1cc/ Saline 2cc NebMaxair Autohaler 1spMaxair Autohaler 1-2spMaxair Autohaler 2spMaxair Autohaler 4spProventil/Ventolin MDI 1-2spProventil/Ventolin MDI 1spProventil/Ventolin MDI 2spProventil/Ventolin MDI 4sp IMMEDIATLEY IMMEDIATELY / YELLOW ZONE: CAUTION!Wait 20 minutes. Repeat Peak Flow / WORSENING ASTHMA
A If Peak Flow is greater than (80%) and symptoms have resolved, / · Cough, wheeze, shortness of breath, chest tightness, chest heaviness
Return to your GREEN ZONE PLAN / · ↑ Tiredness
NOTE: If you enter your YELLOW ZONE 3 or more times/week, call to / · ↑ Allergy symptoms
set up an office visit with Dr. FILL INwithout one week. / · ↓ Quality of sleep
B If Peak Flow is less than (80%) OR symptoms continue, / · ↓ Usual activity level
Repeat QUICK RELIEF MEDICATION (see above), wait 20 minutes, & If Peak Flow is now greater than
(80%) and symptoms have improved:
1) Use Quick Relief Medication every 6 hours for 24 hours
2) Continue with Green Zone Medications.
C If after QUICK RELIEF MEDICATION has been used two times and your peak flow is less than (80%) but greater than (60%) AND you have reduced asthma symptoms follow the below plan. Otherwise go to RED ZONE plan:
1) Use Quick Relief Medication every 6 hours for 24 hours
2) Take all Green Zone Medication but make these Changes: as neededUntil seen by Dr.