Get the free AsthmA Action PlAn - Kaleida Health

Name Asthma Action Plan School DOB Health Care Provider Providers Phone Parent/Responsible Person / / Parents Phone Do not write in this space Place Patient Label Here Asthma Triggers Identified (Things

How to fill out asthma action plan

1. To fill out an asthma action plan, start by obtaining a copy of the plan from your healthcare provider. Discuss with your provider the best way to manage your asthma symptoms and the specific instructions to include in your action plan.
2. The asthma action plan typically consists of three zones: green, yellow, and red. Each zone corresponds to different levels of asthma symptoms and actions to take. In the green zone, your symptoms are well-controlled and you don't need any additional treatment. In the yellow zone, your symptoms may be worsening and you need to take specific medications or increase their dosage. In the red zone, your symptoms are severe and you may need emergency medical attention.
3. In the green zone, write down the medications you take on a daily basis to keep your symptoms under control. Include the dosage and frequency of each medication. It's also important to include any triggers or factors that may exacerbate your symptoms, such as allergens or exercise.
4. In the yellow zone, describe the symptoms or warning signs that indicate your asthma is worsening. For example, if you experience coughing, wheezing, or shortness of breath, write it down. Include the specific medications you need to take and the dosage for each one. You may also want to note any additional actions you can take, such as using a peak flow meter to monitor your lung function.
5. In the red zone, clearly state the severe symptoms that require immediate medical attention, such as extreme difficulty breathing, chest pain, or bluish lips or face. Provide the contact information for your healthcare provider, emergency services, and any other emergency contacts you may have. It's also crucial to mention any rescue medications, instructions on how to use them, and the dosage.

Who needs an asthma action plan?

1. Individuals with diagnosed asthma should have an asthma action plan. This includes both adults and children.
2. People who experience asthma symptoms, even if their symptoms are mild or infrequent, can benefit from having an action plan. It helps them understand their triggers, know how to manage their symptoms, and provides guidance on when to seek medical help.
3. Asthma action plans are especially important for those with moderate to severe asthma, as they often require more intensive management and may need to take additional medications.
4. If you have a history of asthma attacks or emergency room visits due to asthma, it is crucial to have an asthma action plan in place to prevent further complications.

Overall, anyone with asthma or asthma-like symptoms should consult with their healthcare provider to determine if an asthma action plan is necessary for their specific condition and needs.

For pdfFiller’s FAQs

What is asthma action plan?

An asthma action plan is a personalized plan created by a healthcare provider to help individuals manage their asthma.

Who is required to file asthma action plan?

Individuals diagnosed with asthma are required to have an asthma action plan.

How to fill out asthma action plan?

Asthma action plans are typically filled out by healthcare providers based on the individual's asthma symptoms and triggers.

What is the purpose of asthma action plan?

The purpose of an asthma action plan is to provide guidance on managing asthma symptoms, recognizing worsening symptoms, and taking appropriate actions.

What information must be reported on asthma action plan?

Asthma action plans typically include personalized instructions for medication use, symptom management, and emergency actions.

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