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HS0021 4/15ASTHMA/REACTIVE AIRWAY ACTION PLAN Health Services Department Lincoln Public SchoolsStudent Name:ID#:Grade: INFORMATION FOR PARENTS AND GUARDIANS Your students health record shows a history
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How to fill out asthmareactive airway action plan

01
To fill out an Asthma Reactive Airway Action Plan, follow these steps:
02
Fill in your personal information at the top of the form, including your name, date of birth, and contact information.
03
Provide your emergency contact information, including the name and phone number of someone who can be reached in case of an asthma emergency.
04
Specify your asthma triggers. These are the things that cause your asthma symptoms to worsen or flare up. Common triggers include allergens, exercise, cold air, and infections.
05
Indicate your symptoms. Describe the symptoms you experience during an asthma episode, such as coughing, wheezing, shortness of breath, or chest tightness.
06
Determine your peak flow zones. A peak flow meter measures how well you can breathe out air. Your healthcare provider may instruct you on your personalized peak flow zones based on your lung function.
07
Define your medication plan. List all the medications you take regularly for asthma management and specify the dosage, frequency, and method of administration for each medication.
08
Include emergency medications. Provide information about the rescue medications or quick-relief inhalers you should use during an asthma attack or when your symptoms worsen. Describe the dosage and frequency for using these medications.
09
Follow-up instructions. Your healthcare provider may include specific instructions for follow-up appointments, monitoring your symptoms, or adjusting your medications.
10
Have the plan reviewed. Make sure to review the filled-out Asthma Reactive Airway Action Plan with your healthcare provider to ensure accuracy and understanding.
11
Keep the plan easily accessible. Store your Asthma Reactive Airway Action Plan in a place where it can be easily accessed during an emergency, such as your wallet, purse, or a designated file at home.

Who needs asthmareactive airway action plan?

01
Anyone with asthma or reactive airway disease can benefit from having an Asthma Reactive Airway Action Plan.
02
This plan is particularly important for individuals with moderate to severe asthma symptoms or those who experience frequent asthma attacks.
03
Children with asthma should also have an Asthma Reactive Airway Action Plan in place, as it helps parents and caregivers understand the appropriate steps to take during an asthma emergency.
04
Additionally, individuals who have a history of severe allergic reactions or have been hospitalized due to asthma should have a personalized action plan in case of an asthma emergency.
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Asthma reactive airway action plan is a written set of instructions that helps individuals manage their asthma symptoms and respond to asthma attacks.
Individuals who have been diagnosed with asthma and their healthcare providers are required to create and maintain an asthma reactive airway action plan.
To fill out an asthma reactive airway action plan, individuals and their healthcare providers should work together to outline the individual's asthma triggers, medications, symptoms, and steps to take during an asthma attack.
The purpose of an asthma reactive airway action plan is to help individuals manage their asthma effectively, recognize early warning signs of an asthma attack, and know what steps to take to prevent or treat an asthma attack.
An asthma reactive airway action plan should include information on the individual's asthma triggers, medications, peak flow measurements, symptoms, and steps to take during an asthma attack.
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