Asthma Action Plan

2018 Dr. Paul Tervit.

Patient Details (Optional)	Peak Flow (Calculate Predicted or Use Personal Best)	Current Maintenance Treatment
Name: NHI:	Use to calculate the predicted peak flow: Age (10 - 80): Height (cm): Gender: Male Female Personal Best PF: L/min	Preventer: Reliever:

Your Personal 4 Stage Action Plan

Name:

NHI:

Practitioner:

Date Plan Prepared:

Review Date:

Feeling Good	Your Asthma is Under Control you don’t have asthma symptoms most days (wheeze, tight chest, a cough or feeling breathless) you have no cough or wheeze at night you can do all your usual activities and exercise freely most days you don’t need a reliever	Maintenance Therapy:	Remember: We strongly suggest that you use a spacer, if one can be used with your preventer inhaler Carry your reliever at all times
Getting Worse	Caution‐ your asthma is getting worse when you have symptoms most days (wheeze, tight chest, a cough or feeling breathless) you are waking at night with symptoms you are getting a cold you feel short of breath when you exercise	Lets get prepared: Use your reliever 2 - 6 puffs – through a spacer, if one can be used with your reliever inhaler	Other Instructions:
Severe	Caution‐ your asthma is getting severe when your symptoms are getting severe (wheeze, tight chest, a cough or feeling breathless) your reliever is only helping for 2‐3 hours, or you are using more than 12 puffs a day you feel you need to see your doctor	Lets Take Action: Continue you medicine for "getting worse" Start Steroid if you have it: Important: you need to see your doctor today	Other Instructions
Emergency	Emergency your symptoms are getting more severe quickly you are finding it hard to speak or breathe your reliever is not helping much you are using your reliever every 1‐2 hours	Let’s keep calm... Dial 111 for ambulance Keep using your reliever as often as needed – through a spacer, if one can be used with your reliever inhaler Even if you seem to get better seek medical help right away If you haven’t started taking your prednisone, start now	Other Instructions:

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