Asthma Action Plan

Asthma Action Plan

Summary

An asthma action plan is a comprehensive written guide to managing an asthma condition. The guide is developed by a physician and personalized for each patient. It offers detailed information on when asthma medications should be taken, what types should be used, what dosages are best and what to do in the event of a severe reaction.

In addition to being a great general guide to everyday asthma management, an asthma action plan also outlines how to prevent more severe reactions. By listing triggers and symptoms that may be associated with an asthma attack, the plan can help an individual to prevent or quickly suppress an attack. The plan also uses peak flow numbers to help asthmatic individuals keep track of their lung function – an objective indicator of how blocked their airways may be.

In the event of a severe reaction, the plan provides emergency information such as physician phone numbers, hospital phone numbers and medicine recommendations. This information can help a person with a severe reaction keep calm and get help quickly. Parents can provide the plan to their child’s school or care provider to be sure their child gets the proper care when away from home.

A person should create an asthma action plan with the help of a physician because the plan includes critical medical information, including what types of medications should be taken in the event of an emergency. Many physicians will be able to provide pre–made forms to make this process easier. Plans should be updated frequently as medical conditions change.

About the asthma action plan

An asthma action plan helps patients to manage their asthma condition by providing written, step–by–step instructions for treating the condition. Developed by their physician, the plan gives individuals a guide to taking daily medicines, dealing with an asthma attack and properly responding in the event of a severe attack.

The plan also provides parents with a comprehensive guide they can easily give to others who may be supervising their asthmatic child (e.g., teachers, coaches, baby sitters).

Developing a plan is important to the long–term management of asthma. It improves quality of life and may prevent long–term damage from uncontrolled asthma, such as airway remodeling.  In general, the goals for asthmatics include the following (as outlined by the National Heart, Lung and Blood Institute):

  • Minimal or no symptoms, including at night
  • Minimal number of asthma attacks
  • Normal or almost normal activities (i.e., no days lost at work or school)
  • Minimal use of short–acting beta2 agonists
  • No visits to an emergency room
  • No (or few) limitations on physical activity
  • Almost normal lung function

Though each plan varies depending on the condition of the individual, the plan generally consists of several pieces of important information arranged in three classifications:

  • Green zone. Indicates a normal asthma condition.

  • Yellow zone. Indicates an asthmatic reaction, or mild attack.

  • Red zone. Indicates a serious asthma attack that requires immediate medical intervention.

Dividing the plan into three categories allows the information to be easily understood while providing a clear understanding of how serious a condition really is. Each colored category contains the following information:

  • Peak flow range. This measurement of an individual’s lung function is obtained by regularly using a home peak flow meter. A patient’s personal best peak flow reading should be noted on the asthma action plan. The further below an individual’s baseline (personal best) peak flow number is from their current number, the more serious the attack.

  • Types of medications. Each category explains what types of medication are appropriate to use, and explains the proper dosage and usage of each drug.

  • Symptoms. Each level of the plan explains the symptoms that would normally be experienced with that zone. For example, an individual having a yellow (moderate) reaction may experience tightness in the chest.

The asthma action plan also contains a list of triggers that may set off an asthma attack. This list, which varies from individual to individual, helps a person avoid any problem situations or conditions. In order to identify triggers, physicians may ask patients to record a diary. By analyzing the details leading up to an asthma attack, a physician is often able to recognize trends and identify triggers.

One of the most important things an asthma action plan provides is a clear outline of what to do in an emergency. By including emergency numbers and physician contact information, the plan can help a person save valuable minutes when a severe asthma attack occurs.

Along with noting when to take emergency medications, who to notify and when to call for an ambulance, the plan can keep individuals from panicking in the event of a strong attack and give others the correct information for how to help. A plan may also include instructions on the proper way to take medications.

Creating an asthma action plan

Asthma action plans are usually broken down into three levels, which help identify the severity of an asthma attack and coordinate the appropriate level of response. Each attack plan will differ slightly based on an individual’s specific condition as well as physician recommendations. Individuals should work closely with their physicians when they are creating their plans.

One of the most useful methods asthmatic individuals can use to evaluate themselves is a home peak flow meter. This device measures the peak airflow from a person’s lungs. By comparing the results of a peak flow meter against earlier results (achieved under normal conditions) an individual can determine whether they are having an attack, and determine how severe it is.

The three sections of an asthmatic individual’s action plan should include all of the following information, with data specified to each individual:

  • Green zone. This level indicates good control. Individuals at this level should be able to produce 80 percent or better of their best peak flow results. There are generally no symptoms associated with this level (e.g., coughing, wheezing), and individuals should be able to carry out their usual activities. Individuals should also be able to sleep normally without symptoms wakening them. People in this zone should continue with their regular asthma treatment.

    This section should clearly lay out all daily asthma medications, as well as when they should be taken, and the proper dosage for each. Any special instructions for medication use should be explained here in detail. The locations of all medications and the local pharmacy’s contact information should also be noted in this section.

    It is a good idea to make a note of any personal triggers that might lead to an attack. While these are likely to vary by individual, some are common to many people with asthma (e.g., exercise, dust, tobacco smoke). Recording these triggers can help an individual to avoid them.

  • Yellow zone. This level indicates that a person’s asthma is getting worse and that they should be cautious. Individuals at this level should be able to produce between 50 and 80 percent of their best peak flow results. This zone often involves some types of asthma symptoms, particularly with activity or at night. Though symptoms often vary by individual, these may include (and should be noted in the plan):

    • Coughing
    • Wheezing
    • Chest pain or tightness
    • Shortness of breath

      Other factors that may place a patient in the yellow zone include:

    • Exposure to a known asthma trigger
    • Early signs of a cold  Individuals in this zone are usually experiencing some sort of asthma exacerbation, and will probably be unable to carry out all of their usual activities. They should take any quick–relief medications recommended by their physician (e.g., short–acting bronchodilators) in addition to continuing with their regular medications. The quick–relief medications, dosages and instructions should be completely noted in this section of the action plan.

      The yellow zone should also note instructions for individuals whose peak flow returns to the green zone and whose symptoms diminish. After a yellow zone episode, many physicians recommend continuing with regular quick–relief medications for several days or temporarily increasing the dosage of some regular medications. A physician may also recommend adding a new type of medication. Individuals developing their plans should discuss this situation with their physician.   Individuals who fail to improve despite the use of medication should contact their physician.

  • Red zone. This zone is considered an emergency medical alert. Individuals in this zone will only be able to produce less than 50 percent of their best peak flow.  Anyone who remains in the red zone for more than 15 minutes should go directly to the hospital or call for an ambulance. Symptoms of this condition include (and should be noted on the plan):

    • Extreme Shortness of breath
    • No response to quick–relief medications
    • Inability to carry out usual activities
    • Yellow zone symptoms that persist longer than 24 hours or get worse

      Anyone who displays the following symptoms should go immediately to the hospital or call for an ambulance (do not wait 15 minutes):

    • Shortness of breath that results in difficulty walking or talking

    • Blue lips or fingernails (cyanosis)

    • Sucking in of the skin between the ribs when breathing

Individuals at this level usually need to take additional medication, such as an increased dose of a short–acting bronchodilator and/or an oral corticosteroid. A physician should help an individual fill in drug and dosage information for this section.  Asthma action plans should also contain basic patient information and emergency contact information including:

  • Patient’s name

  • Name and phone number of an emergency contact (typically a nearby family member or friend)

  • Emergency room phone number

  • Closest hospital phone number and location

  • Physician’s name and phone number (both daytime and nighttime/weekend numbers)

Individuals should discuss their asthma action plans with their physician at least once a year to make sure they contain up–to–date information. Plans may need to be changed as a patient’s baseline (personal best) peak flow number changes or their medications are altered. Parents of asthmatic children should routinely update the plans on file with schools and other caregivers.

Lifestyle considerations

It is important to note that an asthma action plan may need to be changed as an individual’s condition changes. Individuals should frequently discuss their plans with their physician to make sure they have the latest medical information. Emergency phone numbers should be checked regularly as well.

Peak flow numbers will change over time and must be updated to be useful. Asthmatics should check their own peak flow (using a home peak flow meter) at least twice a week – though individuals with severe asthma may need to check up to several times a day. Using a peak flow meter frequently will not only allow an individual to have the latest baseline information (personal best) for their asthma action plan, it can also alert a person to a sudden drop in lung function that may indicate a worsening of asthma conditions. This allows for the control of asthmatic inflammations before external symptoms are ever noticed.

In order for asthma action plans to be effective, they must be accessible at the first sign of an asthma attack. Asthma patients should carry a copy of their plan with them at all times in a wallet or purse. Copies should also be kept in the patient’s medical chart, and be provided to other contacts, such as family, friends and coworkers, as needed.

In addition, an individual’s family and friends should be aware of the asthma action plan and know what they are expected to do in the case of a severe reaction.

Questions for your doctor

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to asthma action plans:

  1. What types of information should be included in my asthma action plan?
  2. Who should carry a copy of my asthma action plan?
  3. How often should I update my asthma action plan?
  4. Where should my asthma action plan be kept or posted?
  5. How will I know if my asthma action plan is effective?
  6. Under what circumstances will you make changes to my asthma action plan?
  7. Under what circumstances should I contact you in regards to asthma symptoms?
  8. Under what circumstances should I seek emergency medical attention for my asthma?
  9. What steps should I take when I am showing signs of an impending asthma attack?
  10. How often should I check my peak flow?
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