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Your doctor may have given you a written "Asthma Action Plan" with directions for treating mild, moderate and severe flare-ups. (A sample "Asthma Action Plan" appears at the end of this handout.) If you don't have an action plan, ask your doctor for written directions about treating asthma flare-ups. If you have the symptoms of a serious flare-up or if your PEF is less than 50 percent of your personal best, call your doctor right away or go directly to the nearest hospital emergency room (by ambulance, if necessary).
Asthma Action Plan
Name ______________________________ Date __________________
To manage your asthma, you need to keep track of your symptoms, your medicine use and your peak expiratory flow (PEF). Using your PEF as a guide, here are some tips for treating your asthma symptoms:
•Green means Go--you're feeling OK. Just keep using your preventive (anti-inflammatory) medicine.
•Yellow means Be Careful--you're having some symptoms. It's time to use your quick-relief
(short-acting bronchodilator) medicine, in addition to the preventive medicine.
•Red means STOP--Your symptoms are serious. You need to get help from a doctor!
Your green zone is _________ , which is 80 to 100 percent of your personal best peak flow.
Go! Breathing is good, with no cough, wheezing or chest tightness.
•Keep taking your usual daily medicines.
Your yellow zone is __________, which is 50 to 80 percent of your best peak flow. Be careful! You may have symptoms like coughing, wheezing or chest tightness. Your peak flow level has dropped, or you notice that you need to use quick-relief medicine more often, or you have more asthma symptoms in the morning, or asthma symptoms are waking you up at night.
•Take ______ puffs of _________________________ (your quick-relief medicine). Repeat this dose every 20 minutes, up to ____ more times. Use ____ puffs regularly every four to six hours for the next two days.
•Take ______ puffs of ___________________ (your anti-inflammatory medicine) ______ times per day.
•Start taking oral steroid medicines (or increase your dose): ________________ in a dose of ____ mg every a.m. ____ p.m. _____.
•Call your doctor or a hospital emergency room for advice today.
Your red zone is ___________, which is 50 percent or less of your best peak flow. Danger! Your peak flow number is very low, or you continue to feel worse after taking more medicines according to the directions for the yellow zone.
•Take ______ puffs of your quick-relief medicine. Repeat this dose every 20 minutes, up to ____ more times.
•Start taking an oral steroid medicine (or increase the dose). Take _______ mg right now.
•Call your doctor now! If you can't reach your doctor, go to a hospital emergency room.
Call your doctor at any time if you have any of the following problems:
•Your asthma symptoms get worse even though you're taking oral steroids
•Inhaled quick-relief medicine isn't helping you for as long as four hours
•Your PEF stays at 50 percent of your personal best (or gets even lower) even though you're using your action plan.
Important telephone numbers:
•Doctor's office _____________________________
•Doctor after hours _________________________
•Hospital emergency room __________________
How do I know if a flare-up is serious?
Here's a good way to see how bad a flare-up is: measure your peak expiratory flow (also called "PEF") using a peak flow meter. Your doctor can show you how to use a peak flow meter to keep track of your asthma. A peak flow meter costs less than $30, and you only have to buy it one time. First, you find out your "personal best" peak flow. This is the highest reading you can get on the meter over a two-week period when your asthma is under good control.
Here are some general guidelines you can use to find out how serious an asthma flare-up is:
•During mild flare-ups, you may notice shortness of breath when you walk or exercise, but when you sit still, you feel okay. You can usually breathe well enough to talk in complete sentences. You may hear some wheezing, mostly at the end of exhaling (breathing out). Your peak flow readings will be 80 to 100 percent of your personal best.
•During moderate flare-ups, you may feel short of breath when you talk or lie down, but if you sit quietly, you feel better. You may talk in a few words rather than using whole sentences because you're short of breath. You may feel anxious or tense. You may be using your neck muscles to help you take deeper breaths. You may hear loud wheezing, especially when you breathe out. Your peak flow readings will be about 50 percent to less than 80 percent of your personal best.
•During serious flare-ups, breathing will be very difficult and faster than usual. Even when you're sitting still, you'll feel short of breath. You might be able to talk only in a few words at a time because you're so short of breath. You'll feel anxious or tense. Your peak flow readings will be less than 50 percent of your personal best. If you feel sleepy and confused, and breathing is making you more and more tired, you may be having a life-threatening problem. Serious flare-ups mean you need to be treated right away, preferably in a hospital emergency room. Don't wait to get medical help if you have the symptoms of a serious flare-up!
Asthma symptoms vary in severity from occasional mild bouts of breathlessness to daily wheezing that persists despite taking large doses of medication. After exposure to asthma triggers, symptoms rarely develop abruptly but progress over a period of hours or days. Occasionally, the airways have become seriously obstructed by the time the patient calls the doctor.
The classic symptoms of an asthma attack include:
•Wheezing when breathing out is nearly always present during an attack. Usually the attack begins with wheezing and rapid breathing, and, as it becomes more severe, all breathing muscles become visibly active.
•Shortness of breath (dyspnea). Shortness of breath is a major source of distress in patients with asthma. However, the severity of this symptom does not always reflect the degree to which lung function is impaired. Some patients are not even aware that they are experiencing shortness of breath. Such patients are at particular risk for very serious and even life-threatening asthma attacks, since they are less conscious of symptoms. Those at highest risk for this effect tend to be older, female, and to have had the disease for a longer period of time.
•Coughing. In some people, the first symptom of asthma is a nonproductive cough. Some patients find this cough even more distressing than wheezing or sleep disturbances.
•Chest tightness or pain. Initial chest tightness without any other symptoms may be an early indicator of a serious attack.
•Neck muscles may tighten, and talking may become difficult or impossible.
•Rapid heart rate.
•Chest pain occurs in about three-quarters of patients. It can be very severe, although the pain's intensity is not necessarily related to the severity of the asthma attack itself.
The end of an attack is often marked by a cough that produces a thick, stringy mucus. After an initial acute attack, inflammation persists for days to weeks, often without symptoms. (The inflammation itself must still be treated, however, because it usually causes relapse.)