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New York City Department of Health
Community Asthma Program

Asthma Action Plan

Directions to the Provider:
The purpose of the Asthma Action Plan is to help families become proactive and anticipatory with respect to asthma exacerbations and their control. The Asthma Action Plan should be used as an education and communication tool between the provider and the patient and his or her family. The patient/family should be able to demonstrate and understanding of the plan and the appropriate use of medicines.

This form has been designed for the primary care provider to use with families who need a relatively simple asthma management regimen. Once a family has become more informed about asthma, a plan can be developed with additional flexibility in treatment.

Families should be given additional educational materials about asthma, peak flow monitoring, and environmental control.

Give the top two copies of the form to the family, with instructions to give one copy to the child's school or day care. Keep one for your records.

The following information has been taken from the 1997 Guidelines for the Diagnosis and Management of Asthma, National Heart, Lung and Blood Institute.

Zone Instructions:
Children over the age of six may be given peak flow meters to monitor their asthma. Parents of children under the age of six should use symptoms to determine the child's zone.

The "Personal Best" peak flow should be determined when the child is symptom-free. A diary can be used to determine personal best, and usually are part of the peak flow meter package. A peak flow reading should be taken at all asthma visits and personal best should be redetermined regularly. Because peak flow meters vary in recording peak flow, instruct your patients to bring their peak flow meter to every visit.

Green:
 List all daily medicines. Fill in actual numbers, not percentages, for peak flow readings.
Green zone is 100% - 80% of personal best.
Yellow:
 Add medicines to be taken in the yellow zone and instruct the patient to continue with green zone medicines.
Yellow zone is 80% - 50% of personal best.
Include how long to continue taking these medicines and when to contact the provider.
Red:
 List any medications to be taken while waiting to speak to the provider or preparing to go to the emergency room.
Red zone is 50% or below personal best.

Peak Flow Chart:
Personal Best - 100% 100 110 120 130 140 150 160 170 180 190 200 210 220 230 240 250 260 270 280
Yellow - 80% 80 90 95 105 110 120 130 135 145 150 160 170 175 185 190 200 210 215 225
Red - 50% 50 55 60 65 70 75 80 85 90 95 100 105 110 115 120 125 130 135 140


Personal Best - 100% 300 310 320 330 340 350 360 370 380 390 400 420 440 460 480 500 520 540 560
Yellow - 80% 240 250 255 265 270 280 290 295 305 310 325 335 350 370 385 400 415 430 450
Red - 50% 150 155 160 165 170 175 180 185 190 195 200 210 220 230 240 250 260 270 280

Personal Best - 100% 580 600 620 640 660 680 700
Yellow - 80% 465 480 495 510 535 545 560
Red - 50% 290 300 310 320 330 340 350

The Asthma Action Line telephone number is 1-877-ASTHMA-0 or 1-877-278-4620.

February 1999