Many written asthma action plans are available, as different action plans suit different people. Fill it in with your doctor so you can answer these questions. Asthma action plan for children age 618 child health bc. Diagnosis and management 2015, translated action plans available in chinese and punjabi, and fillable pdf. When this happens there can be coughing, a whistling sound when you breathe wheezing, chest tightness, and difficulty breathing. Asthma is getting worse cough, wheeze, chest tightness, or shortness of breath, or waking at night due to asthma, or can do some, but not all, usual activitiesorpeak flow. Green zone doing well breathing is good no coughing, wheezing, chest tightness, or shortness of breath during the day or night, and able to do usual activities work, play, and exercise, and peak flow is more than. This brochure provides an asthma action plan that will help you learn the steps to selfmanage your asthma so you can live a life as symptomfree as possible. This brochure is an asthma action plan for doctors to complete and give to child patients and their parentscaregivers.
It lists the medicines your child needs to take every day to stay well, what to do if their asthma gets worse, and what to do in an asthma attack. Jun 04, 2014 cdc asthma asthma action plan apr 24, 2009 people with asthma should have an asthma action plan the asthma action plan shows your daily treatment, such as what kind. And provide you with information on what action to take. I should continue using my normal medications as directed by my doctor, and remeasure my peak flow every weeks months. Action plans are particularly helpful in preventing multiple visits to the emergency room. Asthma action plans by national asthma council australia. To request a supply of hard copy asthma action plans, please fill out our online form or complete the order form pdf or word and submit it via email of fax. An asthma management plan is a special plan that the doctor will make. An asthma action plan allows you and your healthcare provider to create a personalized program for managing your asthma. Take this to your doctor here is your asthma action plan. This brochure is a asthma selfmanagement action plan for adults to be completed by doctors together with their patients with asthma.
Mar 01, 2016 providing this asthma education at the time of diagnosis and reinforcing it at all subsequent visits lead to better outcomes in terms of achieving the goals of asthma therapy, namely few symptoms, no limits on activity, rare exacerbations, and normal lung function. Child asthma action plan better breathing, better living name. Asthma action plan for children age 15 child health bc. Exercise smoke, strong odors or spray mold colds respiratory infections chalk dustdust carpet pollen change in temperature animals dust mites tobacco smoke cockroaches. Our library includes some of the many different written asthma action plans available. Using a spacer if you use a metered dose inhaler mdi, a spacer will help to get the right dose of medicine into your lungs. Asthma action plan for older children childrens healthcare of atlanta. Before taking this form to your health care provider, complete the top left section with. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. Asthma action plan asthma severity see reverse side asthma triggers identified things that make your asthma worse. To download straight to your computer, right click and choose save target as. Always give adrenaline autoinjector first, and then asthma reliever puffer if someone with known asthma and allergy to food, insects or. Asthma provider printed name and contact information. Developing an asthma action plan asthma health information.
Communication with your health care provider is an important part of using the asthma action plan. Asthma action plan community care of north carolina. Shareyour childs action plan with school, grandparents. My asthma action plan name date doctor doctors phone number symptoms my breathing is normal.
Adapted from finger lakes asthma action plan and nhlbi revised 10. Asthma action plan national heart, lung, and blood institute. If student stays in red zone, begin emergency plan. I need to see my asthma nurse every six months parents get the most from your childs action plan make it easy for you and your family to find it when you need it take a photo and keep it on your mobile and your childs mobile if they have one stick a copy on your fridge door share your. An asthma action plan is a written series of steps and management techniques that should be used when a patient with asthma experiences worsening in symptoms of the condition. Connect with us 1200 first street, ne, washington, dc 20002 phone. The asthma action plan includes information related to treatment regimes and patient selfmanagement. Asthma action plans may be based on symptoms with or without peak flow measurements.
If you would like more information on illinois asthma program, please contact the illinois department of public health at 2177823300. An asthma action plan created by physician, educator and patient online collaboration with usability and visual design optimization. Electronic, fillable pdf versions of asthma action plans click below to open forms. These tools for asthma control were created following the evidencebased guidelines. To access the various versions of the asthma action plans, please utilize the links below. Every person with asthma needs to have a personalized asthma action plan.
For more information contact the asthma society of canada at. I give written authorization for the medications listed in the action plan to be administered in school by the nurse or other school members as appropriate. Breathe in and out normally for 4 breaths keeping your mouth on the spacer. If student improves to yellow zone, send student to doctor or contact doctor. They comprise of either 3 or 4 stages depending on patient and health professionals. Apr, 2020 the goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. You can use it as a strategy to identify when your asthma may be flaring up and how to manage your asthma when it gets out of control. This plan will help you know what to do when asthma is in control and when asthma symptoms start to act up. Remember not to share your spacer with anyone else, and ask for a new one every year. This colourful my asthma plan is designed especially for children age from six to 11. An asthma action plan aap is a written plan of action that uses 3 stoplight zones greenyellow red to help decide what treatment relating to symptoms or peak flow results is recommended to get and keep asthma under good control. The zones correspond to the colors of a traffic light.
Perform spirometry at baseline and at least every 1 to 2 years for patients 5 years of age. Asthma triggers try to stay away from or control these things. The 2012 revised dc asthma action plan fillintheblank pdf form is now available in english and spanish based on the national heart, lung, and blood institute s 2007 guidelines for the diagnosis and management of asthma. Asthma action plan library national asthma council australia. Asthma and asthma action plan asthma is a disease of the respiratory system. My asthma action plan childrens healthcare of atlanta. My asthma action plan times per day every day take only noas needed see below starting in yellow zone or before excercise times per day every day times per day every day 2 puffs 46 puffs 1 nebulizer treatment gargle or rinse mouth after use special instructions when i am doing well be careful ask for help asthma triggers check all that. It includes how to use a spacer, how to clean an inhaler, and actions to take for different stages of asthma from well, worse to worried. Gibson and powell confirmed that using a written asthma action plan improves health outcomes for persons with asthma. Press down on puffer canister once to fire medication into spacer. Assess asthma control at every visit by selfadministered standardized test or verbal history. Using a spacer how to care for your spacer child asthma. In addition to the academy and dhmhs recommendation for using the asthma action plan, a study published in thorax by drs.
Merely noting the symptoms would not help to cure this disease if you do not know what actually you should take note of. The asthma action plan chosen should be appropriate for the persons age, educational status, language and culture. It causes swelling and narrowing of the airways inside the lungs. Perform skin or blood allergy tests for all patients with persistent asthma. Electronic, fillable pdf versions of asthma action plans. You can use the colors of a traffic light to help learn about your asthma medicines. Illinois department of public health asthma action plan.
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