Asthma Action Plan - nwtcedu 2025

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  1. Click ‘Get Form’ to open the Asthma Action Plan in the editor.
  2. Begin by filling in your name and medical record number at the top of the form. This personal information is crucial for your healthcare provider.
  3. Next, provide your emergency contact details and healthcare provider's information, including their phone number. This ensures that help can be reached quickly if needed.
  4. In the GREEN ZONE section, document your best peak flow measurement and any long-term control medications you take daily. Specify dosages and special instructions as necessary.
  5. Move to the YELLOW ZONE section. Here, note any symptoms you experience and follow the outlined steps for monitoring and medication adjustments.
  6. Finally, complete the RED ZONE section by detailing emergency procedures and medications required during severe asthma episodes. Ensure all fields are filled accurately for effective management.

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English Transcript. Allergist Steve Dorman, MD: The Rule of Twos inside asthma is if somebody is well controlled per our guidelines. They use the rescue inhaler less than two times a week during the day, less than two times a month during the night, and they have no limitation during their physical activities.
The 4x4x4 method is a simple but effective approach to managing asthma symptoms during an attack. It involves giving 4 puffs of Ventolin, the casualty talking 4 breaths after each puff and waiting 4 minutes. The goal of this technique is to regulate breathing and alleviate the symptoms of an asthma episode.
The best way to remember the steps is the 6 breaths, 6 puffs, 6 minutes rule. Take 6 puffs of your reliever inhaler, with 6 deep breaths per puff. Repeat this every 6 minutes until help arrives or until regular breathing returns.
If you do not have a written Asthma Action Plan, take the form below to your doctor and have them fill it out for you. Asthma Action Plans also tell school and other caregivers about your childs asthma. This could include teachers, school nurses, and after school care staff.
Your asthma action plan will include your medicines and instructions for what to do when you are feeling well, what to do when you have asthma symptoms and what to do when your asthma symptoms are getting worse. It should include the names of your medicines, how much to take and when to take it.