Asthma Action Plan
Take this Asthma Action Plan with you when you visit your doctor

Patient details:	Doctor’s contact details:	
		
Emergency contact:  Name: 	Phone: 	Relationship: 

WHEN WELL	Asthma under control (almost no symptoms)	
Always carry your reliever with you 	Peak flow* (if used) above:  
Your preventer is (name & strength):–    	  Use a spacer with your inhaler
Take:  	puffs/tablets   	times every day   
Your reliever is (name):–    	  Use a spacer with your inhaler
Take:  	puffs   	When you have symptoms like wheezing, coughing or shortness of breath
Other instructions: (e.g. other medicines, trigger avoidance, what to do before exercise)

WHEN NOT WELL	Asthma getting worse (needing more reliever than usual, having more symptoms than usual, waking up with asthma, asthma is interfering with usual activities)	
	Peak flow* (if used) between        and   
Keep taking preventer (name & strength):–    	  Use a spacer with your inhaler
Take:  	puffs/tablets   	times every day   
Your reliever is (name):–    	  Use a spacer with your inhaler
Take:  	puffs   	
Other instructions: (e.g. other medicines, when to stop taking extra medicines)	 Contact your doctor

IF SYMPTOMS  GET WORSE	Severe asthma flare-up/attack (needing reliever again within 3 hours,  increasing difficulty breathing, waking often at night with asthma symptoms) 	
	Peak flow* (if used) between        and   
Keep taking preventer (name & strength):–    	  Use a spacer with your inhaler
Take:  	puffs/tablets   	times every day   
Your reliever is (name):–    	  Use a spacer with your inhaler
Take:  	puffs   	
Other instructions: (e.g. other medicines, when to stop taking extra medicines)	Contact your doctor today
Prednisolone/prednisone:
Take:      	each morning for     	days   

DANGER SIGNS	Asthma emergency (severe breathing problems, symptoms get worse very quickly, reliever has little or no effect)	
	Peak flow* (if used) below:   
Call an ambulance immediately
Say that this is an asthma emergency		Dial 000 for AMBULANCE
Keep taking reliever as often as needed
ο Use your adrenaline autoinjector (EpiPen or Anapen)

Asthma Action Plan
What to look out for

WHEN WELL
This means:
• you have no night-time wheezing, coughing or chest tightness
• you only occasionally have wheezing, coughing or chest tightness during the day
• you need reliever medication only occasionally or before exercise
• you can do your usual activities without getting asthma symptoms

WHEN NOT WELL
This means any one of these:
• you have night-time wheezing, coughing or chest tightness
• you have morning asthma symptoms when you wake up
• you need to take your reliever more than usual
• your asthma is interfering with your usual activities
THIS IS AN ASTHMA FLARE-UP

IF SYMPTOMS GET WORSE
This means:
• you have increasing wheezing, cough, chest tightness or shortness of breath
• you are waking often at night with asthma symptoms
• you need to use your reliever again within 3 hours
THIS IS A SEVERE ASTHMA ATTACK (SEVERE FLARE-UP)

DANGER SIGNS
This means:
• your symptoms get worse very quickly
• you have severe shortness of breath, can’t speak comfortably or lips look blue • you get little or no relief from your reliever inhaler
CALL AN AMBULANCE IMMEDIATELY – DIAL 000
SAY THIS IS AN ASTHMA EMERGENCY.

Asthma Medicines
PREVENTERS
Your preventer medicine reduces inflammation, swelling and mucus in the airways of your lungs. Preventers need to be taken every day, even when you are well. Some preventer inhalers contain 2 medicines to help control your asthma (combination inhalers).

RELIEVERS
Your reliever medicine works quickly to make breathing easier by making the airways wider.
Always carry your reliever with you – it is essential for first aid. Do not use your preventer inhaler for  quick relief of asthma symptoms unless your doctor has told you to do this.

To order more Asthma Action Plans visit the National Asthma Council website. A range of action plans are available on the website – please use the one that best suits your patient. nationalasthma.org.au

Developed by the National Asthma Council Australia and supported by GSK Australia.
National Asthma Council Australia retained editorial control. © 2015

* Peak flow not recommended for children under 12 years.