How should parents set up an asthma action plan?

Q: Our pediatrician said we should have an asthma action plan for our son. How do we do that?

A: An asthma action plan is designed to help families manage a child’s asthma. The goal is to avert asthma emergencies by preventing and controlling flare-ups.

Because asthma affects people differently, asthma action plans will be customized for your child.
Generally, plans include a list of medications you are taking, early warning signs of asthma symptoms, and instructions on how to use the medication and call your doctor

You should give a copy of the plan to your child’s school, childcare provider, and any other place your child spends a lot of time.

If your pediatrician did not give you a blank schedule to fill out, you can download one from the American Academy of Allergy, Asthma & Immunology website,

Your child’s asthma action plan will be broken down into a traffic light format:

• Green means go: This is what your child’s daily schedule looks like.

• Yellow means be careful: This is when your child is not feeling well. Follow everything in the green, but add other options.

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• Red Zone means Danger: This is urgent if your child needs medication and medical attention quickly.

The plan should also include:

• Contact Information: Each plan should include information about your child, including name and family contact information. It should also include the name and phone number of the doctor who cares for your child’s asthma, whether it’s your pediatrician or a pulmonologist.

• Peak Flow: Depending on your child’s age, there may be a number at the top of your schedule. This number measures how hard your child can exhale when feeling healthy on a peak flow machine. It’s a good way to see if breathing effort is normal.

This is how the zones are divided:

Green zone: every day

The green zone represents what you should do if your child is feeling normal. Do this when your child is breathing calmly, sleeping through the night, not coughing or wheezing, and is able to play. This means your child’s peak flow range is normal.

Your child’s daily controller medications are listed here, along with the amount and when they are taken. This is the drug that your child should take every day. Examples of this are inhaled steroids or anti-allergy medication.

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Some children have exercise-induced asthma or asthma symptoms that flare up at this time. For children with this problem, medications that they need to take before exercising should be listed.

Yellow zone: first signs of illness

The yellow zone is for when your child becomes ill and is at risk of having an asthma attack. Symptoms include cough or cold symptoms, wheezing, a known trigger for an flare-up (such as a change in weather), coughing at night, or chest or abdominal pain (small children have trouble knowing if they have abdominal pain or chest pain).

The peak flow range listed is less than normal.

Your child must take all Green Zone medications as well as those listed in the Yellow Zone. The asthma action plan includes how much and how often of the medicine to take.

Your plan also lists when to call your child’s doctor if symptoms don’t improve or worsen.

Red Zone: This is urgent!

The red zone is in case your child is sick and his asthma attack is dangerous. Medication does not help, you notice that your child is breathing heavily and/or rapidly, you can see your child’s ribs while he is breathing, your child’s nose widens when he is breathing (known as flapping), or your child cannot speak because it cannot speak have difficulty breathing. The peak flow range listed is low.

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Call your doctor right away. If the office is closed, go to the emergency room or call 911.

You should also administer all Green Zone medications and all Emergency Medication in your Red Zone. Your asthma action plan will also tell you how much and how often to take the medicine.
Ask your pediatrician for help if you have questions about completing the plan.

dr Sheila Razdan is a Fellow in Neonatology and Perinatal Medicine at Stanford University School of Medicine and a Fellow of the American Academy of Pediatrics. Follow her on Twitter at @SheilaRazdan. For more information, visit, the AAP’s website for parents and carers.

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