My Action Asthma Plan							
When my asthma is
WELL CONTROLLED		When my asthma is
GETTING WORSE		When my asthma is
SEVERE		How to recognise
LIFE-THREATENING ASTHMA	
• No regular wheeze, or cough or chest tightness at night time, on wakng or during the day		•	At the first sign of worsening asthma symptoms associated with a cold		•	Need reliever puffer every 3 hours or more often		Dial 000 for an ambulance and/or 112
from a mobile phone if you have any of
the following danger signs:	
•	Able to take part in normal physical activity without wheeze, cough or chest tightness		•	Waking from sleep due to coughing, wheezing or chest tightness		•	Increasing wheezing, choughing, chest tighness		•	extreme difficulty breathing
•	little or no improvement from reliever puffer	
•	Need reliever medication less than three times a week (except if it is used before exercise)		•	Using reliever puffer more than 3 times a week (not including before exercise)		•	Difficulty with normal activity
•	Waking each night and most mornings with wheezing, coughing or chest tightness
•	Feel that asthma is out of control		•	lips turn blue
and follow the Asthma First Aid Plan below while waiting for ambulance to arrive.	
•	Peak Flow above * <Controlled, Peak Flow Above>  		•	Peak Flow * between <Worse, Flow Low> <Worse, Flow High> 		•	Peak Flow *  <Severe, Flow Low> <Severe, Flow High>		A serious asthma attack is also
indicated by:	
                          
What should I do?         		
What should I do?                      		
What should I do?                 		•	symptoms gettingn worse quickly
•	severe shortness of breath or difficulty in speaking	
Continue my usual treatment as follows
		Increase my treatment as follows:		Start Oral Prednisolone (or other steroid) and increase my treatment as follows:		•	you are feeling frightened or panicked
•	Peak Flow * below <Severe, Flow High>	
PREVENTER
<Preventer>

RELIEVER
<Reliever>

COMBINATION MEDICINE
<Combination Medicine>

Always carry my releiver puffer		<Worsening, What should I Do ?>

See my doctor to talk about my asthma getting worse.		<Severe, What should I Do>

See my doctor for advice.		Should any of these occur, follow the
Asthma First Aid Plan below.
Asthma First Aid Plan
1	Sit upright and stay calm.
2	Take 4 separate puffs of a reliever puffer (one puff at a time) via a spacer device. Just use the puffer on its own if you don’t have a spacer. Take 4 breaths from the spacer after each puff.
3	Wait 4 minutes. If there is no improvement, take another 4 puffs.	
Doctor:<DrName> 

Parent/Carer: <Parent/Carer>
		Ph: <UsrPhone> 

Ph: <Parent/Carer Ph:>		Signature:		4	If little or no improvement CALL AN AMBULANCE IMMEDIATELY (DIAL 000 and/or 112 from mobile phone) and state that you are having an asthma attack. Keep taking 4 puffs every 4 minutes until the ambulance arrives	

						See your doctor immediately after a
serious asthma attack.	
Name: <PtFullName>
		Date: <TodaysDate>		Best Peak Flow: <Best Flow>		Next Dr's Appointment:<Next Appt>	
	
	* Not recommended for children under 12 years