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View DoctorsMy personal best peak flow is:__________
My PREVENTER inhaler is:__________
I need to take my preventer inhaler every day, even when I feel well.
I take _________________ puff(s) in the morning, and __________________ puff(s) at night.
My RELIEVER inhaler is: _________________________ __________________________ (Name/ Colour) I need to take my reliever inhaler only if I need to.
I take _______________ puff(s) of my reliever inhaler if
any of the below things happen:
Other medications I take for my asthma every day:__________________________________________
My aim is to have no symptoms. If I haven’t had any symptoms or needed to use my reliever inhaler for at least 12 weeks, I will ask a member of my asthma action plan health care team members to review and revise my medication dosages.
If you have allergies, your attacks can be more severe.
My symptoms are coming back (wheeze, chest tightness, breathlessness, cough) I am waking up at night My symptoms are interfering with my usual daily activities (e.g. work or exercising) I am using my reliever inhaler_________________ times a week or more My peak flow drops to below _________________
This is what I can do now to get on top of my asthma:
Urgent! Call pulmonary clinic today and let them know I have started taking steroids and make an appointment to be seen within 24 hours.
My reliever inhaler is not helping or I need to increase the dose to be every __________ hours I find it difficult to walk or talk I find it difficult to breathe I’m wheezing a lot or have a very tight chest or I’m coughing a lot My peak flow is below __________
This is an EMERGENCY, take action now
a) If I feel worse at any point while I’m using my inhaler (CALL 999 Ambulance takes longer than 15 minutes? Repeat step 2) b) If I don’t feel any better after 10 puffs (CALL 999 Ambulance takes longer than 15 minutes? Repeat step 2)
c) If I feel better make an urgent same day appointment with pulmonary clinic
If I feel better, and have made my urgent same day appointment:
Please take your asthma action plan to the Emergency Department.
The best way to avoid an asthma flare-up is to make sure your asthma is well controlled. Following an asthma action plan can decrease your need to seek emergency care.
Your asthma action plan is tailored to you and will help you manage your asthma. Once this is set with your health care team members, it will help you to know what to do if you are unwell and help you stay as well as possible.
RESCU rules:
Taking my medications and avoiding triggers will help me reduce my flare-ups ___________________________________
My Annual Asthma Action Plan Review:
During my annual asthma action plan review, we will:
My next review date: ___ / ___ / ________
If you have any questions please contact:
My asthma action plan health care team members: Dr._________________________________________ /
Nurse_________________________________________
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This information is provided by Cleveland Clinic Abu Dhabi, part of the M42 group, and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.
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