Sr asthma action plan 4 1 asthma action plan personal best peak flow important info name melissa martin date doctor name doctor phone. Apr, 2020 everyone with asthma needs his or her own asthma action plan. Asthma action plan pdf fill out and sign printable pdf. For more information and a pef chart template go to peak flow chart. My written asthma action plan helps me judge how well i am and know what i need to do if im not. I need to see my asthma nurse every six months parents get the most from your childs action plan make it easy for you and your family to. My asthma action plan name date doctor doctors phone number symptoms my breathing is normal. The use of this websitepacnj asthma treatment plan and its content is at your own risk. This brochure is a asthma selfmanagement action plan for adults to be completed by doctors together with their patients with asthma. The diagnosis of persistent asthma must be in the problem list in order for the bpa to appear. How to use a breath of life video with parents april 16 2014. A list of the persons triggers and how to avoid them, instructions for taking asthma medicine, information on what to do during an asthma episode, instructions on when to call a doctor, and.
In the actions column, your healthcare provider will recommend actions for you. There is not a specific standard action plan available for. If time permits, have the groups answer the questions on the. An asthma action plan is a written, individualized worksheet that shows patients and caretakers the steps to. See the reverse side for things you can do to avoid your asthma triggers.
Asthma action plan national heart, lung, and blood institute. Asthma action plan for home and school pdf asthma action plan pdf asthma medicine schedule pdf avoiding and controlling your asthma triggers worksheet pdf barriers to asthma glbc. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. Complete the asthma action plan smartform by clicking on the appropriate medications and. The asthma flow sheet is provided as a service through l. If you or someone you are responsible for has asthma, ask about developing an asthma action plan with your doctor. For more information contact the asthma society of canada at. When i use a peak flow meter my peak flow is more than 80 percent or more of my. Asthma action plan name school dob health care provider providers phone parentresponsible person parents phone additional emergency contact contact phone asthma severity see reverse side asthma triggers identified things that make your asthma worse. The next page provides a worksheet of the zones in the asthma action plan. The purpose of this project was to develop an asthma action plan application for smartphones.
Start a free trial now to save yourself time and money. You and your parents can get your questions answered. An asthma action plan also provides guidance on when to call the healthcare provider or when to go to. They comprise of either 3 or 4 stages depending on patient and health professionals. If you are interested in talking with our certified pediatric asthma educators to learn how to better control your childs asthma, please call the pediatric asthma program of cape fear valley at 910 6153185 to make an appointment. The current british thoracic societyscottish intercollegiate guidelines network guideline includes the asthma uk action plan in its annexes. This plan should be discussed at each physician visit and updated as needed.
If you have asthma, work with your healthcare provider to create a plan with instructions for early treatment of your asthma symptoms. Asthma shouldnt keep a child from experiencing the joy of the holiday season. An asthma action plan is a written, individualized worksheet that shows you the steps to take to keep your asthma from getting worse. Make sure your child knows what to do if they have an asthma flare. I should continue using my normal medications as directed by my doctor, and remeasure my peak flow every weeks months. A written asthma action plan encourages selfmanagement of asthma. Addressing common concerns of primary care providers by jennifer lail, md, faap and jim stout, md, mph, faap caring for children and youth with asthma in a primary care, nonspecialty setting requires creation of office protocols to permit scheduled and planned asthma visits. Work with your health care provider to create a plan that works for you. Before taking this form to your health care provider, complete the top left section with. The downloadable pdf below provides a worksheet of the zones in the asthma action plan.
Asthma action plans national asthma council australia. Your goal is to prevent and control your asthma attacks. Get copies of common action plan templates on our sensitive choice website. This asthma action plan can help you better control your asthma. Connecticut department of health asthma action plans in pdf and word. Use this to develop your personal asthma action plan with your doctor and caregivers. Send your friends, family and coworkers a photo of it. This plan should detail when to call the childs physician and when to take the child to the emergency department. Make changes and reselect the correct letter template. This is the asthma action plan for dc public schools provided by the department of health. Just i case i misplace my papers asthma is chronic disease that is hallmarked by the inflammation of the bronchial or breathing tubes, in the lungs. Action plan templates are available from many different sources. Take a photograph of it and keep it on your phone you can check what to do if your asthma gets worse. Then, follow the medication steps in the plan, as ordered by your health care provider.
Create an asthma action plan american lung association. Always bring your asthma action plan with you to healthcare appointments and emergency department visits. Asthma is getting worse cough, wheeze, chest tightness, or shortness of breath, or waking at night due to asthma, or can do some, but not all, usual activitiesorpeak flow. Fill out, securely sign, print or email your asthma action plan pdf asthma and allergy foundation of america aafa instantly with signnow. An asthma action plan aap is a written plan of action that uses 3 stoplight zones greenyellow red to help decide what treatment relating to symptoms or peak flow results is recommended to get and keep asthma under good control. Pediatric asthma program at cape fear valley health system. Asthma action plan is personalized to suit individual activities and severity. Fill, sign and download action plan template online on.
The guide provides parents and caregivers the information they need to improve their childrens quality of life. Our library includes some of the many different written asthma action plans available. Mon fri call our friendly expert nurses 0300 222 5800 get information, tips and ideas. Planning care in your medical home for children with asthma.
Write down things that make your asthma worse date i got my asthma plan. Here is an easytoread guide for parents of children with asthma. The national asthma education and prevention programs guidelines for the diagnosis and management of asthma epr3 guidelines recommend that health care providers caring for patients with asthma work with them to develop an asthma action plan. This guide suggests things you can do to avoid your asthma triggers. Not all asthma medications are listed and the generic names are not listed. Asthma action plans for children and adults in spanish and english. Share your childs action plan with school, grandparents and babysitter a printout or a photo. Asthma treatment plan student parent instructions the pacnj asthma treatment plan is designed to help everyone understand the steps necessary for the individual student to achieve the goal of controlled asthma. This test should be done by your healthcare provider at least once a year. If bpa does not display because the action plan is not due at this time, click the more activities button. The plan is designed to tell you what to do when there is a change in the severity of asthma symptoms and in peak flow numbers. This asthma treatment plan is meant to assist, not replace, the clinical decisionmaking required to meet individual patient needs. I have less energy for my daily activities increased or thicker phlegmmucus using quick relief inhalernebulizer more often swelling of ankles more than usual more coughing than usual i feel like i have a chest cold poor sleep and my symptoms woke me up my appetite is not good my medicine is not helping. Ask your healthcare provider to complete an asthma action plan to tell you what to do daily and what to do in case of an asthma flareup.
Pediatric asthma program, educational service for inpatients and outpatients. The aim of this study was to evaluate the role of asthma action plan on asthma control, reducing unscheduled hospital visits of. Asthma action plans may be based on symptoms with or without peak flow measurements. The dc asthma action plan second edition is now available in english and spanish based on the revised national heart, lu. My asthma triggers taking my asthma medicine each day will help reduce my reaction to these triggers. This helps you make quick decisions about treatment so that you can avoid more serious attacks and get better. Go to the hospitalemergency department or call for an ambulance now. Written asthma action plans are one of the most effective asthma management tools available. Care patients in these product lines that are identified with asthma. Be sure to include the three zones created by the national institutes of healthexternal icon in your plan. After finishing the video, ask groups to take 510 minutes to do the. Everyone with asthma needs his or her own asthma action plan. Put a check next to the triggers that you know make your asthma worse and ask your doctor to help you find out if you have other triggers as well. Asthma action plan in word and pdf formats toggle navigation.
Asthma action plan you can use the colors of a traffic light to help learn about your asthma medicines. The most secure digital platform to get legally binding, electronically signed documents in just a few seconds. Planning care for children with asthma in your medical home. The 2012 revised dc asthma action plan fillintheblank pdf form is now available in english and spanish based on the national heart, lung, and blood institute s 2007 guidelines for the diagnosis and management of asthma. Follow the yellow and red zone plans for rescue medicines according to asthma symptoms. Complete the asthma action plan smartform by clicking on the appropriate medications and directions. Asthma action plan library national asthma council australia.
Everyone with asthma should have an asthma action plan in. The list of symptoms is not comprehensive, and you may experience other symptoms. Then decide with your doctor what steps you will take. Both the asthma provider and the parent feel that the child may carry and selfadminister their inhalers. Your plan will be unique to you and may be adjusted by your doctor based on your past experience, personal resources, and general health.
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