Using an asthma action plan is especially important if your child has moderate to severe asthma or has had a serious asthma attack in the past. With a written asthma action plan, its easier for you to measure whether your childs asthma is under control and it lets you know exactly what steps to take when it isnt. Allergy and anaphylaxis emergency plan childs name. Asthma exacerbation management childrens hospital colorado. My asthma action plan times per day every day take only noas needed see below starting in yellow zone or before excercise times per day every day times per day every day 2 puffs 46 puffs 1 nebulizer treatment gargle or rinse mouth after use special instructions when i am doing well be careful ask for help asthma triggers check all that. Allergens animal dander some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. The goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. Instructions for appropriate use of asthma medications. Diagnosis and management 2015, translated action plans available in chinese and punjabi, and fillable pdf. With the help of your doctor complete this action plan to ensure a safe funfilled summer. Together, you can modify it as needed so that you always know when a change in your symptoms means something serious.
If you cannot contact your doctor, go directly to the emergency room. Assess asthma control to determine if therapy should be adjusted see page 6. Here are the basic guidelines to remember when formulating an asthma action plan. Asthma action plan national heart, lung, and blood institute. Asthma action plan caring for kids canadian paediatric society. This child has the knowledge and skills to selfadminister quickrelief medicine at school or daycare with approval of the school nurse. I give permission for the medicines listed in the action plan to be administered in school by the nurse or other school staff as appropriate. An asthma management plan is a special plan that the doctor will make. Studies show that following a written asthma action plan can lead to fewer asthma attacks and better disease management. Pediatricadult asthma coalition of new jersey asthma action plans in.
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. Our goals include improving diagnoses, management and prevention of asthma by stimulating research, and providing evidencebased educational resources for worldwide use. For more information contact the asthma society of canada at. They can also reduce asthma attacks and prevent loss of lung function. Discharge plan controller for persistent asthma oral steroids home bronchodilator therapy every 4 hours for 72 hours or until completing oral steroids finalize and document asthma action plan and asthma education during phase 3 place orders for relabel of asthma medications for home use and. Simply put, an asthma action plan provides the person with asthma andor their carer clear instructions on what to do when symptoms of asthma appear. Using an asthma action plan can help you stay active with fewer asthma problems. Indiana asthma plan 5 a strategic plan for addressing asthma in indiana indiana asthma plan is the product of almost 20 months of planning. My asthma action plan childrens healthcare of atlanta. Asthma action plans division of disease prevention. Asthma action plans respiratory health association. The principles of pediatric asthma management are generally accepted.
Asthma action plan for adults american lung association. Cough, wheeze, chest tightness, or shortness of breath, or. Pediatric asthma action plan from iggy and the inhalers asthma information for kids patient education package. Summer can be a fun time to do many outdoor activities. Feel free to download and print this pdf for your patients. Keeping your child symptomfree at home is also very important, so at the breathing institute, we make aaps a priority during outpatient visits, as well. Work with your doctor to make an asthma action plan what is a pdf document. Aug 28, 2019 with a written asthma action plan, its easier for you to measure whether your childs asthma is under control and it lets you know exactly what steps to take when it isnt. Provider instructions for asthma action plan children ages 05 determine the level of asthma severity see table 1 fill in medications fill in medications appropriate to that level see table 1 and include instructions, such as shake well before using use with spacer, and rinse mouth after using. Signs of an asthma episode or asthma attack when to seek emergency care. Assess asthma severity to initiate treatment see page 5.
Yellow zone caution continue with green zone medicine and add quickrelief medicine. The global initiative for asthma gina strives to increase awareness of asthma among health professionals, health authorities, and the general public. Accurately assess asthma severity and level of control and develop a comprehensive treatment plan. This test will provide a score that may help your doctor determine if your childs asthma treatment plan is working or if it might be time for a change. Perform spirometry at baseline and at least every 1 to 2 years for patients 5 years of age. Providing this asthma education at the time of diagnosis and reinforcing it at all subsequent visits lead to better outcomes in terms of achieving the goals of asthma therapy, namely few symptoms, no limits on activity, rare exacerbations, and normal lung function. A written asthma action plan encourages selfmanagement of asthma. An asthma action plan is a written plan that tells you what asthma medicine to take every day and how to treat an asthma attack. Yes no if child refusesis unable to selftreat, an adult must give medicine important reminder anaphylaxis is a potentially lifethreating, severe allergic reaction.
Date hospitalemergency department phone number green zone doing well no cough, wheeze, chest tightness, or shortness of breath during the day or night can do usual activities and, if a peak flow meter is used, peak flow. Apr, 2020 the goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. Oct, 2014 pediatric asthma action plan from iggy and the inhalers asthma information for kids patient education package. Following your plan is a big step toward controlling the disease so you can live the life you want.
It lists the medicines your child needs to take every day to stay well, what to do if their asthma gets worse, and what to do in an asthma attack. Explains green, yellow, and red zones in an action plan. Green zone doing well breathing is good no coughing, wheezing, chest tightness, or shortness of breath during the day or night, and able to do usual activities work, play, and exercise, and peak flow is more than. What actions to take when you are or your child is having symptoms of asthma or a low peak flow meter reading. Asthma action plans division of disease prevention mecdc. Illinois department of public health asthma action plan. An asthma action plan, sometimes called asthma management plan, is a form used to keep track of medications, remind you what your peak flow is, and indicate what steps to take if you find yourself having an asthma attack. 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. Your healthcare provider might also change your usual asthma treatment according to the level of asthma control over time. Iggy and the inhalers includes comic books, trading cards, videos, and stickers for kids with asthma. This colourful my asthma plan is designed especially for children age from six to 11. This asthma action plan outlines steps for you to selfmanage asthma when you start having more symptoms. If you would like more information on illinois asthma program, please contact the illinois department of public health at 2177823300.
Asthma action plan for children age 15 child health bc. Merely noting the symptoms would not help to cure this disease. Send a supply of daily medicines and medicines to treat an asthma attack, including a quickrelief inhaler and spacer. Tell the camp nursecounselor that your child has asthma.
The pacnj asthma treatment plan is the only written plan. The pediatricadult asthma coalition of new jersey is sponsored by the american lung association of the midatlantic. Pediatric documentation templates overview when documenting a visit in an electronic health record ehr, having templates for acute and chronic conditions can assist providers by increasing the efficiency with which a visit is documented and enhancing adherence to clinical guidelines for those conditions. Pediatric asthma action plan 115 years mild intermittent symptoms persistent symptoms or moderate or severe. Community health worker pediatric asthma home visiting program program summary. Asthma action plan for children age 618 child health bc. Services as meeting the requirements of the new jersey law. These tools for asthma control were created following the evidencebased guidelines. Mar 01, 2016 providing this asthma education at the time of diagnosis and reinforcing it at all subsequent visits lead to better outcomes in terms of achieving the goals of asthma therapy, namely few symptoms, no limits on activity, rare exacerbations, and normal lung function. Yes no if child refusesis unable to selftreat, an adult must give medicine. This asthma action plan provides authorization for the administration of medicine described in the aap.
Yearly percentage of asthma action plans distributed to outpatients. Identify barriers to good asthma control and how to. Global initiative for asthma global initiative for. Assess asthma control at every visit by selfadministered standardized test or verbal history. Childhood asthma control test for children 4 to 11 years old.
Assessing asthma control monitoring symptoms taking medicines as directed avoiding known asthma triggers asthma action plans an asthma action plan is a tool to help selfmanage asthma and is developed with the patient, caregiver and doctor. Name asthma action plan, for children 6 years or older. By following the steps written in the general action plan, you can help your child perform normal, daytoday activities without experiencing alarming episodes or symptoms of asthma. Before taking this form to your health care provider, complete the top left section with. Download the printable version of the summer fun action plan pdf. 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.
The guide provides parents and caregivers the information they need to improve their childrens quality of life. Make an appointment with your asthma care provider within two days of an er. Pediatric documentation templates ahrq digital healthcare. Patientcentered asthma care minnesota department of health. It can help you make quick decisions in case you are not able to think clearly during an attack. This could include teachers, school nurses, and after school care staff. Pediatric asthma in a nutshell american academy of. Perform skin or blood allergy tests for all patients with persistent asthma. Work with your health care provider to create a plan for your child. Yes no if yes, higher chance severe reaction child has had anaphylaxis. Many people with asthma are allergic to the dried droppings and remains of cockroaches. Asthma resources for professionals childrens hospital of. Asthma resources for professionals childrens hospital. This plan will help you know what to do when asthma is in control and when asthma symptoms start to act up.
This brochure provides an asthma action plan that will help you learn the steps to selfmanage your asthma so you can live a life as symptomfree as possible. Children with asthma have swollen inflammation, sensitive airways that lead to episodes of trouble breathing. If you or your child has asthma that requires daily treatment, it is important to have an asthma action plan. In the early part of 2003, the leadership of the indiana department of health and the indiana department of environmental management invited people and organizations to form the. Differentiate asthma from other conditions that cause wheezing and cough. An individualized asthma action plan indicates the steps that must be taken to keep your asthma from getting worse.
Here is a sample asthma action plan you can use for students in school. Download the printable school asthma action plan pdf. Identify commonly used asthma medications, their mechanism of action, and their adverse effect profile. Develop your own asthma action plan to help you control your childs asthma, establish goals. Pacnj asthma treatment plan the pediatric adult asthma. Weve made great progress since making aaps a priority. Connecticut department of health asthma action plans in pdf and word formats. The colors of a traffic light will help you use your asthma medicines. Review your childs asthma symptoms and peak flow zones with the camp nursecounselor. Here is an easytoread guide for parents of children with asthma. For almost 20 years, the community asthma prevention program has focused on fighting disparities in asthma through strong community ties, high performingcollaborations and partnerships, community health workers, integration of healthcare services and tailored environmental interventions to increase the effectiveness of care for people with asthma. I consent to communication between the prescribing health care provider or clinic, the school nurse, the school medical advisor and school.
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