Tips for creating and following an asthma action plan

Creating an action plan in consultation with a physician is an important step in preventing unexpected asthma attacks, and patients as well as those who care for them should understand how to create and use an action plan, says an expert from global health system Cleveland Clinic ahead of World Asthma Day on May 3.

“It’s important for asthma patients and those who care for them to understand what their symptoms are and what they have to do if they’re getting worse,” says Cleveland Clinic pulmonary medicine specialist Nirosshan Thiruchelvam, MD. “It’s also important for patients to work with their healthcare providers to improve their symptoms rather than allowing them to get worse.”

An asthma action plan prepares patients in case of an attack, while also improving their day-to-day lives. This plan can serve as a tool for patients as well as their caregivers and physicians. For parents, it’s an important resource for their child’s school nurse and teachers.

Asthma plans usually include contact information and a list of medications that are divided into traffic colors or “zones”, usually color-coded in green, yellow and red. These zones help determine what steps to take depending on the severity of symptoms. The plan should also list items such as a person’s immunization history, including the dates of receiving flu and COVID-19 vaccinations.

The different stages of the asthma plan make it clear what medications to use and what additional steps to take based on the symptoms. “The asthma plan takes any guesswork out of deciding what to do when a patient has an asthma attack,” Dr. Thiruchelvam explains.

“Individualized care is key,” adds Dr. Thiruchelvam. “Especially when you’re treating asthma, there are two different paths. One is avoiding triggers and the other is treating the symptoms.”

As a plan isn’t one-size-fits-all, patients will fill in the different zones of their personal asthma plans when they see their physician. This should be updated during office visits to monitor any improving or weakening symptoms, Dr. Thiruchelvam says. “It’s going to be a living document, so it’s not going to be set in stone. The controller medication might be different and things might change.”

Here, Dr. Thiruchelvam outlines elements of a typical asthma action plan, as well as additional steps to take in the case of a child having an asthma attack.

Contact information

The asthma action plan should contain important contact information, including the patient’s name,  their doctor’s information, and the name and phone number of an emergency contact. It should also include the date the plan was created, so anyone reviewing will know how current it is.

Symptoms and medications by zones

One section should include a list of symptoms to identify. Based on those, the patient’s doctor fills out the appropriate steps to take. Depending on the triggers, symptoms and previous steps taken, each zone lists certain medications and actions to take.

The green ‘Go’ zone lists the medications the patient takes daily to control their asthma. In the green zone, the patient is able to get a good night’s sleep, breathe at a good rate without any coughing or wheezing, work and play during the day. The green zone will also list what medication should be taken in the event of exercise-induced asthma.

The yellow ‘Caution’ zone lists additional steps the patient should take, on top of continuing all of the green zone medications. Patients would follow these steps if they had the first signs of a cold, exposure to an unknown trigger, a cough, mild wheezing or feelings of a tight chest, or coughing at night. In addition to taking the yellow zone medications indicated, patients should call their asthma care provider to update them on their status.

The red ‘Danger’ zone comes into play if the asthma continues to worsen even after patients have taken the medications outlined in the green and yellow zones. This section lists additional medications a patient should take when other medicine isn’t helping and breathing is hard and fast, the patient is having trouble speaking, their nose is opening wide or, in children, their ribs are showing. In addition to taking the medications listed for the red zone, patients or the person taking care of them should contact their doctor immediately, or if this is not possible, go directly to an emergency room.

Personalized best peak flow

Peak flow refers to how quickly a patient can push air out of the lungs when he or she blows out as hard and as fast as possible. Everyone’s peak flow is different and is found by using a peak flow meter. The personal best flow should be recorded in the plan, as well as the peak flows for each zone on the plan.

Triggers

Everyone has different triggers that could set off an attack, whether it be a change in weather or seasons, certain foods, dust, exercise or even emotional triggers, and these should be mentioned in the plan.

Follow the 4:4:4 rule for children

In addition to the steps in the action plan, the 4:4:4 rule is important to know when children are having an active attack. This shortcut will help the parent, child minder or teacher remember the specifics for helping the child to use their inhaler during an attack. When a child is showing shortness of breath, tightness in their chest, wheezing or other severe symptoms of asthma, the 4:4:4 rule is as follows:

• Have the child sit upright.
• Give four puffs, one at a time, from their inhaler.
• Wait four minutes.
• If there is no improvement, give another four puffs.

By creating an asthma action plan and knowing the 4:4:4 rule, patients and those who care for them can be confident they are prepared for a possible asthma attack. Copies of the plan should be available at home, at the physician’s office and at any school or daycare center for children.