Asthma Action Plans
Everyone with asthma needs their own Asthma Action Plan. Work with your health care provider to create a plan that works for you. Your goal is to prevent and control your asthma attacks.
Create your own plan using CDC’s Asthma Action Plan [PDF – 569 KB] tool.
Doing Well
- I don’t have cough, wheezing, chest tightness, or trouble breathing at any time.
- I can do all the things I usually do.
- When I use a peak flow meter my peak flow* is more than 80 percent or more of my best peak flow.
- Continue taking your long-term control medicine.
Asthma Is Getting Worse
- I have some cough, wheezing, chest tightness, or trouble breathing. Or
- I wake up at night because of my asthma. Or
- I can’t do some of the things I usually do. Or
- When I use a peak flow meter my peak flow* is half to three quarters of my best peak flow.
- Add your quick-relief medicine and continue your long-term control medicine.
- If your symptoms get better after an hour keep checking them and continue your long-term control medicine.
Medical Alert!
- I have a lot of trouble breathing. Or
- My quick-relief medicines don’t help. Or
- I can’t do any of the things I usually do. Or
- I was in the yellow zone for 24 hours and I’m not getting better. Or
- When I use a peak flow meter my peak flow* is less than half of my best peak flow.
- Add the other medicines your doctor has prescribed and call your doctor.
- If your symptoms don’t get better and you can’t reach your doctor, go to the hospital.
*Peak flow measurement is a quick test to measure air flowing out of the lungs.
Print and Fill Forms
These plans are easy to use. Select the one that is best for you, print a copy and fill in the information requested.
- Connecticut Department of Health Asthma Action Plans in PDF and Word formats. Includes Authorization for Administration of Medicine.
- Maine Asthma Prevention and Control Program Action Management Plans in PDF and information to order NCR forms.
- Minnesota Department of Health Asthma Action Plans in PDF (Child or Adult; English or Spanish).
- National Heart, Lung, and Blood Institute Asthma Action Plan
- Utah Department of Health Asthma Action Plan [PDF – 151 KB]
Electronic Forms
Open these forms online and fill in all the required information before you print them out.
- Pediatric/Adult Asthma Coalition of New Jersey Asthma Action Plans in English, Spanish, or English/Spanish (links to electronic fillable forms are on the right side of page).
- University of Michigan Hospitals and Health Centers Asthma Action Plans providing a choice of three different plans by age of the person with asthma.
Computer-based interactive plan
Follow these step-by-step instructions to create a customized Asthma Action Plan.
- Minnesota Department of Health’s interactive Asthma Action Plan is a computer-based program that uses information entered by the healthcare provider to create a personalized plan for each patient. The plan lists daily and rescue medications with steps to take when asthma symptoms occur.
