An Asthma Action Plan for Your Child
Name: Personal Best Peak Flow: Date:
Provider’s Telephone: After-hours Telephone:
Green ZonePeak flow is greater than (80%) See provider every ______ months. Symptoms:
Asthma Medications Controller medication(s), take daily:
Quick relief, take minutes before exercise:
Other medication(s):
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Yellow ZonePeak flow is between (50%) and (80%) Call provider if in yellow zone for hours. Symptoms:
Asthma Medications Quick-relief, take for symptoms:
Controller medication(s), increase for days:
Other medication(s), add for days:
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Red ZonePeak flow is less than (50%) Call Provider’s Office! Symptoms:
Asthma Medications Quick-relief, take for symptoms:
Controller medication(s), increase for days:
Other medication(s), add for days:
Call 911 if your child:
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