Four Seasons Pediatrics

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Asthma Action Plan and Asthma Control

What is an asthma action plan?

An asthma action plan is a set of guidelines for children who are old enough to use a peak flow meter to help you manage your asthma and keep you as healthy as possible.  With the COVID-19 pandemic, it is very important to have good asthma control.  This is especially important as we head into the fall.  The most common month for asthma hospitalizations is September and October.   If you have not had an asthma review in the past 6 months, this is a good time to come in for an asthma review appointment.  We will develop an asthma action plan with you.

An asthma action plan can prevent attacks by helping recognize the early signs of an asthma attack and to use your medications properly.

Asthma attacks occur when the lungs become inflamed, causing plugging and narrowing of your breathing tubes.

This narrowing is what makes it hard to breathe during an attack.

If you don’t have a peak flow meter or are unable to use one, it is important to recognize the symptoms of an early asthma attack.

Pay attention to the symptoms that come before severe difficulty breathing such as an annoying cough, allergy symptoms, cold symptoms etc.

It is important to remember that no two people with asthma are alike; the plan below is only a general guideline. If you have questions about the best way to control your asthma, please call our office for an appointment.

How do I begin using an asthma action plan?

To begin using an asthma action plan, you must first establish a personal best, or measurement of how your lungs perform when you are healthy.

When you experience symptoms, you will be able to determine their severity compared to your baseline.

To establish your personal best, follow the instructions below on using a peak flow meter:

  • The peak flow meter measures how much air you can blow out of your lungs as fast as you can.
  • Take peak flow readings once or twice a day for a week when you are feeling healthy.
  • You may want to keep these numbers in a diary or table.

It is a good idea to use the peak flow meter each morning to see how your lungs are doing.

Always check a peak flow reading at the earliest sign of difficulty breathing such as an annoying cough as this is the easiest time to head off an asthma attack.

What role do my medications play in managing my asthma?

Some asthma medications must be taken EVERY DAY to be effective, even when you are feeling well.

These medications act by toning down the inflammation in your lungs and include steroids inhaler medications: (Aerobid®, Azmacort®, Beclovent®, Flovent® etc.) .

Other medications should be used when you have difficulty breathing or before exercise if exercise is a trigger.

  • A common medication of this type is albuterol (Ventolin® or Proventil® or Proair®).

Once you know your baseline lung performance, you can use your peak flow meter to determine the degree of your symptoms.

  • Then you can use this information to decide how often you should use your nebulizer or inhaler.
  • Once you know your baseline, a peak flow reading can tell you that your airways are narrowing even before you experience difficulty breathing.

How do I use a peak flow meter?

A peak flow meter measures how much air you can blow out of your lungs as fast as possible. Use these steps to take a peak flow reading:

  • Step 1. Move the arrow to the bottom of the meter (at zero).
  • Step 2. Stand up straight and take a deep breath.
  • Step 3. Put the meter in your mouth, closing your lips tightly around the opening. Make sure that your tongue is not blocking the opening.
  • Step 4. Blow out as much air as you can, as quickly as you can. Don’t try to keep blowing for a long time – try to get it all out as fast as possible.
  • Step 5. When you are done, write down the number you get from the meter.
  • Step 6. Repeat Steps 1-5 twice to get two more peak flow readings. Use the highest number as your reading.

What does my peak flow reading mean?

Compare your peak flow reading to your baseline (normal) reading. Follow the management instructions below under the appropriate zone for your reading.

To calculate your zone, follow these steps:

  1. Using a calculator, enter your baseline peak flow reading (for example, 560).
  2. To find 80% of your baseline, multiply your peak number by 0.80 (for example, 560 x 0.80 = 448). If your reading is between this number and your baseline, you are in the GREEN ZONE (for example, a reading of 500).
  3. To find 60% of your baseline, multiply your peak number by 0.60 (for example, 560 x 0.60 = 336). If your reading is between this number and your 80% value, you are in the YELLOW ZONE (for example, a reading of 350).
  4. If your number is less than the 60% value, you are in the RED ZONE (for example, a reading of 220).

We suggest calculating and recording these ranges when you determine your baseline, so that you will not have to calculate them when you are having an attack.

You can adjust the colored arrows on your peak flow meter to show you where the zones are.

The next time you come to our office for an appointment, please bring your ranges with you so we can see how you are doing.

If you are confused or are having difficulty calculating your zones, call our office to speak with a nurse.

GREEN ZONE (between 80-100% of your baseline)

Great! Your lungs are doing fine. Use your daily medications normally as directed by our office. If you continue to have any difficulty breathing, check your peak flow again. If you have any questions or concerns, or if you have any doubts about the severity of your symptoms, Call Our Office Now.

YELLOW ZONE (between 60-80% of your baseline)

Caution–You are probably experiencing some symptoms such as coughing or mild wheezing. If you are having difficulty breathing or feel like you need to use your albuterol nebulizer or inhaler, try the following:

  1. Take two puffs of your albuterol (Ventolin®, Proventil®, Proair®) inhaler as often as every 15 minutes during the first hour, and then every four hours after that.
  2. Recheck your peak flow before each dose of albuterol.
  3. If your peak flow returns to the green zone, great! Recheck your peak flow reading at the first sign of trouble.
  4. If your peak flow has not improved or has gotten worse after the first hour, Call Our Office Now.
  5. If you are taking a daily medicine such as inhaled steroids take twice as many puffs as usual (for example, four puffs instead of two) for the next two days.
  6. If you need to use your inhaler more often than every four hours after the first hour, or if you have any questions or concerns, or if you have any doubts about the severity of your symptoms, Call Our Office Now.

RED ZONE (below 60% of your baseline)

Danger! Your peak flow is very low, indicating a severe asthma attack. Try the following:

  1. Take two or three puffs of your albuterol inhaler.
  2. After 5 minutes, recheck your peak flow.
  3. If you are still in the red zone, take two more puffs and Call Our Office Now.
  4. If you are in the yellow zone, take two puffs and follow the yellow zone instructions.


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