Every person with asthma needs to have a personalized asthma action 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. Asthma action plan national heart, lung, and blood institute. Clinical guideline for the diagnosis, evaluation, and management of adults and children with asthma 2011 pdf asthma action plan. San francisco bay area regional asthma management plan. Work with your doctor to make an asthma action plan what is a pdf. Asthma action plan, for children 6 years or older, continued doctor doctors phone number. Here is an easytoread guide for parents of children with asthma. Childhood asthma control test for children 4 to 11 years old.
An asthma management plan is a special plan that the doctor will make. This child has the knowledge and skills to selfadminister quickrelief medicine at. Maintaining good daytoday asthma control is the key to keeping symptoms at bay and. Work with your doctor and a grownup to complete your asthma action plan. Instructions for appropriate use of asthma medications.
Tell the camp nursecounselor that your child has asthma. Assess asthma control at every visit by selfadministered standardized test or verbal history. 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. The pacnj asthma treatment plan is designed to help everyone understand the steps necessary for. Asthma action plans national asthma council australia. Assess asthma control to determine if therapy should be adjusted see page 6. Using their reliever 3 times a week, or more, to relieve asthma symptoms not including before sport. Asthma action plans division of disease prevention. 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. Yes no if yes, higher chance severe reaction child has had anaphylaxis. The asthma action plan chosen should be appropriate for the persons age. A written asthma action plan encourages selfmanagement of asthma. The goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks.
The colors of a traffic light will help you use your asthma medicines. If you or your child has asthma that requires daily treatment, it is important to have an asthma action plan. Following your plan is a big step toward controlling the disease so you can live the life you want. The pediatricadult asthma coalition of new jersey, sponsored by the american lung. Asthma action plan for adults american lung association. 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. Asthma resources for professionals childrens hospital. An asthma action plan can help you know what to do each day to help manage your asthma. Using an asthma action plan can help you stay active with fewer asthma problems. The aim of an asthma action plan is to help the person with asthma andor their carer take early action to prevent or reduce the severity of an asthma attack.
Diagnosis and management 2015, translated action plans available in chinese and punjabi, and fillable pdf. Allergens animal dander some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. Illinois department of public health asthma action plan. 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. These tools for asthma control were created following the evidencebased guidelines. Here is a sample asthma action plan you can use for students in school. This test will provide a score that may help your doctor determine if your childs asthma treatment plan is. Many people with asthma are allergic to the dried droppings and remains of cockroaches. Download the aim pdf based eaaps that include drop down menus for all asthma, gerd and allergy medications and dosages, in 3 versions.
Shareyour childs action plan with school, grandparents. A list of the persons triggers and how to avoid them, instructions for taking asthma medicine, information. Asthma action plan for children age 618 child health bc. If you would like more information on illinois asthma program, please contact the illinois department of public health at 217782.
What actions to take when you are or your child is having symptoms of asthma or a low peak. Asthma action plan and discharge plan for children healthy wa. 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. Perform spirometry at baseline and at least every 1 to 2 years for patients 5 years of age. 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. Date hospitalemergency department phone number green zone doing well no cough. Work with your health care provider to create a plan for your child. Asthma action plan library national asthma council australia. Name asthma action plan, for children 6 years or older. Asthma is the most common chronic childhood disease and a common reason for pediatric emergency medical treatment. I need to see my asthma nurse every six months parents get the most from your childs action plan make it easy for you and your family to find it when. Pediatricadult asthma coalition of new jersey asthma action plans in.
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. Asthma action plans also tell school and other caregivers about your childs asthma. Asthma action plans respiratory health association. The guide provides parents and caregivers the information they need to improve their childrens quality of life.
This plan will help you know what to do when asthma is. 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. This could include teachers, school nurses, and after school care staff. Assess asthma severity to initiate treatment see page 5. School health forms and action plans schoolage health. Community health worker pediatric asthma home visiting program. Our library includes some of the many different written asthma action plans available. This asthma action plan provides authorization for the administration of medicine described in the aap. For almost 20 years, the community asthma prevention program has focused on fighting disparities in asthma through strong community ties, high performingcollaborations and. An asthma action plan is a written plan that tells you what asthma. Before taking this form to your health care provider, complete the top left section with.
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. Review your childs asthma symptoms and peak flow zones with the camp nursecounselor. Green zone doing well breathing is good no coughing, wheezing, chest. Allergy and anaphylaxis emergency plan childs name. Asthma action plan and informational materials asthma clinical guideline tool. 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. Asthma action plan for older children childrens healthcare of atlanta. Connecticut department of health asthma action plans in pdf and word formats. Asthma action plan for children age 15 child health bc.