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<div class="HwContainer HwElement" id="HwContainer"><a class="HwMainSkipNavigation" href="#HwContentTitle"><span class="HwAccessibilityText">Skip Navigation</span></a><div class="HwBlock" id="HwMain" role="main"><div class="HwRow"><div class="HwColumn" id="HwColumnSidebar1"><div class="HwCustom" id="HwCustomSidebar"> </div></div><div class="HwColumn" id="HwColumnContent"><div id="HwContentTop"> </div><div class="HwTypeFocus HwContentWrapper HwElement" role="article" id="HwContentWrapper"><div class="HwCustom" id="HwCustomContentTop"> </div><div class="HwContentHeader"><p><a name="top" id="Hwtop"><span class="HwAccessibilityText">Top of the page</span></a> </p></div><div class="HwContentTitle"><h1 id="HwContentTitle" tabindex="-1">My Asthma Action Plan</h1></div><div class="HwContentTopNavigation"> </div><div class="HwContent"><div class="HwNavigationSection HwSectionSpecialSection" id="sec-zd1600_sec"><h2 class="HwSectionTitle" fingerprint="b4cb0a40" fingerprint-exact="e7c3d1bb">Overview</h2><ul fingerprint="8af4e07e" fingerprint-exact="a831e7f0"><li>My name ______________________________________ </li><li>Doctor's name _________________________________ </li><li>Doctor's phone ________________________________ </li></ul><table class="hw-table-border" style="width: 99%" fingerprint="fba22b6f" fingerprint-exact="e67d9c83"><colgroup><col width="25%"><col width="25%"><col width="25%"><col width="25%"></colgroup><thead><tr><th>Controller medicine</th><th>How much?</th><th>How often?</th><th>Other instructions</th></tr></thead><tbody><tr><td> </td><td> </td><td> </td><td> </td></tr><tr><td> </td><td> </td><td> </td><td> </td></tr><tr><td> </td><td> </td><td> </td><td> </td></tr></tbody></table><table class="hw-table-border" style="width: 99%" fingerprint="d65bfb11" fingerprint-exact="4e8570d1"><colgroup><col width="25%"><col width="25%"><col width="25%"><col width="25%"></colgroup><thead><tr><th>Quick-relief medicine</th><th>How much?</th><th>How often?</th><th>Other instructions</th></tr></thead><tbody><tr><td> </td><td> </td><td> </td><td> </td></tr><tr><td> </td><td> </td><td> </td><td> </td></tr><tr><td> </td><td> </td><td> </td><td> </td></tr></tbody></table><h3 class="HwSubSectionTitle" fingerprint="4c11a6a0" fingerprint-exact="caa12de0">Important</h3><p fingerprint="29f95a7c" fingerprint-exact="4d87f429"><b>EMERGENCY:</b> If it's hard to walk or talk because of shortness of breath or if your lips or fingertips are blue, <b>CALL</b><span class="HwEmergencyNumber"> 911 </span> or go to the hospital for help right away.</p><table class="hw-table-border" style="width: 99%" fingerprint="514266e9" fingerprint-exact="ac6d7f89"><colgroup><col width="33%"><col width="33%"><col width="33%"></colgroup><tbody><tr><td><b>GREEN ZONE</b> This is where I want to be!</td><td><b>YELLOW ZONE</b> My asthma is getting worse.</td><td><b>RED ZONE</b> Danger!</td></tr><tr><td><p><b>Symptoms</b></p><ul><li>I have no shortness of breath, cough, wheezing, or chest tightness. </li><li>I can do all of my usual activities. </li><li>I sleep well at night. </li></ul></td><td><p><b>Symptoms</b></p><ul><li>I'm coughing or wheezing or have chest tightness or shortness of breath. </li><li>Symptoms keep me up at night. </li><li>I can do some but not all of my usual activities. </li></ul></td><td><p><b>Symptoms</b></p><ul><li>I'm very short of breath. </li><li>I can't do my usual activities. </li><li>Quick-relief medicine doesn't help, or my symptoms don't get better after 24 hours in the yellow zone. </li></ul></td></tr><tr><td><p><b>Peak flow</b> (if I use a peak flow meter)</p><ul><li>_________ or more (80% or more of my personal best) </li></ul></td><td><p><b>Peak flow</b> (if I use a peak flow meter)</p><ul><li>______ to ____ (50% to 79% of my personal best) </li></ul></td><td><p><b>Peak flow </b>(if I use a peak flow meter)</p><ul><li>_____ or lower (less than 50% of my personal best) </li></ul></td></tr><tr><td><p><b>Actions</b></p><ul><li>[ ] Take controller medicine(s) every day. </li><li>[ ] Avoid asthma triggers. </li><li>[ ] ____ minutes<b> before exercise</b>, take quick-relief medicine called ________________. </li></ul></td><td><p><b>Actions</b></p><ul><li>[ ] Take _____ puff(s) of my quick-relief medicine called ________________. Repeat ____ times. </li><li>[ ] If my symptoms don't get better or my peak flow has not returned to the green zone in 1 hour, then: <ul><li>[ ] Take _____ puff(s) of my medicine called ________________. Take it ___ times a day. </li><li>[ ] Begin or increase treatment with corticosteroid pills. Take ______ mg of ________________ every _______________. </li><li>[ ] Call my doctor at _______________. </li></ul></li></ul></td><td><p><b>Actions</b></p><ul><li>[ ] Take _____ puff(s) of my quick-relief medicine called _____________. Repeat _____ times. </li><li>[ ] Begin or increase treatment with corticosteroid pills. Take ________ mg now. </li><li>[ ] Call my doctor at ______________. If I cannot contact my doctor, I need to go to the emergency department or call for help right away. </li><li>[ ] Other numbers I might call are ______________, ______________, ______________. </li></ul></td></tr></tbody></table></div><div class="HwNavigationSection HwSectionRelatedInformation" id="sec-zd1600-RelInfo"><h2 class="HwSectionTitle" fingerprint="d5f858e0" fingerprint-exact="c0ffe04b">Related Information</h2><ul fingerprint="3045b7c4" fingerprint-exact="6d9b022c"><li class="HwOptionalAny"><a data-hw-type="Focus" data-hw-document-href="ug2879" data-hw-section="acl5125" hw:document-type="Focus" hw:document-href="ug2879" data-hwid="ug2879" hw:section-href="acl5125" href="?id=ug2879#acl5125">Asthma Action Plan</a></li><li class="HwOptionalAny"><a data-hw-type="Focus" data-hw-document-href="hw161511" data-hw-section="hw161511_sec" hw:document-type="Focus" hw:document-href="hw161511" data-hwid="hw161511" hw:section-href="hw161511_sec" href="?id=hw161511#hw161511_sec">Asthma Action 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