“Asthma action plans make a difference,” says John Oppenheimer, MD, who is a part of the Division of Allergy Immunology at Rutgers University of Medicine and Dentistry of New Jersey in New Brunswick, as well as Pulmonary Allergy Associates in Cedar Knolls, New Jersey. “People really like to have some level of comfort about what to do when they’re in trouble.” Having an action plan in place could also help save your life in the case of a severe asthma attack. With input from your doctor, make sure your action plan includes the following.
1. Your asthma triggers
If you know that certain things make your asthma symptoms worse, mark these triggers down along with steps you can take to avoid them. Not all asthma triggers, such as stress or changes in weather, can be avoided completely, so you should also include instructions for what to do before and after exposure to your triggers. For example, colds or seasonal allergies can sometimes set off major symptoms, even in people who usually have mild asthma, explains Dr. Oppenheimer. “Identifying these triggers is important because it allows us to target therapy to be more aggressive before their season,” he says.
2. Your symptoms
When your asthma flares up, what does it typically feel like? “The importance of the emergency plan is to remind people of signs and symptoms that they need help, such as wheezing, shortness of breath, and coughing — especially at night or during exercise — or using a rescue inhaler more frequently,” says Oppenheimer. For milder symptoms, the plan will tell you what to do to curb the problem or if first-line treatment doesn’t help.
3. What medications you take, and when and how to take them
List all of the medications you take, along with the dosage and instructions from your doctor. Asthma treatment typically consists of long-term controller medications and quick-relief (or rescue) medications that you take when your symptoms flare up, according to the National Heart, Lung, and Blood Institute. If you have eosinophilic asthma, your doctor may also prescribe newer medications called biologics to target eosinophils. Your doctor will recommend treatment for each situation in your asthma action plan — when things are going well, when you may be experiencing worsening symptoms, and when you need to seek emergency medical attention. If you use an inhaler, your action plan should include instructions for how to use it. Many people don’t use their inhalers correctly, so ask your doctor to check your technique.
4. Your peak flow readings
If your doctor recommends it, include readings from a peak flow meter, a simple device that assesses your air flow as you exhale. Peak flow rates below your personal best may be the first sign that your asthma is worsening. Your personal best is the highest number you achieve during a two- to three-week period when your asthma is under control, according to the American Lung Association (ALA). Your doctor might also use your peak flow measurements to help make decisions about adjusting your treatment.
5. Your asthma zones
These green, yellow, and red color-coded zones are based on your symptoms and peak flow readings and can help you assess how well your asthma is controlled. Green means you’re doing well; yellow indicates your symptoms are getting worse, but you’re not in imminent danger; and red is when you need help right away. Your action plan should include advice on what to do in each zone. Your asthma zones are personalized based on your history. “Each person’s action plan is a little bit different,” says Oppenheimer. For example, if someone typically has no symptoms and then starts to need their inhaler more than once a day or more than two days in a row, that’s a significant change in asthma control, even though it may not seem severe. “I like to include cutoffs of when you should start escalating your therapy and when you should call for help,” says Oppenheimer.
6. What to do if you have an asthma attack
Your asthma action plan should break down what to do and when to call for help during an asthma attack, says Oppenheimer. Your doctor will give you instructions on when and how to take your medication and recommend other steps you can take to help get your asthma under control. “When people have an asthma exacerbation, there’s often a lag of two to three days between the onset of symptoms and the peak of symptoms,” says Oppenheimer. Treating the problem correctly at the outset can help you avoid discomfort later. Your action plan should also outline who to call and what steps to take if your asthma attack becomes an emergency. If you’re in the red zone, seek help immediately. You may need to call your doctor or 911 or go to the emergency room if you’re having difficulty walking, talking, or breathing, your lips or fingernails are turning blue, or your medications aren’t improving your symptoms.
7. Contact information for your doctor, hospital, and emergency contact
Keep your action plan up-to-date with contact information for your doctor and hospital. You should also include phone numbers for any family members or friends who should be contacted if you have an emergency. The ALA has a template you can use for your asthma action plan, or you can ask your doctor for other recommendations. Once you have a plan in place, keep a copy of it somewhere prominent and review it regularly with your doctor in case anything changes. “You need to constantly be vigilant in remembering that [your asthma] can become unstable at any time, whether you have mild or severe disease,” says Oppenheimer.
