Fillable 341 Nac Asthma Action Plan Writable A4

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341 Nac Asthma Action Plan Writable A4

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NAME
DATE
NEXT ASTHMA CHECK-UP DUE
DOCTOR’S CONTACT DETAILS
EMERGENCY CONTACT DETAILS
Name
Phone
Relationship
Your preventer is: ...................................................................................................................................
(NAME & STRENGTH)
Take ................................. puffs/tablets............................................................ times every day
Use a spacer with your inhaler
Your reliever is:.......................................................................................................................................
(NAME)
Take ................................. puffs .....................................................................................................................
When: You have symptoms like wheezing, coughing or shortness of breath
Use a spacer with your inhaler
Peak flow* (if used) above:
OTHER INSTRUCTIONS
(e.g. other medicines, trigger avoidance, what to do before exercise)
................................................................................................................................................................................
................................................................................................................................................................................
...............................................................................................................................................................................
................................................................................................................................................................................
Asthma under control (almost no symptoms)
WHEN WELL
ALWAYS CARRY YOUR RELIEVER WITH YOU
Peak flow* (if used) between and
Asthma getting worse (needing more reliever e.g. more than 3 times per week, waking up with asthma,
more symptoms than usual, asthma is interfering with usual activities)
OTHER INSTRUCTIONS
Contact your doctor
(e.g. other medicines, when to stop taking extra medicines)
................................................................................................................................................................................
................................................................................................................................................................................
...............................................................................................................................................................................
................................................................................................................................................................................
WHEN NOT WELL
Keep taking preventer: ......................................................................................................................
(NAME & STRENGTH)
Take ................................. puffs/tablets........................................................... times every day
................................................................................................................................................................................
Use a spacer with your inhaler
Your reliever is:.......................................................................................................................................
(NAME)
Take ................................. puffs .....................................................................................................................
................................................................................................................................................................................
Use a spacer with your inhaler
IF SYMPTOMS GET WORSE
Asthma is severe (needing reliever again within 3 hours, increasing difficulty breathing,
waking often at night with asthma symptoms)
Peak flow* (if used) between and
OTHER INSTRUCTIONS
Contact your doctor today
(e.g. other medicines, when to stop taking extra medicines)
Prednisolone/prednisone:
Take
........................................................................ each morning for ....................................days
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
................................................................................................................................................................................
Keep taking preventer: ......................................................................................................................
(NAME & STRENGTH)
Take ................................. puffs/tablets............................................................ times every day
................................................................................................................................................................................
Use a spacer with your inhaler
Your reliever is:.......................................................................................................................................
(NAME)
Take ................................. puffs ...................................................................................................................
................................................................................................................................................................................
Use a spacer with your inhaler
www.nationalasthma.org.au
* Peak flow not recommended for children under 12 years.
Call an ambulance immediately
Say that this is an asthma emergency
Keep taking reliever as often as needed
DANGER SIGNS
Asthma emergency (severe breathing problems,
symptoms get worse very quickly, reliever has
little or no effect)
P e a k fl o w ( i f u s e d ) b e l o w :
DIAL 000 FOR
AMBULANCE
ASTHMA ACTION PLAN
Take this ASTHMA ACTION PLAN with you when you visit your doctor
ASTHMA
MEDICINES
PREVENTERS
Your preventer medicine reduces inflammation,
swelling and mucus in the airways of your
lungs. Preventers need to be taken every day,
even when you are well.
Some preventer inhalers contain 2 medicines to
help control your asthma (combination inhalers).
RELIEVERS
Your reliever medicine works quickly to make
breathing easier by making the airways wider.
Always carry your reliever with you – it is
essential for first aid. Do not use your preventer
inhaler for quick relief of asthma symptoms
unless your doctor has told you to do this.
THIS MEANS:
• you have no night-time wheezing, coughing or chest tightness
• you only occasionally have wheezing, coughing or chest tightness during the day
• you need reliever medication only occasionally or before exercise
• you can do your usual activities without getting asthma symptoms
WHEN
WELL
THIS MEANS ANY ONE OF THESE:
• you have night-time wheezing, coughing or chest tightness
• you have morning asthma symptoms when you wake up
• you need to take your reliever more than usual eg. more than 3 times per week
• your asthma is interfering with your usual activities
WHEN
NOT WELL
THIS MEANS:
• you have increasing wheezing, cough, chest tightness or shortness of breath
• you are waking often at night with asthma symptoms
• you need to use your reliever again within 3 hours
THIS IS AN ASTHMA ATTACK
IF
SYMPTOMS
GET WORSE
THIS MEANS:
• your symptoms get worse very quickly
• you have severe shortness of breath,
can’t speak comfortably or lips look blue
• you get little or no relief from your reliever inhaler
CALL AN AMBULANCE IMMEDIATELY: DIAL 000
SAY THIS IS AN ASTHMA EMERGENCY.
DIAL 000 FOR
AMBULANCE
DANGER
SIGNS
To order more Asthma Action Plans visit the National Asthma
Council website. A range of action plans are available on the website
– please use the one that best suits your patient.
www.nationalasthma.org.au
Developed by the National Asthma Council Australia and supported by GlaxoSmithKline Australia.
National Asthma Council Australia retained editorial control.
ASTHMA ACTION PLAN
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341 Nac Asthma Action Plan Writable A4

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Completed 24 July 2020

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