Asthma action plan, for children 6 years or older, continued doctor doctors phone number. Every individual with asthma should complete an asthma action plan. One of the best things you can do to look after your childs asthma is to make sure theyre always using an uptodate asthma action plan. Our library includes some of the many different written asthma action plans available. The washington asthma initiative and the washington state department of health support the plan. Give copies of the asthma treatment plan to everyone who provides care for your child, for example. Avoid smokinga known asthma triggerand avoid having your child in a house where someone smokes. Allergens animal dander some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. Regular play and exercise is good for your childs health. Asthma action plan library national asthma council australia. Review and update at each doctors visit green zone.
This asthma plan was developed by a committee facilitated by the childhood asthma initiative, a program funded by the california children and families commis sion, and the regional asthma management and prevention ramp initiative, a program of the public health institute. Asthma discharge plan respiratory health association. Asthma action plan for children age 618 child health bc. Build a trigger list of what seems to make your childs asthma act up.
Yes no if yes, higher chance severe reaction child has had anaphylaxis. Patientcentered asthma care minnesota department of health. You can also request a copy of this form at your childs school. Asthma action plan for children age 15 child health bc. It identifies personal best peak flow, levels of symptom severity, and appropriate patient action. Provider instructions for asthma action plan children ages 05 determine the level of asthma severity see table 1 fill in medications fill in medications appropriate to that level see table 1 and include instructions, such as shake well before using use with spacer, and rinse mouth after using.
My asthma action plan times per day every day take only noas needed see below starting in yellow zone or before excercise times per day every day times per day every day 2 puffs 46 puffs 1 nebulizer treatment gargle or rinse mouth after use special instructions when i am doing well be careful ask for help asthma triggers check all that. Perform skin or blood allergy tests for all patients with persistent asthma. Daily asthmaallergy management plan photo identify the. Shareyour childs action plan with school, grandparents. Parents should give a copy of their childs asthma action plan to the school, pre school andor childcare facility. Use the action plan to recognize the signs of rapidly worsening asthma, such as trouble speaking, use of abdominal muscles to breathe or wide nostrils when breathing in. Child asthma action plan 2009 minnewaska area high school. Diagnosis and management 2015, translated action plans available in chinese and punjabi, and fillable pdf. Childhood asthma control test for children 4 to 11 years old. Nac aap colour nac aap black and white an aap provides clear information and instructions for managing your asthma.
Work with your health care provider to create a plan for your child. Circle the triggers that make your childs asthma worse. Asthma action plan national heart, lung, and blood institute. 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. Before taking this form to your health care provider, complete the top left section with. Using a spacer if you use a metered dose inhaler mdi, a spacer will help to get the right dose of medicine into your lungs. White school child care copy pink family copy yellow doctor copy permission to reproduce blank form asthma action plan check all items that trigger your asthma and things that could make your asthma worse.
Aug 28, 2019 use the action plan to recognize the signs of rapidly worsening asthma, such as trouble speaking, use of abdominal muscles to breathe or wide nostrils when breathing in. The goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. Every person with asthma should have an asthma action plan aap in writing. Asthma and allergy foundation of america 1235 south clark street suite 305, arlington, va 22202 phone. Simply put, an asthma action plan provides the person with asthma andor their carer clear instructions on what to do when symptoms of asthma appear. Child is well and has no asthma symptoms, even during play. Apr, 2020 the goal of asthma selfmanagement is to achieve better health through controlling and preventing asthma attacks. Once completed, the asthma action plan is given to the person with asthma andor their carer to keep. 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.
Theyve very few or no asthma symptoms during the day or night wheezing, coughing, shortness of breath. If your child has a cold, use your childs action plan. One of the best things you can do to look after your child s asthma is to make sure theyre always using an uptodate asthma action plan. 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. Please provide a copy of the asthma action plan for all caretakers, including parents, grandparents, extended family, neighbors, school staff, and child care providers. Asthma action plans also tell school and other caregivers about your child s asthma. About the asthma plan this updated version of the washington state asthma plan reflects the current landscape of asthma care and management in washington. It includes how to use a spacer, how to clean an inhaler, and actions to take for different stages of asthma from well, worse to worried. By following the steps written in the general action plan, you can help your child perform normal, daytoday activities without experiencing alarming episodes or symptoms of asthma. These tools for asthma control were created following the evidencebased guidelines.
Parents should give a copy of their childs asthma action plan to the school, preschool andor childcare facility. This asthma action plan matches specific symptoms to actions that will help your child manage his or her asthma. Asthma action plans national asthma council australia. Asthma action plan for children ages 5 and younger handling asthma flareups is easier and less stressful for you and your child when you have a plan. This form, when completed by health care providers, gives parents and school personnel a written asthma management plan for children. As901, as902, as903, as904, as905, as906, as907, as908 this form, when completed by health care providers, gives parents and school personnel a written asthma management plan for children. Asthma is getting worse cough, wheeze, chest tightness, or shortness of breath, or waking at night due to asthma, or can do some, but not all, usual activitiesorpeak flow. If your child has symptoms with exercise, it may mean that hisher asthma is not well controlled. Download national asthma council asthma action plan pdf. I need to see my asthma nurse every six months parents get the most from your child s action plan make it easy for you and your family to find it when you need it take a photo and keep it on your mobile and your child s mobile if they have one stick a copy on your fridge door share your. Using a spacer how to care for your spacer child asthma. This plan is an update to the second state asthma plan, released in 2011, and is considered to. If your child uses a peak flow meter, the action plan will also tell you when low peak flow readings signal that your child s asthma attack has become an emergency. Asthma action plan asthma australia nations peak consumer.
Danger signs asthma emergency severe breathing problems, symptoms get worse very quickly, reliever has little or no effect. My asthma action plan childrens healthcare of atlanta. Every person with asthma needs to have a personalized asthma action plan. It causes swelling and narrowing of the airways inside the lungs. Asthma action plans also tell school and other caregivers about your childs asthma. This asthma action plan provides authorization for the administration of medicine described in the aap. This child has the knowledge and skills to selfadminister quickrelief medicine at school or daycare with approval of the school nurse. Massachusetts asthma action plan personal best peak flow. An asthma action plan is a printed form with specific instructions based on childs names asthma that tells when to change the amount or type of medicine, when to call the doctor for advice, and when to go to the emergency room.
Download and print the form above to take to your childs doctor. Name asthma action plan, for children 6 years or older. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. Assess asthma control at every visit by selfadministered standardized test or verbal history. When your child has an asthma flare, its natural to worry that hes in serious trouble or wonder if he just needs a tweak to his medicine. Your child s asthma action plan gives you the stepbystep advice you need to keep your child well. Asthma action plans respiratory health association. The colors of a traffic light will help you use your asthma medicines. Your childs asthma action plan gives you the stepbystep advice you need to keep your child well. This could include teachers, school nurses, and after school care staff. Remember not to share your spacer with anyone else, and ask for a new one every year.
When this happens there can be coughing, a whistling sound when you breathe wheezing, chest tightness, and difficulty breathing. Child asthma action plan better breathing, better living name. 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 you need it take a photo and keep it on your mobile and your childs mobile if they have one stick a copy on your fridge door share your. Asthma and asthma action plan asthma is a disease of the respiratory system. Avoid things that make your childs asthma worse give your child the controller medicines everyday. Asthma action plans aaps are written, individualized selfmanagement and educational tools that provide daily and emergency guidance to asthma patients, parents, and caregivers at home, school, and the workplace and community settings. Perform spirometry at baseline and at least every 1 to 2 years for patients 5 years of age. If your child uses a peak flow meter, the action plan will also tell you when low peak flow readings signal that your childs asthma attack has become an emergency. Asthma action plan and discharge plan for children healthy wa. Yes no if child refusesis unable to selftreat, an adult must give medicine important reminder anaphylaxis is a potentially lifethreating, severe allergic reaction.
Here is a sample asthma action plan you can use for students in school. The asthma action plan should be regularly modified to meet the changing needs of the patient and medicine regimes. This brochure is an asthma action plan for doctors to complete and give to child patients and their parentscaregivers. Following the steps on this handy plan means your child is far less likely to have asthma symptoms or an asthma attack. Asthma action plan take this asthma action plan with you when you visit your doctor. Does your child have any of the following symptoms when they seem well. School health forms and action plans schoolage health and. If your child has asthma, cps requests that you and your childs physician complete our asthma action plan form. The asthma action plan is to be completed by a primary care provider for each individual child or adult that has been diagnosed with asthma. The child should feel better within 2060 minutes of the quickrelief treatment. It contains student medication administration authorization.
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