Many people with asthma are allergic to the dried droppings and remains of cockroaches. If you or your child has asthma that requires daily treatment, it is important to have an asthma action plan. A written asthma action plan encourages selfmanagement of asthma. This written document should spell out how to treat your asthma daily, what to do when symptoms get worse, and how to handle situations such as exercise or when you have a cold or virus. Shareyour childs action plan with school, grandparents. Asthma resources for professionals childrens hospital. Community health worker pediatric asthma home visiting program program summary. Write down how to manage your asthma both routinely and during an attack.
Diagnosis and management 2015, translated action plans available in chinese and punjabi, and fillable pdf. Here is a sample asthma action plan you can use for students in school. Before taking this form to your health care provider, complete the top left section with. Yes no if child refusesis unable to selftreat, an adult must give medicine. Asthma action plan for kids american lung association. Asthma action plans division of disease prevention mecdc. Pediatric documentation templates ahrq digital healthcare. Download the printable version of the summer fun action plan pdf. Lung association of the midatlantic alama, the pediatricadult asthma. A copy of the plan should be with your childs school, day care center, babysitter, coach, grandparent and anyone else that helps take care of your child. You or your childs asthma action plan is based on changes in asthma symptoms.
Feel free to download and print this pdf for your patients. Asthma and outdoor air pollution pdf 499 kb external icon. Allergy and anaphylaxis emergency plan childs name. With the help of your doctor complete this action plan to ensure a safe funfilled summer. Asthma action plan, for children 05 years child care health.
Asthma action plan for children age 15 child health bc. Your asthma action plan has three parts called zones. 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 find yourself having an asthma attack. 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 possible. Connecticut department of health asthma action plans in pdf and word formats. This asthma action plan outlines steps for you to selfmanage asthma when you start having more symptoms. This child has the knowledge and skills to selfadminister quickrelief medicine at school or daycare with approval of the school nurse. Asthma action plans also tell school and other caregivers about your childs asthma. Think of these zones like the red, yellow, and green lights in a traffic light. 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. Assess asthma severity to initiate treatment see page 5.
If your child doesnt have an asthma action plan, talk to his doctor about getting one. Asthma action plan national heart, lung, and blood institute. English pdf spanish pdf asthma triggers at home and in the workplace. Asthma exacerbation management childrens hospital colorado. Asthma action plans the national asthma council australia. Asthma resources for professionals childrens hospital of. After being diagnosed with asthma, you and your doctor will draw up your personal plan of treatment, called an asthma action plan. Asthma action plan library national asthma council australia. If you are interested in talking with our certified pediatric asthma educators to learn how to better control your childs asthma, please call the pediatric asthma program of cape fear valley at 910 6153185 to make an appointment. Apr, 2020 minnesota department of healths interactive asthma action plan is a computerbased program that uses information entered by the healthcare provider to create a personalized plan for each patient. Pediatric asthma action plan 115 years mild intermittent symptoms persistent symptoms or moderate or severe. Assess asthma control to determine if therapy should be adjusted see page 6. Find out how this written plan can help you care for your child with asthma.
Work with your doctor and a grownup to complete your asthma action plan. Asthma action plan for adults american lung association. First signs of a cold exposure to known trigger cough wheeze tight chest coughing at night your asthma is. Illinois department of public health asthma action plan. In the early part of 2003, the leadership of the indiana department of health and the indiana department of environmental management invited people and organizations to form the. The asthma action plan may be based on symptoms andor peak expiratory flow pef measurements and is individualised according to the pattern of the persons asthma. Studies show that following a written asthma action plan can lead to fewer asthma attacks and better disease management. For almost 20 years, the community asthma prevention program has focused on fighting disparities in asthma through strong community ties, high performingcollaborations and partnerships, community health workers, integration of healthcare services and tailored environmental interventions to increase the effectiveness of care for people with asthma. Yes no if yes, higher chance severe reaction child has had anaphylaxis. Mar 01, 2016 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, namely few symptoms, no limits on activity, rare exacerbations, and normal lung function. For more information contact the asthma society of canada at. Our library includes some of the many different written asthma action plans available. Make an appointment with your asthma care provider within two days of an er. The colors of a traffic light will help you use your asthma medicines.
It will help them understand how to recognize and handle an asthma attack. Asthma action plan for children age 618 child health bc. An asthma action plan can help you know what to do each day to help manage your asthma. Instructions for appropriate use of asthma medications. Db now age 28, was yearsold when he was referred to the pediatric asthma program at vidant medical center. Work with your health care provider to create a plan for your child. 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. Allergens animal dander some people are allergic to the flakes of skin or dried saliva from animals with fur or feathers. Green zone doing well breathing is good no coughing, wheezing, chest tightness, or shortness of breath during the day or night, and able to do usual activities work, play, and exercise, and peak flow is more than.
A list of the persons triggers and how to avoid them, instructions for taking asthma medicine, information on what to do during an asthma episode, instructions on when to call a doctor, and. It lists the medicines your child needs to take every day to stay well, what to do if their asthma gets worse, and what to do in an asthma attack. Asthma action plan, for children 6 years or older, continued doctor doctors phone number. This colourful my asthma plan is designed especially for children age from six to 11. It can help you make quick decisions in case you are not able to think clearly during an attack. The asthma action plan chosen should be appropriate for the persons age, treatment regimen, asthma severity, culture, language, literacy level, and ability to selfmanage. If you would like more information on illinois asthma program, please contact the illinois department of public health at 2177823300. 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 increasing the efficiency with which a visit is documented and enhancing adherence to clinical guidelines for those conditions. Asthma action plans respiratory health association. Preventiontake these medicines everyday, good days and bad days. Your healthcare provider might also change your usual asthma treatment according to the level of asthma control over time. Tell the camp nursecounselor that your child has asthma.
Work with your doctor or other medical professional to use this plan. Oct, 2014 pediatric asthma action plan from iggy and the inhalers asthma information for kids patient education package. The north carolina asthma plan 202018 i updated story of db. Name asthma action plan, for children 6 years or older. If you cannot contact your doctor, go directly to the emergency room.
Clinical guideline for the diagnosis, evaluation, and management of adults and children with asthma 2011 pdf asthma action plan. Develop your own asthma action plan to help you control your childs asthma, establish goals. Send a supply of daily medicines and medicines to treat an asthma attack, including a quickrelief inhaler and spacer. 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. He had severe persistent asthma and had experienced 10 inpatient admissions and 19 emergency department visits prior to being referred to the program. A printable version of the children asthma action plan and discharge plan from the asthma model of care keywords.
Review your childs asthma symptoms and peak flow zones with the camp nursecounselor. 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. This asthma action plan provides authorization for the administration of medicine described in the aap. Summer can be a fun time to do many outdoor activities. 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 is the most common chronic childhood disease and a common reason for pediatric emergency medical treatment. Indiana asthma plan 5 a strategic plan for addressing asthma in indiana indiana asthma plan is the product of almost 20 months of planning.
Asthma action plan and informational materials asthma clinical guideline tool. Peak flow numbers may also be part of the asthma action plan. Community health workerled pediatric asthma home visiting protocol manual. An asthma action plan is a written, customized plan to help you manage asthma episodes. Iggy and the inhalers includes comic books, trading cards, videos, and stickers for kids with asthma.
Yellow zone caution continue with green zone medicine and add quickrelief medicine. This plan will help you know what to do when asthma is in control and when asthma symptoms start to act up. An asthma management plan is a special plan that the doctor will make. I consent to communication between the prescribing health care provider or clinic, the school nurse, the school medical advisor and school. Asthma action plans division of disease prevention. An asthma action plan is a written plan that tells you what asthma medicine to take every day and how to treat an asthma attack. This could include teachers, school nurses, and after school care staff. Look on the back for a list of possible asthma triggers and ways to avoid them. Pediatric asthma action plan personal best peak flow. 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. Signs of an asthma episode or asthma attack when to seek emergency care. The pediatricadult asthma coalition of new jersey is sponsored by the american lung association of the midatlantic. Pacnj asthma treatment plan the pediatric adult asthma.
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