Asthma action plans offer guidelines and procedures to follow in the event of an asthma attack. They also offer information that can help reduce or prevent asthma symptoms. Asthma action plans are crucial for children who have asthma, and for the caregivers who watch over them. Parents, relatives, babysitters, school officials, coaches and other caregivers should be aware of a child’s asthma action plan, and know how to use it properly in the event of an asthma attack.

Once asthma has been diagnosed in a child, a physician will work with the patient and his or her parents to develop step-by-step instructions for what to do when symptoms begin to appear. Asthma action plans categorize symptoms according to three colors, with each color indicating an appropriate level of response. These levels dictate how a child and caretaker should respond to asthma symptoms:

• Green: Indicates that the child is doing well, with no significant asthma symptoms.
  
  
• Yellow: Symptoms and warning signs such as coughing, wheezing and mild shortness of breath indicate an asthma attack may be imminent.
  
  
• Red: Symptoms such as frequent and severe coughing, severe shortness of breath and rapid breathing indicate that immediate medical attention is needed.

Asthma action plans also include basic information about a child’s asthma condition. This information usually includes:

• Listings of the child’s usual symptoms
  
  
• Allergens and irritants known to trigger the child’s symptoms
  
  
• Normal peak flow meter readings for the child
  
  
• Medications the child takes and instructions for how, and when to take them

Asthma action plans also contain all information vital to treating a child’s asthma, such as medications and dosage levels, emergency phone numbers, and a physician’s phone number.

As children’s asthma symptoms change over time, their asthma action plans should be updated as well. This should always be done in consultation with the child’s physician, and should take place at least annually. Emergency contact information should also be checked and updated regularly.

Asthma action plans are a detailed list of information and instructions that can help patients and caregivers reduce or prevent asthma symptoms, as well as respond during an asthma attack.

Having an asthma action plan in place is particularly important for a child with asthma. Children often have trouble keeping track of their own medications, and many are too young to even know what to do in the event of an attack. Having a written plan that can be easily given out provides whoever is watching a child clear instruction on what to do in the event of an asthma attack. In the event of a severe attack, this information can save a child’s life.

An asthma action plan is customized to each individual, and will differ from child to child. It is important that parents and caregivers follow a physician’s recommended plan closely, and that they understand what the information means.

A child’s asthma action plan should help parents and caregivers address four key topics:

• How to identify signs of an impending asthma attack
  
  
• What steps the caregiver and child can take to manage symptoms
  
  
• How to recognize the signs of a more serious attack
  
  
• When to seek emergency care

The asthma action plan should be written out and those who care for the child should have easy access to it. Every adult who serves as a caregiver to the child should have access to the asthma action plan at a moment’s notice. Parents and guardians should carry a copy with them in their wallet or purse when they are away from home.

As children get older they should be taught which steps they can take themselves and when to seek an adult for help.

Although asthma action plans vary, they share some basic information. A child’s asthma action plan should include the following detailed information:

• A list of the child’s asthma triggers and steps for avoiding them.
  
  
• A list of the child’s normal peak flow meter readings, along with personal-best readings and defined danger-levels.
  

  

• A list of symptoms typically experienced by the child prior to and during an asthma attack.
  
  
• Steps that should be taken if the child awakens in the middle of the night with symptoms.
  
  
• Steps that should be taken before the child exercises.
  
  
• The name and dosage of any medications the child takes to treat asthma symptoms. These include both “controller” medications (taken to prevent symptoms before they appear) and “reliever” medications (taken to stop and reverse symptoms once they appear).
  
  
• Emergency telephone numbers and a list of locations for emergency care. This should include the name and number of the child’s physician, as well as a name and number of someone who can be called if the physician is unavailable. After-hours numbers should be included.
  
  
• Emergency numbers and the location of medical care facilities near the child’s school or daycare facility, and near vacation homes or other travel destinations.

It may also be a good idea to include the child's name, age, grade, date of birth and a photo.

In addition, the asthma action plan should feature basic guidelines that help patients and caregivers determine the severity of a child’s asthma symptoms at any given time. Most asthma action plans help caregivers determine a child’s condition based on a color-coded categorization system:

• Green. This is the optimal level for every child. It indicates the child is showing no signs or symptoms of asthma. All daily activities and sleep patterns are uninterrupted by symptoms, and peak flow meter readings are between 80 percent and 100 percent of the child’s personal best.
  
  
• Yellow. Parents or caregivers should be concerned if a child’s level falls to yellow. This level is characterized by coughing, wheezing or mild shortness of breath. Daily activities and sleep may be impacted and disturbed, and the child’s peak flow meter readings generally are 50 to 80 percent of the personal-best level. The asthma action plan should state which medication and dosage a child at this level should take. A child who repeatedly drops into the yellow zone should see a physician.
  
  
• Red. This is a very dangerous level for a child. Symptoms include frequent, severe cough, severe shortness of breath, wheezing, trouble talking and walking and rapid breathing. This level is indicated by peak flow meter readings that have dropped to less than 50 percent of a child’s personal best. At this level a child should be given the proper medication as indicated by the asthma action plan, and immediate medical help should be sought. Parents or caregivers should dial 9-1-1 if the child is gasping for air, displays blue lips or fingernails (cyanosis), or is unable to complete a peak flow meter reading.

The asthma action plan should be posted in the home in a location that both the parents and children can quickly and easily reach (e.g., on the refrigerator, on the child’s door).

In the home, parents should make sure that any medications a child may need are stored in a single location that is accessible by everyone. Keeping medicines together in a consistent location can cut down on confusion and searching and save valuable time in the event of a severe asthma attack.

When putting an asthma action plan into practice, parents must not forget to attend to the needs of the child. Many children are likely to be frightened during an asthma flare–up, and the calming presence of an adult can help the child to relax, possibly reducing symptoms. Parents and caregivers should try to remember the following:

• Stay calm and speak to the child in a reassuring tone.
  
  
• Give the medication prescribed by a physician as soon as it is warranted.
  
  
• Give the child plenty of liquids to prevent dehydration.
  
  
• Try to determine what triggered the attack. If possible, try to separate the child from the offending trigger.

Parents and caregivers should always err on the side of caution when trying to decide whether or not symptoms warrant the response detailed in their child’s asthma action plan. A child’s asthma symptoms may not always indicate the depth of the problem. When in doubt, assume the problem is worse than it appears, and react accordingly.

Asthma action plans should be evaluated by a child’s physician at least annually. Physicians may choose to modify the plan as a child’s symptoms and medication dosages change over time. Emergency contact information should also be checked and updated regularly. Parents must remember to provide caregivers with these newer versions so that up-to-date instructions are always on hand.

Children may spend long periods in daycare or school settings, so it is very important that adult supervisors in these environments are aware of a child’s asthma action plan. Parents should request that a child’s physician compose an asthma action plan specifically written for school or daycare officials. This should include the following information:

• A list of the child’s asthma triggers (e.g., dust, pollen, exercise).
  
  
• A list of symptoms typically experienced by the child prior to and during an asthma attack (e.g., wheezing, coughing, tightness in chest, difficulty breathing).
  
  
• A list of the child’s medications and the proper methods for taking them.
  
  
• Times medications should be used and at what doses.
  
  
• Which medications the child should take when symptoms appear.
  
  
• Which medications may be necessary before physical activities, such as gym class or recess.
  
  
• Whether or not the child is capable of self-administering medication, and if so, which medications. Some older children are able to manage their own day-to-day medications, while others are too young to handle this responsibility.
  
  
• Whether or not the child is capable of reliably reporting their asthma symptoms to a caregiver.  
  
  
• Whether or not the child is capable of alerting a caregiver when they need medication.
  
  
• Times a peak flow meter should be used.
  
  
• What to look for in peak flow meter readings.
  
  
• Parent or guardian contact information. This includes the street address and home phone number, as well as cell phone numbers and work numbers. Additional contact information of family or close friends should be included in case the parents or guardians cannot be reached.
  
  
• Emergency phone numbers. This should include the name and number of the child’s physician, as well as a name and number of someone who can be called if the physician is unavailable. After-hours numbers should be included.

A child’s asthma action plan must be straightforward and comprehensive enough that an adult can quickly understand what to do if the child is having a sudden attack. The plan should be written with the assumption that the parents and child will be unable to explain any of the details on the plan.

Any adult who will regularly be in charge of a child should have a copy of their asthma action plan. This includes:

• School principal
• Teachers
• School nurse
• Coaches
• Daycare instructors
• Babysitters
• Dorm monitors (if the child is at a boarding school or college)

At the beginning of each school year or new daycare relationship, parents should contact and possibly meet officials to explain both the child’s asthma action plan and the role officials should take when symptoms appear. All caregivers likely to have contact with the child – including teachers, coaches, nurses and others – should be included in the meeting if possible. 

Possible meeting topics include:

• Factors in a school setting that can trigger asthma symptoms, such as classroom pets, chalk dust and foods to which the child may be allergic, and steps to reduce the child’s exposure to them.
  
  
• How to use a peak flow meter and what the readings indicate.
  
  
• Plans for making up missed schoolwork in the event that asthma symptoms force a child to miss days regularly.

How the child’s medication will be stored at the school. Some schools allow children to carry their own medication, while others have rules that a teacher or other faculty member must hold on to the medication for the child.

Encourage the school staff – particularly teachers – to treat the child just like other students. It is important for children’s self-esteem that attention not be unnecessarily drawn to their asthma and medication needs. Children may feel self-conscious about taking medication at school, so it may be a good idea to work with school officials to construct a plan that allows the child to take medication discretely.

It is important to keep the lines of communication open with school officials so adjustments can be made to the asthma action plan as warranted.

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions about their child’s asthma action plan:

1. Will my child’s asthma action plan change as they get older?
   
   
2. How often should my child’s asthma action plan be updated?
   
   
3. Who should have a copy of my child’s asthma action plan?
   
   
4. Can you create a separate asthma action plan for me to give the staff at my child’s school?
   
   
5. How can I tell if my child’s asthma action plan is working?
   
   
6. Under what circumstances should I contact you in regards to my child’s asthma symptoms?
   
   
7. Under what circumstances should I seek emergency medical attention for my child’s asthma?
   
   
8. What steps should I take when my child shows signs of an impending asthma attack?
   
   
9. Under what circumstances may you make changes to my child’s asthma action plan?
   
   
10. What should I do if I can’t determine the severity of my child’s symptoms?