Everyone with asthma needs to know what to do if asthma gets worse. Date: __________________________________

Completed with your Dr. ____________________
Green light: I Feel Great.
  1. ________________________________
  2. ________________________________
  3. ________________________________
  4. ________________________________
  5. ________________________________

Peak flow above: ____________________

 Actions:
  1. ________________________________
  2. ________________________________
  3. ________________________________
  4. ________________________________
  5. ________________________________
Yellow light: I Feel Different.
  1. ________________________________
  2. ________________________________
  3. ________________________________
  4. ________________________________
  5. ________________________________

Peak flow ______________ to _______________

 Actions:
  1. ________________________________
  2. ________________________________
  3. ________________________________
  4. ________________________________
  5. ________________________________
Orange light: I Feel Bad.
  1. ________________________________
  2. ________________________________
  3. ________________________________
  4. ________________________________
  5. ________________________________

Peak flow less than: ____________________

 Actions:
  1. ________________________________
  2. ________________________________
  3. ________________________________
  4. ________________________________
  5. ________________________________
Red solid: I Feel Scared.
  1. Medication used for relief does not help.
  2. Breathing gets difficult.
  3. Having trouble walking or talking.
  4. Lips or nails turn blue.

Peak flow less than: ____________________

 Actions:

    Call 911 or _________________

    Go to the hospital immediately!

    Dr. _________________________

    Ph. # _______________________

Asthma Signals:

Use a tick to show the number of times you are:
a. Coughing or wheezing
b. Short of breath
c. Waking up in the night due to asthma
d. Having trouble playing
e. Missing school due to asthma
Peak Flow:
  • Use your peak Flow Meter to test how hard you can blew.
  • Mark on the graph the best of your three blows
  • Do this in the morning and the evening or as needed.
  • Do your peak flow before you take your medication, or as advised by your doctor.
Asthma Actions:
  • List your medicines. Include the number of puffs and how often you take them.
  • As you take them put a tick in the diary to show how often.


Notes:
  • What did you do today?
  • List things that might bother your asthma. (example: Pets, smoke, colds, running, etc.)

Sample chart on right.
| Coping with Asthma | Asthma Clinic| Respiratory Care | Rehab Medicine Misericordia |