Asthma Action Profile

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Your Respiratory System

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Warning Signs

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Common Triggers

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Resources and More

Your Asthma Record

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NAME BIRTH DATE AGE

ADDRESS

CITY STATE ZIP COUNTY

PARENT/GUARDIAN/SIGNIFICANT OTHER

HOME PHONE WORK PHONE CELL PHONE

EMERGENCY CONTACT RELATIONSHIP PHONE

PRIMARY DOCTOR PHONE DATE OF LAST VISIT

ASTHMA DOCTOR PHONE DATE OF LAST VISIT

PHARMACY PHONE DATE OF LAST VISIT

ASTHMA SEVERITYAsthma is: (See back cover for definitions)2 Intermittent 2 Mild Persistent 2 Moderate Persistent 2 Severe Persistent

PAST YEAR ASTHMA HISTORYPlease check all asthma-related answers to show what happened in the past year.Work______ School______ days missed: 2 None 2 1-5 2 more than 5Emergency Room visits: 2 None 2 1-3 2 more than 3Hospital admissions: 2 None 2 1-3 2 more than 3Uses Peak Flow meter: 2 Yes 2 No 2 Doesn’t have onePersonal Best reading: __________________________________________________________ 2 Doesn’t have oneUses an Inhaler: 2 Yes 2 No 2 Doesn’t have oneUses a Spacer: 2 Yes 2 No

TRIGGERSWhat starts your asthma attack? (check all that apply)2 Colds 2 Animals 2 Food 2 Smoke 2 Exercise 2 Dust 2 Weather 2 Other___________________________________________________________________________________________________________________________________________

EARLY WARNING SIGNSHow do you look, sound, act before an asthma attack? (check all that apply)2 Wheezing 2 Coughing 2 Chest tightness 2 Pain in chest 2 Pain in back 2 Shortness of breath 2 Difficulty breathing 2 Little energy for play 2 Other___________________________________________________________________________________________________________________________________________

MEDICATIONS (questions about medications should be discussed with your asthma doctor) List yours below: Medicine R-Rescue C-Controller How Much Time Taken Side Effects

BEFORE EXERCISE, I USE THIS MEDICINE

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also known as Air Sacs (enlarged view)

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EARLY WARNING SIGNS of an Asthma Attack

Knowing your early warning signs helps you

prepare to take control of your asthma. Early

warning signs can include some or all of the

things listed at right, which describe how you

look, sound, and/or act before an asthma attack.

Circle all the signs in the following list that apply to you and your asthma.

1. Dry cough and/or wheeze

2. Stuffy nose, watery eyes, sneezing, itchy

throat

3. Feeling tired, no energy, moody

4. Stomachache, headache, ear pain

5. Shortness of breath or fast breathing

6. Fast heartbeat

7. Tight chest

WHEN YOU HAVE an Asthma Attack, your lungs change on the inside.Look at the pictures below and note the differences.

1. ______________________________________________________________________________________________________________

2. _____________________________________________________________________________________________________________

3. ______________________________________________________________________________________________________________

There’s more mucus.The walls inside swell.The muscles tighten.

Asthmaticbronchi

Normalbronchi

1. 3.

2.

Understanding your Respiratory System

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THE PRIMARY PARTS: Match the words below to the correct body part and fill in the missing letters.DIAPHRAGM BRONCHIOLE NOSE ALVEOLI MOUTH TRACHEA BRONCHI

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There are two types of medication used to help manage asthma. They are:

• BRONCHODILATORS are sometimes referred to as rescue medications and can provide quick relief.

• ANTI-INFLAMMATORIES are controller medications used to reduce swelling and mucus. They can provide long-acting relief.

Understanding your Asthma Medications

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For additional information on asthma medications, visit

breathepa.org.

An inhaler is a spray device used to deliver asthma medicine to your lungs.

A spacer/chamber is added to an inhaler to help more of the medicine get into

your lungs. Using an inhaler properly will help to better control your asthma.

Follow these easy steps:

1. Remove the cap and hold inhaler upright.

2. Shake the inhaler.

3. Insert the inhaler into the spacer/chamber.

4. Tilt head back slightly and breathe out slowly.

5. Close mouth tightly around mouthpiece of spacer/chamber.

6. Press down on the inhaler to release medicine as you start to breathe in

slowly. Note: Some spacers will whistle if you inhale too fast.

7. Continue to breathe in slowly. Do your best to hold your breath to the count

of 10. Remove chamber/spacer and exhale. This allows the medicine to

reach deeply into your lungs.

8. If your doctor has prescribed two puffs, wait one minute before repeating

steps 2 through 7 for the second puff.

How to Use a Metered Dose Inhaler (MDI) with a Spacer/Chamber

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Understanding your Peak Flow Meter (PFM)

How to Use a Peak Flow MeterA peak flow meter (PFM) is a device that measures how well air

moves out of the lungs. During an asthma episode, the airways of

the lungs begin to narrow. The peak flow meter may tell you if

there is a narrowing in the airways hours or even days before you

have any asthma symptoms. A peak flow meter can also help

determine triggers and the best times to administer medications.

It provides an opportunity to improve self-management.

Follow these easy steps:

1. Reset the indicator to zero.

2. Stand up.

3. Take a deep breath, filling your lungs completely.

4. Place the mouthpiece in your mouth and close your lips

around it. Do not put your tongue inside the mouthpiece.

5. Blow out the air in your lungs as hard and as fast as you can

in a single blow.

• Write down the number that you get.

Note: If you cough or make a mistake, don’t write down the

number. Do it over again.

• Repeat steps 1 through 5 two more times.

Note: In order to determine your Personal Best Number (PBN),

it is recommended that your PFM readings be taken for two

weeks – two times a day, every day, first thing in the morning

and late afternoon when your asthma is under control.

* Record the best of three readings each time. At the end of the

two weeks, you’ll be able to determine your PBN.

* Do readings at approximately same time of day.

How To Clean Chambers/Spacers and Peak Flow Meters

1. Clean weekly and as needed.

2. Disassemble (if possible)—with chambers

DO NOT disassemble the valve.

3. Soak in warm, soapy water for 10 minutes

4. Agitate (shake around) parts in soapy water.

5. Rinse WELL with warm water.

6. Air dry in vertical position overnight.

(Do not towel dry!)

7. Reassemble

8. Can be stored in a resealable plastic bag.

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Let’s Practice: Reading #1_____________________________ Reading #2_____________________________ Reading #3_____________________________ Best of 3 readings_____________________________

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GREEN ZONE = Good to Go

No symptoms of asthma / Able to do usual activities

WHAT’S YOUR GREEN ZONE?

Your PBN ______ x .8 = ______. This is the starting point for

your green zone. If you get PFNs at this point or above, you are in

your green zone – have fun!

YELLOW ZONE = Caution

Experiencing mild asthma symptoms / Less able to

do usual activities

WHAT’S YOUR YELLOW ZONE?

Your yellow zone consists of all the numbers between the starting point

for your green zone ______ and thestarting point for your red zone______.

If you get PFNs between these two points, you are in your yellow zone –

be careful, and take action to get your asthma under control.

First, establish what your Personal Best Number (PBN) is. This is the highest Peak Flow Number (PFN) achieved over a two-week period when your asthma was under good control.

Your Personal Best Number (PBN) is _________.

Next, plug your PBN into the equations below to determine your peak flow meter zones. Note: It is important to discuss this information with your doctor.

How to Determine Your Peak Flow Meter Zones

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RED ZONE = Medical Alert

Experiencing extreme asthma symptoms / Unable to do simple

tasks with ease

WHAT’S YOUR RED ZONE?

Your PBN ______ x .5 = ______. This is the starting point for

your red zone. If you get PFNs at this point or below, you are in your red zone – this is a medical

emergency, take action immediately!

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Knowing your Asthma Triggers

POLLUTANTS

Auto Exhaust

Cigarette Smoke

Dust

Fumes and Vapors

Ozone

Sulfur Dioxide

ALLERGIES

Animals

Feathers

Pollens

Dust Mites

Molds

Mildew

Certain Foods

INFECTIONS

Influenza

Common Cold

EXERCISE

HOUSEHOLD PRODUCTS

Sprays

Aerosols

Cleaners

Paints

SLEEP

( Nocturnal Asthma)

EMOTIONS

Stress

Excitement

Laughing

Crying

MEDICATIONS

Aspirin

Ibuprofen

Preservatives

Certain Heart Medicines

COLD AIR

Triggers: Below is a list of the most common things, considered triggers, that can start an asthma attack. Circle your triggers.

1. Take your short-acting inhaled beta-agonists before you exercise. These are called quick-relief or rescue medications.

• Take them 10 to 15 minutes before exercise.

• They can help up to 4 hours.

2. Long-acting inhaled beta-agonists may also help.

• Use them at least 30 minutes before exercise.

• They can help up to 12 hours.

ALLERGIES are things that, when you come in contact with them, cause your body to have a reaction. Circle yours below.

1. Animals 2. Feathers 3. Pollen 4. Dust 5. Mold 6. Mildew 7. Certain foods

IRRITANTS are things that irritate your lungs. Some examples of the things that irritate your lungs are listed below:

1. Cold air 2. Strong odors 3. Weather changes 4. Cigarette smoke

COLDS and FLU can make your asthma worse. True False Ask your doctor about your flu shot.

Exercise can trigger asthma. This is known as EXERCISE-INDUCED ASTHMA (EIA). Talk to your doctor about these recommendations.

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This is an educational booklet where you can record your asthma information. It is not a treatment plan and should not be used in place of a doctor’s care.

SYMPTOMS CLASSIFICATION

Do you have: • A cough, wheeze, or shortness of breath two days a week or less• Nighttime asthma symptoms no more than two times per month• No symptoms between episodes• No limitation with normal activity • Peak Flow GREATER THAN 80% of personal best (green zone)

OR

• Symptoms MORE THAN two days per week but not daily • Nighttime asthma symptoms three to four times per month• Minor limitation with normal activity• Peak Flow GREATER THAN 80% of personal best (green zone)

OR

• Daily symptoms• Symptoms affecting activity and sleep• Nighttime asthma symptoms MORE THAN one time per week, but not nightly• Some limitation with normal activity• Peak Flow BETWEEN 50% and 80% of personal best (yellow zone)

OR

• Symptoms throughout the day• Nighttime asthma symptoms often (seven or more times per week)• Extreme limitation with normal activity• Severe episodes in spite of medication• Peak Flow LESS THAN 50% of personal best (red zone)

The information presented here is to help understand how asthma severity classifications are defined.

EVERYONE DOES NOT FIT PRECISELY INTO THESE CLASSIFICATIONS. This information is provided to

assist in working with your Asthma Doctor in the development of an Asthma Action Profile. Before

treatment is started, asthma severity is determined according to various criteria. These criteria often

overlap. The most severe step in which any criteria occur is used to classify the asthma. Your Doctor may

assign a severity classification while you are taking medication but still haven’t achieved best control.

After your asthma is under control, your Doctor may classify your asthma according to the treatment needed to maintain control. For example:

INTERMITTENT

rescue medication taken as-needed for symptoms. If you are using rescue medication more than 2 times per

week for symptoms, your Doctor may suggest the need to start long-term control medication.

MILD PERSISTENT one daily long-term control medication is necessary.

MODERATE PERSISTENT inhaled corticosteroids with or without additional long-term control medications as indicated.

SEVERE PERSISTENT

multiple long-term control medications are required, including high-dose inhaled corticosteroids and, if

needed, oral corticosteroids.

INTERMITTENT

MILDPERSISTENT

MODERATEPERSISTENT

SEVEREPERSISTENT

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