An asthma action plan is one of the most important documents you can have as someone living with asthma. It takes the guesswork out of what to do when your symptoms change, so you’re not trying to make decisions under pressure when you’re already struggling to breathe.
Key Takeaways
- An asthma action plan divides your management into green, yellow, and red zones based on symptoms and peak flow readings.
- Tracking daily symptoms and peak flow against your action plan zones helps you respond appropriately to worsening asthma.
- Recording rescue inhaler use frequency is a key indicator of whether your controller medication is adequate.
- A completed action plan with personal best peak flow values gives emergency responders critical information during severe attacks.
The template below is based on the green-yellow-red zone framework recommended by most respiratory health organizations. Use it as a starting point, then work through it with your pulmonologist or asthma nurse to customize it with your personal best peak flow reading, your specific medications, and your doctor’s contact information.
If you haven’t read our guides on tracking your asthma triggers and understanding your peak flow numbers, those are worth reading alongside this template. The action plan is most powerful when you’re tracking your numbers daily and know what your baseline looks like.
Asthma Action Plan Template
My Information
Name: ___________________________________
Date created / last updated: _______________
Doctor name: ________________________________
Doctor phone: ________________________________
Emergency contact: __________________________
Emergency contact phone: ____________________
My personal best peak flow: _______________ L/min
GREEN ZONE: Doing Well
You’re in the green zone when all of the following are true:
[ ] No shortness of breath, wheeze, or chest tightness
[ ] No nighttime or early morning symptoms
[ ] Able to do usual activities without restriction
[ ] Peak flow is 80% to 100% of personal best (above ___ L/min)
Green Zone Daily Medications
| Medication | How much | When |
|---|---|---|
| ____________________________________ | __________ | __________ |
| ____________________________________ | __________ | __________ |
| ____________________________________ | __________ | __________ |
Green Zone: Before Exercise
[ ] Take: __________________________ ___ puffs ___ minutes before activity
[ ] No pre-exercise medication needed (circle with doctor)
Note: Even in the green zone, take your controller medications as prescribed every day. Skipping controller medication is a common cause of moving into the yellow zone.
YELLOW ZONE: Caution
You’re in the yellow zone when any of the following are true:
[ ] Cough, wheeze, shortness of breath, or chest tightness present
[ ] Symptoms wake you at night or first thing in the morning
[ ] Symptoms are interfering with usual activity
[ ] Peak flow is 50% to 79% of personal best (between ___ and ___ L/min)
[ ] You have been sick with a respiratory infection
Yellow Zone: What to Do First
Take your quick-relief medication:
Medication: ________________________________
How much: ___ puffs
Repeat every: ___ hours as needed
Wait 20 minutes and reassess. If peak flow returns to the green zone and symptoms improve, you may stay in yellow zone monitoring. If you do not improve or you return to yellow zone within a few hours, take the steps below.
Yellow Zone: Additional Steps
[ ] Add: ___________________________ ___ puffs ___ times per day
[ ] Call my doctor if I am still in the yellow zone after ___ hours
[ ] Call my doctor: _______________________
[ ] Start oral corticosteroids (only if prescribed for this): _________________________ ___ mg for ___ days
Trigger avoidance reminder: While in the yellow zone, avoid known triggers: ______________________________________________
Continue monitoring: Check peak flow every ___ hours and log readings and symptoms in the Clarity Asthma app.
RED ZONE: Medical Alert
You’re in the red zone when any of the following are true:
[ ] Very short of breath, even at rest
[ ] Quick-relief medication not helping or lasting less than ___ hours
[ ] Cannot do usual activities
[ ] Peak flow below 50% of personal best (below ___ L/min)
Red Zone: Do This Immediately
Step 1: Take ___ puffs of ___________________________ (quick-relief inhaler) NOW.
Step 2: Call my doctor immediately: _______________________ OR go to the emergency room.
Step 3: If directed by doctor, take ___________________________ ___ mg oral steroids.
Step 4: If symptoms are severe and worsening rapidly, call 911 immediately. Do not drive yourself.
DANGER SIGNS: Call 911 immediately if:
[ ] Lips or fingernails are turning blue or gray
[ ] Nostrils are flaring with each breath
[ ] Neck muscles are visibly working with each breath
[ ] Difficulty walking or speaking due to breathlessness
[ ] Quick-relief medication has no effect
My Known Triggers to Avoid
List the triggers you have identified through your peak flow tracking and symptom log:
1. ___________________________________
2. ___________________________________
3. ___________________________________
4. ___________________________________
5. ___________________________________
Plan Review
Next review with my doctor: ____________________
Review triggers after: any new flare, change in medication, or every 3 to 6 months
Using This Plan with Daily Tracking
An action plan is most effective when paired with consistent daily logging. Download the Clarity Asthma app and log your peak flow, symptoms, and medication use each day. You’ll spot yellow zone trends before they reach red, and you’ll have a complete record to share with your doctor at every appointment.
This template is for informational purposes only and is not a substitute for an asthma action plan developed with your doctor. Do not use this as your sole guide to managing asthma without review and customization by a qualified healthcare provider. In any life-threatening emergency, call 911 immediately.