You searched for an asthma action plan template, so we won’t spend the intro defining one. The template below is a fillable green-yellow-red zone plan that tracks your personal best peak flow, your daily controller and rescue medications, your specific yellow-zone step-up, and the danger signs that mean call 911. It is built to be filled in once with your pulmonologist or asthma nurse and then kept where you can actually find it at 2 a.m.
If you have ever been told your wheeze is “just anxiety,” or sent home from urgent care without a written plan, you are not the only one. The NHLBI’s 2020 asthma guideline update reaffirmed that every person with persistent asthma should leave their doctor’s office with a written action plan, yet roughly half of US adults with asthma report never having received one, according to CDC Asthma Control Program data. This template is the version your appointment should have ended with.
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 zone framework comes from the NHLBI Expert Panel Report and is used by the American Lung Association and the Global Initiative for Asthma (GINA). The numbers are standard. The medications, doses, and personal best peak flow are not, and that is the part you fill in with your prescriber. A blank action plan is not a plan; it has to have your name, your inhaler, and your number on it before it is useful.
This template pairs with two other posts in the asthma series: the asthma trigger tracking guide covers how to find what sends you into the yellow zone, and why your peak flow numbers tell a story your symptoms don’t explains why the L/min readings on your meter often drop before you notice the wheeze. If you also have or are being worked up for COPD, the COPD action plan template uses the same zone structure with a different medication and oxygen layer. The plan below works best when you have a baseline peak flow you actually trust.
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. The most common reason someone slides into the yellow zone is not a new trigger; it is two or three skipped controller doses across a busy week. If your controller has become hard to remember, that is a conversation for your next appointment, not a reason to drop it.
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 every reading, every rescue puff, and the time you took it. Three or more rescue uses in 24 hours, or rescue use that wears off in under four hours, is itself a yellow-to-red signal, not a reason to keep waiting it out. The Clarity Asthma app timestamps each entry so you have the actual interval between puffs, not a guess.
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
A printed action plan on the fridge is a good start. A printed action plan plus a daily log of peak flow, symptoms, and rescue inhaler use is what actually catches a yellow-zone slide before it becomes a 3 a.m. ER trip. Download the Clarity Asthma app, set your personal best as the reference, and log each morning reading. After two weeks you will see whether you are spending most days near 100% of personal best or hovering at 75% and one cold away from a flare.
This template is a starting structure, not a finished plan. The personal best peak flow, the medication names, the doses, and the yellow-zone step-up have to be set by the clinician who knows your history. Bring this to your next appointment, fill it in together, and keep the signed copy somewhere your household can find it without asking you.
Medical disclaimer: This post is for informational purposes only and does not constitute medical advice. The content here is not a substitute for professional medical care, diagnosis, or treatment. Always consult a qualified healthcare provider with questions about your health or a medical condition. If you are experiencing a medical emergency, call 911 or contact your local emergency services immediately.