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Asthma Action Plan
Name ........................................ Personal best peak flow reading is ..........
Doctor / nurse who filled in this form ........................................ Date ..............
| If your asthma symptoms are well controlled |
| If the following describes you... | Your action is |
|
Continue with your usual treatment which is: Preventer: Reliever: Other: See a doctor or nurse at your next routine appointment - which is on .......................................... |
| If your asthma symptoms are troublesome, or may get worse |
| If any of the following occur... | Your action is |
|
Increase your treatment to: Go back to your usual treatment when your asthma symptoms have returned to being well controlled (see section above) for ....... days. See your doctor or nurse within the next week or so if you have had to increase from your usual medication for a while on two or more occasions since your last routine appointment. |
| If your asthma symptoms are getting more severe |
| If any of the following occur... | Your action is |
|
Start taking prednisolone (steroid tablets) at a dose ...... Also, increase your usual treatment to: See your doctor or nurse within the next 24 hours, or immediately if you get worse. |
| If your asthma symptoms are very severe |
| If any of the following occur... | Your action is |
|
This is an emergency. Contact a doctor urgently. If a doctor is not available go straight to hospital accident and emergency. (Call an ambulance if necessary.) Whilst waiting for help:
|
| Note: peak flow readings may not be a good guide of severity for children 12 and under. |
| Useful phone number 1: Useful phone number 2: |
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