Related to this topic: Leaflets | Support | Patient+ | Diagrams | UK Guidelines | Online Videos | News | Weblinks | Poem/Story | Equipment | Books | Your Experience | Other resources | Glossaries
Print options: Printer friendly version of this leaflet (html)     Other options:  AddThis Social Bookmark Button (what's this?)

PatientPlus articles are written for doctors and so the language can be technical. However, some people find that they add depth to the articles found in the other sections of this website which are written for non-medical people.

Asthma Action Plans

(Note, "Action plan" is used in preference to "self-management plan" as it is perceived as less daunting to patients and is felt to be more appropriate working across age groups and engaging parents and carers as well as adult patients.1)

Asthma is a chronic condition where optimal control is obtained by stepping up or down treatment in line with clinical signs and symptoms.
Ideally patients should be empowered with prior advice from health professionals to:

  • Recognise worsening asthma.
  • Be able to self-initiate therapeutic adjustments.
  • Know how and when to access the medical system.

Written personalized asthma action plans are recommended as part of patient education and self-management in current SIGN/BTS Guidelines.1 They should form standard care for all people with asthma, but should always be offered prior to discharge, following in-patient admission for asthma.

In the past, action plans have been poorly taken up and criticized for being overly complex - reflecting the need for good patient-centred communication and patient partnership to bridge the gap between evidence-based guidelines and work with individuals.

Key elements to an action plan:1,2,3

There is inevitably wide variation in education/self-management programmes and whilst there is evidence supporting the efficacy of these types of programme in general (see below), there is no individual component that has been shown to be effective in isolation. In particular, duration, intensity and format for delivery vary. Usual care can be raised to a standard that incorporates many of the key features of successful programmes.
Successful programmes include:

  • Structured education reinforced with written personal action plans.
  • Specific advice as to how to recognise loss of asthma control (although this may be assessed by monitoring symptoms and/or peak flow).
  • Specific advice as to action to take if asthma deteriorates (eg. seek emergency help, start emergency course of oral steroids, recommencing/increasing inhaled steroids) appropriate to clinical severity.
  • Specific advice as to when to seek medical review.
Evidence of efficacy1,2,3,4

Written individualized action plans, as part of self-management education, improve health outcomes in adults with asthma. Hospital admissions, ER visits or emergency visits to the doctor, days missed from work, nocturnal asthma and quality of life are all improved by self-management.5The evidence is strongest in those with the most severe disease, following management in secondary care and in those with recent exacerbations.
There is a relative lack of evidence in primary care.
A meta-analysis of self-management in children and adolescents (2-18 years) also showed improved lung function, reduced morbidity and utilization of healthcare resources.6

Practical steps to patient education and self-management in practice1,2,7
  • Ensure adequate availability of resources - PILs and proforma action plans can be downloaded or ordered. Ensure that these are high quality and ideally non-promotional. See internet and further reading.
  • Ensure all team members are on-board, convinced by the benefits of providing written action plans and will offer consistent advice.
  • Consider which patients to target - sometimes targeting those who are likely to benefit the most (i.e. those with poorly controlled, moderate or severe asthma) via diagnostic or prescription term searches is more realistic initially. Changes in control markers can be audited to review progress.
  • Discuss whether delivery of education and action plans should be part of routine care or delivered individually/in groups in dedicated clinic time etc. Extra consultation time may be required but this may be balanced against a reduction in unscheduled GP appointments in the longer term.
  • An acute consultation offers the chance to check what action a patient has already taken to manage an exacerbation - consider further reinforcement or refining of the existing action plan and the need for routine follow-up to consolidate progress. Similarly, consultations for URTI or other known trigger can be used to rehearse action plans in case of further deterioration.
  • Education and advice should be individualized. Patient ideas, concerns and expectations should be explored. Linking patient goals to brief simple education is most likely to be acceptable to patients.
  • Different approaches may be required for different patient groups eg. teenagers, pre-school children, working adults, the elderly.

Content for educational programme or discussion1

Adapt and tailor to individual's needs:

  1. Nature of disease.
  2. Nature of treatment.
  3. Patient's treatment goals.
  4. How to use treatment.
  5. Skills for self-monitoring .
  6. Negotiation of the asthma action plan with view to (3).
  7. Recognising and managing acute exacerbations.
  8. Avoiding triggers.

Templates for Action Plans

Action plan templates are available from many different sources. Some are listed below in the internet and further reading section. There is not a specific standard action plan available for children currently.

Example of an asthma action plan:

Patient name:
Date of birth:
Best Peak Flow:
Usual doctor/asthma nurse:
Contact numbers:
Asthma triggers:
When my asthma is well controlled:
  • I have no regular day-time symptoms (cough, wheeze, chest-tightness, shortness of breath)
  • I have no difficulty sleeping because of my asthma symptoms.
  • My asthma does not interfere with my usual activities (eg. work, study, housework)
  • I need to use my reliever medicine less than three times a week (not including before exercise).
  • My peak flow is above 80% personal best.
What should I do? Continue your usual treatment.
My usual treatment My preventer/reliever medications are:
When my asthma is getting worse: Moderate symptoms:
  • I have noticed the first signs of a cold (which usually triggers my asthma)
  • I have mild but recurring wheeze, cough or chest tightness during the day.
  • My sleep is disturbed by coughing, wheezing, chest tightness at least once in the week.
  • I am using my reliever puffer more than 3 times a week.
  • My peak flow is between 70-80% personal best.

Severe symptoms:
  • I need my reliever puffer every 3-4 hours or more often.
  • I am having increasing wheezing, coughing, chest tightness.
  • I am waking each night with wheezing, coughing and chest tightness.
  • I am having difficulty with normal activity.
  • My peak flow is between 50 and 70% personal best.
What should I do?
  • Acute treatment - bronchodilator (eg salbutamol 4-6 puffs) via spacer or nebuliser. Repeat every 10-20minutes if necessary.
  • Monitor response - symptoms and peak flow. If deterioating seek medical help. If improving/stable, seek medical review within 48 hours.
  • Step up usual asthma treatment - traditionally advice is to double inhaled steroids in an acute exacerbation although the efficacy of this has been questioned by some8 9.
  • Oral prednisolone 40-50mg od for at least 5 days.
  • When your symptoms have returned to being well controlled, switch back to your usual treatment after 3 days.
How to recognize emergency asthma:
  • I am having great difficulty breathing.
  • My reliever puffer is giving little or no improvement
  • It is difficult to speak or walk due to severe shortness of breath
  • Symptoms are getting worse quickly
  • I am feeling frightened.
  • My peak flow is less than (50% personal best)
What should I do?
  • Contact a doctor urgently and if one is not available call 999 for an ambulance or go straight to hospital.
  • Sit upright and stay calm.
Emergency treatment
Whilst waiting for doctor/ambulance:
  • Take up to 10-20 puffs of salbutamol via spacer inhaling after every single puff.
  • If no oral steroids available take 10-20 puffs of preventer following this.
Updating my action plan:
  • I should see my nurse/doctor for a regular asthma review at least once a year. My next one is due:
  • If your medication has been increased, see the nurse or doctor after a month to review progress.
  • If your symptoms have been very well controlled over at least 3 months, arrange a review as it may be possible to step down your treatment.



Document references
  1. British Guideline on the Management of Asthma, SIGN and British Thoracic Society (2003 - update 2007)
  2. Asthma, Clinical Knowledge Summaries (2007)
  3. No authors listed; Action plans in asthma.; Drug Ther Bull. 2005 Dec;43(12):91-4. [abstract]
  4. Clinical Evidence; Dennis RJ, Solarte I, Fitzgerald JM. Asthma. (2005); Education about acute asthma.
  5. Powell H, Gibson PG; Options for self-management education for adults with asthma.; Cochrane Database Syst Rev. 2003;(1):CD004107. [abstract]
  6. Guevara JP, Wolf FM, Grum CM, et al; Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis.; BMJ. 2003 Jun 14;326(7402):1308-9. [abstract]
  7. Prescriber: self management plans for asthma; Cleland J and Price D Implementing self management plans for asthma. 2004. Prescriber 15; 76-79
  8. FitzGerald JM, Becker A, Sears MR, et al; Doubling the dose of budesonide versus maintenance treatment in asthma exacerbations.; Thorax. 2004 Jul;59(7):550-6. [abstract]
  9. Harrison TW, Oborne J, Newton S, et al; Doubling the dose of inhaled corticosteroid to prevent asthma exacerbations: randomised controlled trial.; Lancet. 2004 Jan 24;363(9405):271-5. [abstract]

Internet and further reading Acknowledgements EMIS is grateful to Dr Chloe Borton for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 279
Document Version: 3
DocRef: bgp25189
Last Updated: 17 May 2007
Review Date: 16 May 2009






















Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.

Advertise on this site














Disclaimer: Patient UK has no control of the content of the above links. Inclusion does not imply endorsement by Patient UK.

Advertise on this site


PS - Health and Poverty

Perhaps the biggest cause of ill health in the world is poverty. Help to Make Poverty History. For example, why not lend some of your money to disadvantaged communities to enable them to trade their way out of poverty through schemes such as Shared Interest.

See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

^ Top of Page