Asthma Action Plan

h-inhalerGreen Zone

Patient is stable and asymptomatic. Normal breathing pattern. No cough, no wheeze and no retractions. Eating, sleeping and playing without difficulty. No need for reliever medication. Continue daily medications as prescribed.

Yellow Zone

These symptoms are an indication that the patient is having an asthma flare-up or exacerbation. Additional therapy should be instituted to resolve symptoms and reduce the risk for progression to red zone/potentially life threatening symptoms.


Mild to moderate cough, which may be frequent. Usually worse during the night. Watch for dry, hacky, or croupy (barky) cough which changes or has associated with it a wet, raspy, junky cough. May or may not wheeze. No retractions or shallow, rapid breathing.


  1. May begin reliever medications (bronchodilators) at 4-6 hour intervals as needed. If the patient can take and hold a deep breath for five or more seconds, a metered dose inhaler (Xopenex, Proventil, ProAir, Albuterol, Ventolin, or Combivent) or breath activated inhaler (Maxair) is appropriate. If unable to hold their breath for at least five seconds, a patient should take a nebulizer treatment (Xopenex, Albuterol, or AccuNeb) as prescribed.
    • If the patient is coughing more after a bronchodilator treatment then can do another treatment right away. If after two treatments back to back the patient is still coughing more and can’t wait four hours for another treatment, then go to your nearest emergency department for evaluation/treatment.

  2. Begin using an oscillatory device if you already have one (which helps break up pulmonary secretions) such as the Quake or Acapella at least four times per day and perform at least 10 breaths each time (inhaling then exhaling makes one breath).

  3. Begin using some type of Robitussin or Mucinex for the cough.

  4. Step up any daily inhaled preventative medications (Advair, Pulmicort, Symbicort, Asmanex).
    1. If currently not on any daily inhaled preventative medications, but has some available from prior use, begin to use at dose of two puffs a day.
    2. If on preventative medications once a day, should max out at two puffs twice a day or start on oral steroids at 1-2 mg/kg per day for children, or 50 mg to 60 mg per day for adults.

  5. Singulair is an optional medication in the yellow zone.
    1. If already on Singulair, continue.
    2. If not, may call the office and have Singulair prescribed by phone once a day for 5-7 days.

  6. May use Pulmicort Respules via the nebulizer in addition to any current used daily inhaled to reliever nebulizers (bronchodilators) twice a day. Xopenex or AccuNeb or Albuterol (reliever medications) plus Pulmicort equals twice a day. May continue reliever medications at four to six hour intervals in between the twice a day combination nebulizer treatments (example: Xopenex plus Pulmicort in the morning and at night then Xopenex alone every four hours in between.)


Should follow up with a physician 48-72 hours after starting oral steroid or sooner if any warning signs appear:

  • Persistent junky cough unresponsive to yellow zone relief measures
  • Fever of 101° F or higher
  • Purulent green or yellow discharge from nose or sputum (cough)
  • Patient appears to gag with cough
  • Coughing episode followed by emesis (vomiting) with thick mucus

Red Zone

Red zone symptoms can quickly become life threatening if not promptly treated and resolution of red zone symptoms is observed.


  • Abnormal respiratory rate (an inspiration and expiration count as one breath)
    • Infant = 40 breaths per minute
    • Preschool = 30 breaths per minute
    • Adolescent/Adult = 20 breaths per minute
  • Rapid, shallow breaths
  • Working to breath
    • Retractions – use of extrathoracic muscles to breathe
      • Diaphragm – will see stomach area come in and out rapidly
      • Intercostals – will see muscles in between ribs contract rapidly
    • Nasal flaring


  1. Immediate nebulization with Xopenex or AccuNeb or Albuterol as prescribed – if no nebulizer is available then use the bronchodilator inhaler (Proventil, Maxair, Ventolin, Albuterol). May add Pulmicort and Atrovent to the nebulizer treatment if you have some available.
    If there is little or no response to initial nebulizer treatment (or inhaler dose), may give second nebulization with Xopenex or AccuNeb or Albuterol (or inhaler if no nebulizer available) immediately after the first.
  2. If have Orapred, Prelone, Pediapred, or Prednisone available then may give first does.


  • If any red zone symptoms persist despite treatment, please seek the nearest Emergency Room.
  • If red zone symptoms respond and resolve with treatment, but reoccur, repeat treatment then seek the nearest Emergency Room.
  • If red zone symptoms appear but resolve with treatment without reoccurrence, the patient should still seek prompt physician evaluation.

Is your asthma stable?

Yes, if:

  • You use less than two beta agonist canisters/year (Proventil, Maxair, Albuterol, Ventolin)
  • You use less than two doses of beta agonist/week [excluding exercise]
  • You wake up less than twice a month with asthma symptoms
  • You have less than two unscheduled doctor visits/year for asthma
  • You needed less than two oral steroid bursts (Prednisone, Orapred, Prelone, Pediapred)/year

If any of the above is occurring, you should seek a prompt physician evaluation.

Asthma Websites

American Academy of Asthma, Allergy & Immunology
American College of Asthma, Allergy & Immunology
Allergy & Asthma Network Mothers of Asthmatics
Starbright Foundation, which empowers ill children to combat their challenges. This group gives away a great asthma teaching CD-ROM video game.

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