When a child with asthma starts coughing at 2 a.m., it is hard to think clearly. An asthma action plan is a written page from your pediatrician that does the thinking ahead of time. It tells you which medicine to use every day, what to do when symptoms start, and when it is an emergency. Every child with asthma should have one, and everyone who cares for your child should know where it is.
What an action plan includes
Most plans look like a traffic light, with green, yellow and red zones. Your child's plan will list:
- The names of your child's medicines and when to use each one
- The amount to give, written by your pediatrician for your child (do not guess or borrow someone else's)
- Your child's known triggers
- For some older children, a "personal best" peak flow number
- Phone numbers for your doctor and emergency instructions
The National Heart, Lung, and Blood Institute offers a sample asthma action plan that shows how the zones are laid out. Your pediatrician fills in the details for your child.
The three zones
Green: doing well
Your child is breathing easily, is not coughing or wheezing, sleeps through the night, and can play and run normally. In the green zone, your child takes any daily controller medicine exactly as prescribed, even though they feel fine. Some plans also say to use quick-relief medicine before exercise.
Yellow: caution
Your child has some symptoms: coughing, wheezing, a tight chest, mild shortness of breath, waking at night from coughing, or slowing down during play. This often happens with a cold, a change in weather, or allergy season. The plan tells you which quick-relief medicine to give and how often, and what to watch for next. If your child is not back in the green zone within the time your plan lists, or you are using quick-relief medicine more than the plan allows, call your pediatrician.
Red: medical alert
Your child is very short of breath, is struggling to talk or walk, has skin pulling in between the ribs or at the neck with each breath, or the quick-relief medicine is not helping or does not last. Lips or fingernails that look blue or gray are a sign of serious trouble. Give the quick-relief medicine as your plan directs and call 911. Do not wait to see if it passes.
If your child uses a peak flow meter, the plan may also give a number range for each zone based on their personal best.
Controller vs. quick-relief medicine
Asthma medicines do two different jobs, and mixing them up is one of the most common problems.
- Controller medicine calms the swelling inside the airways over time. It is often an inhaled steroid and is usually taken every day, even when your child feels well. It does not stop an attack that is already happening. Rinsing the mouth after an inhaled steroid helps prevent thrush.
- Quick-relief (rescue) medicine, such as albuterol, relaxes the muscles around the airways within minutes. It treats symptoms but does not prevent the next flare.
Some children use a single inhaler that does both jobs. If that is your child's plan, follow it as written. If your child needs rescue medicine often, that is a sign the asthma is not well controlled, and the plan may need to change. MedlinePlus explains quick-relief medicines in more detail.
Spacers make inhalers work better
A spacer (also called a holding chamber) is a tube that attaches to a metered-dose inhaler. It holds the medicine so your child can breathe it in slowly instead of trying to time a quick puff. More medicine reaches the lungs and less ends up in the mouth and throat. Babies and toddlers use a spacer with a face mask. Older children use one with a mouthpiece.
Bring your child's inhaler and spacer to visits so the pediatrician or nurse can watch your child use it. Small changes in technique can make a big difference. Also check expiration dates and how many doses are left, since an inhaler can feel like it is working after it is empty.
Share the plan
An action plan only helps if the right people have it. Give a copy to:
- The school nurse, along with any forms the school needs to give medicine or let your child carry an inhaler
- Teachers and coaches, especially for PE and outdoor sports in the Texas heat
- Daycare, babysitters, grandparents and the other parent's household
- Camps and sleepover hosts
Keep a photo of the plan on your phone, and for older kids, on theirs. Make sure a quick-relief inhaler and spacer go wherever your child goes. Teach your child, in age-appropriate words, how to tell an adult that breathing feels hard.
Keep it current
Review the plan with your pediatrician at least once a year and after any ER visit, hospital stay or course of oral steroids. Children grow, medicines change, and triggers shift over time. A start-of-school-year check is a good habit. For more background, see asthma in children on MedlinePlus.
When to call us
Call your A thru Z Pediatrics office if your child is in the yellow zone and not improving as the plan says, needs quick-relief medicine more often than usual, wakes at night with asthma symptoms, misses school or activities because of asthma, or does not have a written action plan yet.
Call 911 or go to the ER for any red zone sign: severe trouble breathing, struggling to speak, skin pulling in at the ribs or neck, blue or gray lips or nails, or quick-relief medicine that is not working.
If it is time to set up or update a plan, request a visit.
This article is general information, not medical advice. If you have concerns about your child's health, call your A thru Z Pediatrics office.