A personalised asthma action

A personalised asthma action plan (also known as a treatment plan) is a written plan designed by you and your healthcare professional that provides instructions on how to control you or your child’s asthma.¹

Because everyone’s asthma symptoms and triggers maybe different, the action plan should be personalised or customised to the individual’s asthma. Contact your healthcare professional and set up an appointment to develop an asthma action plan for yourself or your child.

Before you start managing asthma, it is important to understand a little more about you or your child’s asthma. What are your early warning signs, symptoms, and triggers? This information should be recorded in a diary or an asthma app. Keep a diary either on paper or electronically to record the following:

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Common asthma triggers

Triggers may be unique to each individual who has asthma.² Common triggers include:

Viruses such as a cold or flu
Allergens such as pollen, dust mites, mold spores, pet dander
Physical activity (exercise-induced asthma)
Cold air
Air pollutants and irritants, such as smoke
Certain medications, including beta blockers, aspirin, ibuprofen (Advil, Motrin IB, others) and naproxen (Aleve)
Strong emotions and stress
Sulfites and preservatives added to some types of foods and beverages, including shrimp, dried fruit, processed potatoes, beer and wine
Gastroesophageal reflux disease (GERD), a condition in which stomach acids back up into your throat

It is important to track not only trigger exposure, but also if symptoms occur¹ so that you and your healthcare professional can develop a trigger control plan. This would be useful information to help you and your healthcare professional to not only identify asthma triggers but the information may be used to develop a trigger control plan. These personal triggers and control plan for management of triggers should be listed on the asthma action plan. Managing your indoor air quality may help in managing allergens and triggers.

Symptoms and early warning signs

It will also be helpful to identify symptoms and early warning signs. Examples of symptoms are waking at night, coughing, wheezing, chest tightness, or shortness of breath during exercise. Symptoms are also unique to each person. Not all individuals who have asthma wheeze. In some cases, the only symptom may be a cough³. The asthma action plan should have a place to list personal symptoms and step-by-step instructions regarding how to manage symptoms.

Peak flow readings

The peak flow reading is a measure of how fast you can blow out the air in your lungs using a peak flow meter. Just like triggers and symptoms, a peak flow reading may be unique to anyone who has asthma. Therefore, when using a peak flow meter it is important to determine you or your child’s personal best peak flow reading. A personal best peak flow reading is the highest reading that can be achieved when asthma is controlled. To determine personal best, measure peak flow readings for two weeks twice a day, write these down in a peak flow chart and share these readings with your healthcare professional. Because different peak flow meters may provide slightly different readings, it is important you use the same peak flow meter. Your healthcare professional can use these readings to determine you or your child’s personal best peak flow reading. They can then create a personalised asthma action plan for you. This reading will be used by your healthcare professional to help develop a personalized written asthma action plan.

Understanding the zones in an asthma action plan

The three zones of asthma management are part of an asthma action plan. The zones are a simple colour-coded system to help patients and parents of children with asthma to recognise the severity of asthma symptoms and changes in peak flows, so that they can use their asthma medications at the right time and deliver the correct amount of medication. The instructions in the zone system are set up like a traffic light which makes it simple to understand.

Your healthcare professional may use the information you recorded in your diary regarding asthma triggers, peak flow readings, symptoms and early warning signs to develop a personalised written asthma action plan using the zone system. He or she will teach you to use the zone system to assess the severity and frequency of asthma symptoms, changes in peak flow readings and how to follow their instructions for use of asthma medications.

The zones and written instructions from your healthcare professional will be laid out in the asthma action plan like a traffic light:

Green means that asthma is in good control. You or your child are symptom-free and peak flow readings are 80-100% of the personal best reading. You can GO ahead with regular activities. In the green zone, the medication instructions provide details how to take daily controller medications.

Yellow means symptoms are present, peak flow readings are 50-80% of personal best reading. You should proceed with CAUTION. The yellow zone, contains instructions regarding how often to use the reliever medications and when to call your healthcare professional.

Red means that you or your child are having severe symptoms and peak flow readings are less than 50% of personal best reading. You should STOP and get medical attention. The red zone contains instructions regarding the immediate use of reliever medications and instructions to call the healthcare professional immediately or alternatively to call 999.

PersonalBest peak flow meter zones

Many peak flow meters have zone indicators that can be set by the healthcare professional on the peak flow meter. Once these are set, the indicator will point to the green, yellow or red zone which will allow you to quickly evaluate where your or your child’s peak flow reading fall within the zones. You can then refer to the written personalised asthma action plan and follow the instructions provided by your healthcare professional for how to take asthma medications.

Green zone

Yellow zone

Red zone

Why is an asthma action plan so helpful

Still not sure exactly how an action plan makes such a difference. You can use it to:

pinpoint the signs that show your asthma’s getting worse, so you can get help quickly and cut your risk of having an asthma attack²
understand when and how to take your medicine to keep your asthma well managed
get on top of your asthma again if you haven’t been using your controller inhaler as prescribed
be sure what to do if you have an asthma attack²
monitor your asthma day to day²
let your friends and family know what to do in an emergency – show your action plan to those closest to you²
check when your next review is due²
keep a note of your healthcare professional's contact number.²

What if my asthma changes - won't the plan go out of date?

Your asthma action plan should be reviewed and updated at least once a year at your asthma review with your doctor.¹ You need to remember to take it with you to every asthma appointment - including any emergency or consultant visits - so that if there are any changes to the way you need to look after your asthma, your plan can be updated. It is also useful for hospital staff to be able to glance at the information in your action plan, especially if you are finding it difficult to talk due to your symptoms.²

Be prepared

Keep a list of emergency contact numbers. It is important to list the healthcare professional's phone number and emergency phone numbers on the action plan. If the action plan is for your child, make sure you list your mobile phone number.

Preparation is the key to success. Once you have a personalised asthma action plan, put a plan in place for using it.

Keep the action plan in a handy place so you can act quickly. Keep a copy in a readily available place in your home – such as posted on your refrigerator. Just like the reliever medication make sure you have a copy with you when you travel away from home. Keep a copy in your purse, backpack or wallet so you can have immediate access to it.

Review it with all that are involved in care. This includes your entire family members so they know what to do in case of an emergency. If the action plan belongs to your child, provide a copy to the schools and review it with your child’s teachers and coach.

Keep the action plan up-to-date.

Asthma symptoms, triggers and medications may all change over time. Keep regular check-ups with the healthcare professional and adjust the action plan as needed.

Frequently asked questions

What are the asthma controller (preventer) medications and how do they work?
What are the asthma controller (preventer) medications and how do they work?

Controller medications may also be called preventers. These are medications that are prescribed by your healthcare professional to take daily to control the inflammation (swelling) in your lungs and to prevent asthma attacks. There are several different types of controller medications but the most common are inhaled corticosteroids (steroids) or combination inhaled steroid and long-acting bronchodilators. Long-acting bronchodilators are not prescribed alone for asthma but may be prescribed with an inhaled steroid. This is a medication to keep airways open over a long period of time. Controller medications and combination controller medications should not be used to relieve symptoms during an asthma attack.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017
What are the asthma reliever (rescue) medications and how do they work?
What are the asthma reliever (rescue) medications and how do they work?

Reliever medications are short-acting bronchodilators. They may also be called rescue medications. These are medications that act very quickly to relax the muscles surrounding tightened airways and relieve asthma symptoms.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017
Are you worried that your child's controller medication is not helping?
Are you worried that your child's controller medication is not helping?

Controller medications work differently than reliever medications and must be taken even when symptoms may not be present. The controller medications reduce inflammation but they take time to start working. Your child may need to take them for several days or weeks before you and your child notice an improvement. Your child will not feel that immediate relief that they may feel after taking a reliever medication. Instead they will know that they are working because over time, they will have fewer symptoms and they will need to use their reliever medication less.

References:

asthma.org.uk Advice/inhalers-medicines-treatments/inhalers-and-spacers/preventer. Accessed October 2017.
What will happen if my child doesn't take their controller medication?
What will happen if my child doesn't take their controller medication?

If the inflammation in asthma is not controlled, it will be difficult to manage your child's asthma symptoms. Also over time the inflammation may permanently damage your child's airways.

References:

webmd.com Asthma/features/preventing-permanent-damage#1. Accessed October 2017
What are the possible side effects of inhaled steroids?
What are the possible side effects of inhaled steroids?
If your child uses their inhaler correctly, they are less likely to have side effects. This is because more of the inhaled medicine goes down to the lung where it’s needed. If your child uses inhaled steroids, which is a type of contoller medication, some of the side effects that may occur due to poor inhaler technique include:

a sore tongue

a sore throat

a mouth infection called thrush

These side effects could easily be prevented by rinsing their mouth after inhaling the medication and using a spacer or valved holding chamber when using a metered dose inhaler (MDI).

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017.
Can I stop giving my child controller medication if she/he shows no asthma symptoms for some time?
Can I stop giving my child controller medication if she/he shows no asthma symptoms for some time?

Remember that your child’s asthma changes over time, and some degree of inflammation or swelling is usually present, even when they are not having any symptoms. Generally, the benefit of the treatment is much greater than any risk associated with taking the medication, even in periods where your child seems to be ok. You should not stop your child's inhaled steroid (controller medication) unless you have discussed this with the healthcare professional first.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017.
How long does my child have to take a controller medication before it starts working?
How long does my child have to take a controller medication before it starts working?

It may take several days or a couple of weeks before the medications are effective. Your child may not feel different at the very beginning, but they need to take it every day so its protective effects can build up. Your child should not stop taking it unless you have discussed this with the healthcare professional.

References:

asthma.org.uk Advice/inhalers-medicines-treatments. Accessed October 2017.
How can I be sure I am getting the medication from my inhaler down into my lungs?
How can I be sure I am getting the medication from my inhaler down into my lungs?

When you press down on the top of your inhaler, it creates an aerosol mist traveling very fast. Because the medication mist is moving quickly, timing is important. This means that you should start breathing before you press down on the inhaler and breath in slowly and deeply. Therefore, it is important that you use your inhaler perfectly. Both spacers and Valved Holding Chambers (VHC's) are devices that may be used to overcome these timing issues and help you get more medication where you need it. These are simple devices that attach to your inhaler. When you push down on the inhaler, the mist is dispensed into the device where it is held temporarily until you inhale. This gives you the time to breathe in the medication slowly and deeply into your lungs.

What is an Asthma Action Plan?
What is an Asthma Action Plan?
An asthma action plan (also known as a treatment plan) is a plan for managing your child's asthma. The goal of this plan is to reduce symptoms, prevent serious asthma flare-ups and emergency trips to the hospital. The plan includes written instructions so you and your child can:

identify early symptoms of an asthma flare-up and treat them with the proper medication to prevent them from getting worse

know how to use the medications to manage a full-blown flare-up

know when to call the doctor or seek emergency care

Make sure to bring the asthma action plan on each doctor visit to review and update as necessary. If your child doesn’t have a personal asthma action plan yet, make an appointment with their doctor to create one.

References:

asthma.org.uk. Advice/manage-your-asthma/action-plan. Accessed October 2017
Know your child’s Asthma Action Plan – Green Zone
Know your child’s Asthma Action Plan – Green Zone
A personalised asthma action plan is a written plan designed by you and your doctor that provides instructions on how to control your or your child's asthma. Because everyone's asthma symptoms and triggers may be different, the action plan should be personalised or customised to the individuals asthma. Contact your doctor and set up an appoitnment to develop an asthma action plan.

The green zone in your child's asthma action plan shows what they should be doing when things are going well to prevent asthma symptoms.

The Green Zone means:

Breathing is good

No cough, wheeze, chest tightness or shortness of breath

Sleeping through the night without symptoms

Can play and participate in sports

Peak flow above 80% of personal best

References:

mayoclinic.org. Diseases-conditions/asthma/in-depth/asthma/art-20044888. Accessed October 2017.
Know your child’s Asthma Action Plan – Yellow Zone
Know your child’s Asthma Action Plan – Yellow Zone
The yellow zone in your child's asthma action plan shows what they should be doing when they start to have symptoms or are exposed to a trigger that is likely to cause symptoms.

The Yellow Zone means:

First sign of cold symptoms

Exposure to known triggers

Peak flow between 50% and 80% of personal best

Symptoms may include:

- Cough

- Some wheezing

- Tight chest or shortness of breath

- Coughing at night or wakening at night with asthma symptoms

- Decreased ability to play or do usual activities

References:

aafa.org Page/asthma-treatment-action-plan. Accessed October 2017.
Know your child’s Asthma Action Plan – Red Zone
Know your child’s Asthma Action Plan – Red Zone
The red zone in your child's asthma action plan shows what they should be doing when they have an asthma medical alert. Urgent action is necessary if you child is in the Red Zone.

Red Zone means:

Wheezing, coughing and shortness of become worse after giving yellow zone medicine.

Shortness of breath while walking, talking or resting.

Use of chest muscles while breathing.

Wheezing may be absent if symptoms are very severe.

Child is unable to sleep or do usual activities or play because of trouble breathing.

Peak flow below 50% of personal best

References:

aafa.org Page/asthma-treatment-action-plan. Accessed October 2017.
How to perfom a peak flow measurement using the Philips PersonalBest peak flow meter.
How to perfom a peak flow measurement using the Philips PersonalBest peak flow meter.
The peak flow meter is a simple, hand-held device which is used for measuring your child's peak flow value.

Guide your child to measure their peak flow value with a peak flow meter by following these steps:

Slide off the top cover and unfold the bottom cover into a handle.

Move the red indicator to the bottom of the scale.

Stand up, if possible.

Instruct your child to breathe in as deeply as they can, and put their lips and teeth around the mouthpiece.

Blow out as hard and fast as they can, staying straight. They should not bend over as they blow.

Read the peak flow measurement next to the indicator, and see what colour-coded section their reading is in (if their peak flow zones have been established). Write down the reading. Then slide the indicator back down to the bottom of the scale.

Repeat steps 4 and 5 two more times and write down the reading each time.

Then, the highest reading from three attempts should be recorded as your children's peak flow reading. It's a good idea to let your children practice using the peak flow meter in front of their healthcare professional.

What is a peak flow meter?
Daily peak flow measurements
Daily peak flow measurements

Daily peak flow monitoring using a diary or chart can help you to determine whether your child's asthma is stable or worsening. In conjunction with their prescribed asthma action plan, you can take appropriate action to bring your child's asthma back under control.

What is a peak flow meter?

Personalised Asthma Action Plan

References:

lung.org. Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/measuring-your-peak-flow-rate. Accessed October 2017.

What should I consider when selecting a spacer or valved holding chamber?
What should I consider when selecting a spacer or valved holding chamber?

Look for an enhanced type of spacer that has a valve - this is called a valved holding chamber. This chamber has a one way valve that only opens during inspiration which prevents you from exhaling or pushing the drug out of the chamber. You should also select one that is made of anti-static material. This material keeps the mist in the air longer and the one way valve holds it for a short period of time in the chamber so you have the time to inhale into your lung. Ideally the chamber should also have an audible flow signal, which will alert you if you are breathing too fast.

References:

lung.org. Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/valved-holding-chambers. Accessed October 2017
What should I consider when selecting a face mask?
What should I consider when selecting a face mask?

Babies and all young children who cannot use the mouthpiece of the spacer should be encouraged to use a face mask. It is important that the face mask fits comfortably on the face providing a good fit, to help them receive the proper dose of inhaler medication¹. Philips LiteTouch mask with its soft sculpted patient seal contours to a patient's facial landscape making it easy to fit with less discomfort².

References:
[1] Erzinger, S. et al. Face mask and aerosol delivery in vivo. Journal Aerosol Medicine 2007; 20 (Suppl 1):S78-S84
[2] Tong, K. et al. An Instrumented Valved Holding Chamber with facemask to measure application forces and flow in young asthmatic children. Journal of Aerosol Med and Pulm Drug Del. 2014; 27 (Suppl 1): S55-62.
I use a spacer with mask for delivery of inhaled medication to my child. How do I know when she is breathing the medication in from the spacer?
I use a spacer with mask for delivery of inhaled medication to my child. How do I know when she is breathing the medication in from the spacer?

Make sure you are using a spacer or valved holding chamber that has some type of indicator that you can monitor when your child is breathing in¹. The Philips OptiChamber Diamond has an exhalation valve that you can see moving upon exhalation. This allows you to time the release of medication when the valve goes from open to flat. You can also count the number of breaths he/she takes from the chamber.

References:

[1] lung.org Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/valved-holding-chambers. Accessed October 2017
My two year old fights me when I try to use a mask to give her a puffer. What can I do to make treatment time less of a struggle?
My two year old fights me when I try to use a mask to give her a puffer. What can I do to make treatment time less of a struggle?

Children up to 3 years of age cannot use a mouthpiece, so treatment with a spacer should be given with a face mask¹. Leaks around the face mask can result in decrease medication being inhaled³. To prevent leaks, you may need to hold the face mask on your child's face tightly. This causes the child to cry and fuss during the treatment. Crying causes more of their medication to be inhaled into the stomach and less in the lungs where it is needed. Philips LiteTouch mask with its soft sculpted patient mask seal requires less pressure to contour to patient’s facial landscape - making it easy to fit with less discomfort, especially for small children than conventional VHC masks². Also select a low volume chamber (less then 350 mL) like the OptiChamber Diamond. The larger chambers require more breaths and more time to get all the medication from a single dose⁴. This LiteTouch mask and a low volume spacer such as the OptiChamber Diamond may help you deliver the medication quickly and comfortably to your child.

References:
[1] Global Initiative for Asthma(GINA). Global strategy for asthma management and prevention. ginasthma.org updated Dec 2010. Accessed 13 January 2016.

[2] Tong, K. et al. An Instrumented Valved Holding Chamber with facemask to measure application forces and flow in young asthmatic children. Journal of Aerosol Med and Pulm Drug Del. 2014; 27 (Suppl 1): S55-62.

[3] Erzinger, S. et al. Facemasks and aerosol delivery in vivo. Journal Aerosol Medicine 2007; 20 (Suppl 1):S78-S84
[4] Nikander, K. The evolution of spacers and Valved Holding Chambers. Journal of Aerosol Med and Pulm Drug Del. 2014; 27 (Suppl 1): S4-24.
How can I objectively monitor my child’s asthma?
How can I objectively monitor my child’s asthma?

From age 5+ monitoring your child’s peak flow readings with a peak flow meter and tracking them with a diary or chart can help you to objectively determine whether your child's asthma is stable or worsening. In conjunction with their prescribed asthma action plan, you can take appropriate action to bring your child's asthma back under control.

References:

lung.org Lung-health-and-diseases/lung-disease-lookup/asthma/living-with-asthma/managing-asthma/assess-and-monitor-your. Accessed October 2017
What is the peak flow meter and how does it work?
What is the peak flow meter and how does it work?

A peak flow meter is a small handheld device that is best suited to be used in children 5 years of age or older. It is used to measure the "peak expiratory flow (PEF)" of your child. PEF is a measurement of how fast your child can blow air out of their lungs after they take a full breath. When they blow into the mouthpiece the small marker will move, and where it ends up is the peak flow reading. The highest reading from three attempts should be recorded as their peak flow reading. If your child's asthma is well controlled, their airways are open, so they are able to blow air out of the lungs quickly, which will give a high peak flow reading. However, if your children's asthma is not controlled, the airways will narrow and they will not be able to blow air out so fast, which will give a lower peak flow reading.

References:

Asthma.org.uk. All_about_asthma/controlling_your_asthma/resources_to_help_you/peak_flow_diary. Accessed Oct 2017.
What is personal best peak flow reading?
What is personal best peak flow reading?

Your children's personal best peak flow reading is the highest reading that they can achieve when their asthma is well controlled. Well controlled means that they are feeling good and having no symptoms. To determine personal best peak flow, record the highest peak flow reading from three attempts that are performed twice a day for 2 weeks. Personal best peak flow is the highest reading achieved over this two week period. Remember that keeping track of your child’s peak flow reading is an important step in managing their asthma symptoms and preventing asthma flare-ups. All this information is recorded in a diary used by your healthcare professional.

What is a peak flow meter?

References:

Webmd.com. Asthma/guide/peak-flow-meter. Accessed October 2017.

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DISCLAIMER:
Information on this website is informational only and should not replace the advice of a physician.

FOOTNOTES:
[1] mayoclinic.org/diseases-conditions/asthma/in-depth/asthma/art-20044888. Accessed October 2017.

[2] asthma.org.uk/advice/manage-your-asthma/action-plan. Accessed October 2017.

[3] Webmd.boots.com. Asthma/guide/asthma-symptoms. Accessed Nov 2017.