Why You Need an Asthma Action Plan, and How to Use One

What to know about asthma action plans

About 8 percent of Americans have asthma, a chronic condition that affects the airways of the lungs.

People with the disease often cough, wheeze, or experience shortness of breath when exposed to a trigger such as pollen, dust, or exercise.

This is because asthma causes hypersensitivity in the airways­—the tubes that move air in and out of the lungs. If exposed to something that triggers this sensitivity, the walls that line these airways inflame, swell, and tighten up.

The resulting asthma symptoms can be life-threatening. According to the Asthma and Allergy Foundation of America (AAFA), asthma is responsible for more than 3,500 deaths per year.

But asthma can also impact people’s daily quality of life. If it’s not well managed, asthma could affect your sleep and ability to participate in physical activity, and even increase the risk of developing other chronic conditions, like coronary heart disease, rheumatoid arthritis, and diabetes, according to a study in Allergy, Asthma, and Immunology Research.

Who is at risk for asthma?

Doctors aren’t sure exactly what causes asthma. But several factors could play a role in its development, explains Jennifer Monroy, MD, a Washington University allergist and immunologist at Barnes-Jewish Hospital in Saint Louis, Missouri.

“A person can be at higher risk of developing asthma if they have a parent with asthma,” she says. Along with this potential genetic link, people may be at higher risk for asthma if they have:

• Early exposure to environmental irritants like secondhand smoke or air pollution
• A respiratory illness as a child that causes damage in the lungs
• Eczema, allergic rhinitis, or obesity
• A job that puts them in contact with occupational irritants, like certain chemicals or industrial dust

“Once the processes in the body start leading to asthma, it cannot be undone,” Dr. Monroy says. “Which is why it cannot be cured at this time.”

Yet while it’s a lifelong, chronic condition, asthma is controllable—and people with the disease can live normal, healthy lives with a personal, doctor-designed strategy.

“Asthma action plans are written directions on how to manage an individual’s asthma,” explains Lorene Alba, director of education at the AAFA. With this customized approach, people with asthma can reduce the risk of severe symptoms, prevent lung impairment, and improve their quality of life.

Here’s an example:

Courtesy AAFA

Why asthma action plans are important

An asthma action plan aims to arm people with the information and guidance they need to keep their asthma under control so symptoms have little to no interference in their daily lives.

Joi Lucas, MD, a board-certified pediatric pulmonologist and chief of pediatrics at Lakeland Regional Health in Lakeland, Florida, explains that asthma is considered well controlled if a person:

• Is symptomatic fewer than two days per week
• Has no difficulty with regular activity
• Uses a rescue medication like albuterol fewer than two days per week
• Doesn’t wake up overnight with symptoms more than two times per month

“It is important that you have a personalized asthma action plan to understand how to optimally treat your asthma symptoms,” Dr. Lucas says.

Asthma triggers vary and are different for everyone, she explains. But with an asthma action plan, people know exactly what to do day to day—and how to respond if symptoms worsen.

(These home remedies for asthma can help you manage symptoms.)

What’s included in an asthma action plan?

“Asthma symptoms can occur suddenly and worsen quickly,” Alba says. “Asthma action plans explain the signs and symptoms of worsening asthma and how to respond in a breathing emergency.”

Dr. Lucas says that typically, these plans have red, yellow, and green zones that correlate with symptoms that are severely exacerbated, uncontrolled, and controlled.

The color-coded guide then takes the guesswork out of treating asthma, making it easier for people (or caregivers) to manage their condition effectively.

Symptom guide

An asthma action plan clarifies when a symptom indicates a problem while offering clear instructions on what to do next.

For example, the plan will tell you what to do if:

• You’re breathing normally, sleeping through the night, and have no work or play restrictions
• You’ve been exposed to a known trigger, show the first signs of a cold, feel chest tightness, or are coughing at night
• Your asthma medication is not making you feel better, you are having trouble breathing or speaking, or your nose opens wide

Peak flow readings

Some asthma action plans also include peak flow meter readings alongside the symptoms guide, helping people better recognize early warning signs of asthma exacerbations (aka an asthma attack).

People with asthma can take their own peak flow readings using a handheld device that measures how well air flows in and out of the lungs.

Everyone can benefit from using a peak flow meter, but the tool is especially useful for people who are newly diagnosed or may not fully perceive all of their symptoms, Alba explains.

This is because a dip in your peak flow meter reading can alert you that an asthma episode is coming—even before you feel it physically.

Medication protocols

“Many people with asthma take more than one medicine to manage their condition,” Alba says. “It is easy to confuse which medicine to take, when to take it, and how much to take.”

Broadly speaking, asthma medications include:

• Controller or maintenance medicines that help prevent asthma symptoms by reducing lung inflammation
• Rescue or quick-relief medicines—like albuterol—that relieve asthma symptoms as they occur by relaxing the airways

An asthma action plan will indicate what to take when you’re feeling well, what to take when symptoms occur, and what to do if an episode worsens.

Your medications’ name, dosage, and instructions should be clearly listed, but the amount of a drug you should take may change corresponding to each action plan zone.

Trigger avoidance

“Some action plans will include a list of your asthma triggers and strategies to reduce or avoid them,” Alba explains.

She says that often, medication alone is not enough to manage asthma. Identifying your personal triggers and developing strategies to reduce or avoid them plays a big role.

“Keeping a symptom diary can help,” Alba says. With this approach, you can record when and where you experience asthma symptoms—like inside or outside, at work, or at home.

“This can help you pinpoint your personal triggers and the steps to take to reduce them,” she says.

You may also benefit from an appointment with an allergist. Alba says that about 60 percent of people with asthma have allergic asthma, meaning that their symptoms are triggered by an allergen.

An allergy test can help you understand if you’re experiencing asthma symptoms thanks to an allergen like dust mites, pollen, pet dander, or something else.

How to use an asthma action plan

Your current symptoms—and/or peak flow reading—dictate which section of your asthma action plan you should follow at a given time.

These sections are color-coded as green, yellow, and red, like the colors on a stoplight.

The green zone

“Green means go,” Alba says. When you are in the green zone, she explains, you are not currently having symptoms and should take your medication as listed in your plan.

The yellow zone

“Yellow means caution and slow down,” Alba explains. You are in this yellow zone if you’re experiencing symptoms like coughing, shortness of breath, or wheezing. The action plan will then direct you to the medicines to take for quick relief.

“If symptoms improve and you move back into the green zone, you are good to go,” she says. “If symptoms are not improving, continue to follow your action plan and call your doctor.”

The red zone

The red zone is considered a breathing emergency—and this requires medical treatment right away.

Alba explains that you might fall into this zone of your action plan if you’re breathing hard and fast or having difficulty walking and talking due to shortness of breath.

“Without [this] written management plan, people with asthma may not be able to recognize a breathing emergency,” Alba says.

Because asthma symptoms are serious and can worsen quickly, this delay can interfere with potentially lifesaving medical treatment.

Do asthma action plans ever change?

Asthma can change over time—and so should your action plan to manage it.

“Reviewing your asthma action plan with your doctor can help determine if your current medicines need to be changed, increased, or even decreased based on how well your asthma is controlled,” she explains.

You should review your asthma action plan with your doctor:

• At least once a year, and children should have theirs updated for the start of each new school year, with a copy provided to the school nurse
• When there is a change in your asthma treatment or medicines
• If you get pregnant, as asthma can change during pregnancy

You should also evaluate your plan with your doctor if your asthma changes in severity. For example, someone may experience more symptoms during pollen season, so their treatment plan may change during those months each year.

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