Understanding Asthma Action Plans

The following was originally published on May 27, 2014, at healthcentral.com

Asthma Action Plan Steps

Most asthma experts recommend every asthmatic have an asthma action plan, sometimes called an asthma management plan.  It’s a plan you work on with your doctor to determine what action you should take to manage your asthma both long and short term.  

Asthmatic air passages have some degree of chronic (it’s always there) inflammation. This makes your lungs hypersensitive, or over sensitive, to certain asthma triggers in the world around you. To learn more about asthma triggers check out my post: “Learn how to avoid your asthma triggers.”

When exposed to your asthma triggers, this inflammation may become worse, causing an acute (it’s happening now) asthma attack (flare-up, exacerbation).

This causes:

• Muscles lining your air passages to spasm or constrict, and this obstructs the air passages, causing shortness of breath.
• Goblet cells lining your air passages produce secretions that also obstruct air passages, causing shortness of breath. 

So there are two stages of asthma: chronic and acute. These correlate with the two parts of an asthma action plan:

A. Long-term management:  This part of the plan includes your actions to treat the underlying chronic inflammation and, therefore, prevent asthma from flaring up. It includes all the medicine you take every day, such as Flovent, Qvar, Advair, Symbacort, Dulura and Breo.

B.  Short-term asthma management:  This part of the plan includes your actions to treat acute asthma symptoms. There are two methods of monitoring your asthma to help you determine the action you need to take.

1. Peak flow monitoring:  This is where you use a peak flow meter to help you determine how well your lungs are working.  This type of monitoring works great because it provides an objective number to help you decide what action to take.
2. Symptom monitoring:  This is where you monitor your asthma signs and symptoms to help you determine how well your lungs are working.  This type of monitoring is subjective and does not require the use of a device.
3. Both:  This is where you use both peak flow monitoring and symptom monitoring to help you determine how well your lungs are working.  An ideal plan will include both.

Asthma journal:  An important part of any plan is an asthma journal, which may be something as simple as a spiral notebook.  In this journal you will record your daily peak flows and your daily symptoms.  

Once you have a journal, and when you are feeling well, you should blow into your peak flow meter every day for two weeks and record the results in the  journal.  The peak flow value that is highest during this time will become your personal best.  You then use this value to determine the following:

• Green range: 80% or better means you are in your safe zone and no action is needed (see below).
• Yellow range: 60-80% means you are in your caution zone, and action is needed.  Follow your plan for the correct action to take. 
• Red range:  Less than 60% means you are in your danger zone and action is needed. Follow your plan for the correct action to take.

You will then continue to use your peak flow meter every day, and continue monitoring your asthma symptoms, to help you decide what action to take.

A typical plan will go something like this:

Early warning symptoms:  These may include feeling tired, irritable, anxiety, itchy chin, funny feeling in chest, coughing, trouble sleeping, cold symptoms, sneezing, headache, increased sputum, inability to exercise, breathing changes, and your peak flows are 80% or better of your personal best.  (For signs and symptoms of asthma in infants check out my post “What Are the Signs and Symptoms of Asthma in Infants.”

Action:   Continue taking all the medications recommended as part of your long-term asthma action plan.  If your doctor recommends it, pretreat yourself before you exercise.  If necessary, remove yourself from known asthma triggers.   

Acute asthma symptoms: These may include wheezing, coughing, shortness of breath, chest tightness, and peak flow numbers 50-80% of your personal best.  

Action: Get away from what is triggering your asthma.  May also include taking your rescue medicine, such as 4-8 puffs on your albuterol rescue inhaler 2-5 minutes apart or taking an albuterol breathing treatment.  If your symptoms do not improve, or your peak flow values do not return to your green range,  your plan may include a second dose of the above medicines.  If, within 20-30 minutes of taking action, your symptoms or peak flows do not improve, you should call your physician, who may recommend increasing the frequency you use your rescue medicine (such as taking it every four hours for a while). Systemic steroids may also be recommended.

Late asthma symptoms: These may include uncontrollable coughing, chest tightness, leaning on things to breathe, shoulders raised, unable to move or walk, bluish skin around lips and fingers, and sucking in stomach and lifting shoulders to breathe (paradoxical breathing). It also includes peak flow values of less than 60% of your personal best.

Action:  Take your rescue medicine by inhaler or nebulizer immediately.  Your plan may include repeated doses.  Call your doctor or 911 right away.  If you are this bad you will need to be seen by an expert.  

Make sure you continue to monitor your peak flows and symptoms every day, and record them in your asthma journal.  When you visit your doctor, it is important to take this journal with you. This will help you and your physician recognize trends, such as that your asthma gets worse when you are around horses, or worse in the spring or summer.  This way you and your physician can make changes to your plan as necessary.  

Bottom line:  An asthma action plan is essential for good asthma control.  It should include the medicines you take every day to control and prevent asthma symptoms, and the actions necessary to treat your asthma when it does flare up.    

The plan should also be simple, written on one side of a piece of paper, and kept in a place that is easy to access, such as on the refrigerator or bedside table, wallet, or purse.  This way it is easy to find when you need it.  Check out nationaljewish.org for example asthma action plans for adults, children and infants.