Developing an Asthma Action Plan
To get on board with better control of asthma symptoms, a health care provider can help your child develop a written asthma action plan, which is also called a self-management plan. Keep in mind that the action plan is a way to provide direction — for you, a caretaker, a teacher, a coach, or anyone else who works with your child — to improve daily care and prevent asthma attacks. It also provides a guide to your child, and lets him know if he needs additional help.
The asthma action plan does not replace visiting your health care provider or imply that you and your child are left to manage his asthma alone. But, it gives you and your child points of reference to help you decide when asthma symptoms might be problematic — and what you can do to immediately address them before they become more serious. It also lets you follow a plan and identify when those symptoms indicate a need for emergency help.
Not all asthma episodes or attacks are the same, and some are worse than others. When severe, your child's airways can constrict to the point that they prevent adequate oxygen from getting to the rest of his body. But, by monitoring your child's asthma, most asthma parent's guide to episodes can be handled at home by following your asthma management plan.
Early Warning with Peak Flow Meters
One of the items listed on an asthma action plan is peak flow meter readings. To determine if your child's asthma is about to flare up, you could monitor her symptoms to see if her airways are narrowing — leading to troubled breathing or coughing. However, quicker — and somewhat more reliable method — is to use a peak flow meter, a relatively inexpensive device that can measure lung function when your child blows into it.
Children can start using peak flow meters around the age of five years. With the peak flow meter, the more air the child can blow, higher the numerical reading.
Fact
If your child's airways are tightening, the peak flow meter readings become lower. Peak flow readings may be able to detect a possible asthma flare-up long before reduced breathing or other symptoms in your child become apparent.
To get the most from the peak flow meter, it's important to get “personal best” reading when your child's airways are normal. This reading should appear near the top of the asthma action plan. The packaged inserts with the meter usually provide lists of normal values for their meters. Keep in mind, though, that your child's readings can be above or below these levels.
For infants and toddlers who, of course, are too young for peak flow meters, you should be alert for symptoms that could indicate an asthma attack such as agitated behavior, decreased feeding, rapid breathing rate (see chart below), inability to say more than a few words at a time without taking a breath, bluish discoloration of fingers or lips, and sucking in of the chest around the ribs or collarbone.
Normal respiratory rates change for children as they grow. The following is a guideline for normal breathing rates at rest in children:
AGE (Years) |
RESPIRATORY RATE |
0–1 |
30–40 breaths per minute |
1–2 |
22–30 breaths per minute |
2–4 |
20–26 breaths per minute |
5–10 |
18–22 breaths per minute |
10–18 |
16–20 breaths per minute |
In the Action Plan Zones
These peak flow readings, plus information from the child's medical history, become pivotal in developing three zones to be the used in action plan:
The green zone means the child is doing well in terms of breathing and his asthma appears well-controlled. There is no coughing or wheezing, and he can play or sleep well. He could need some quick-relief medication — maybe before exercising or going outside when high pollen levels are present.
The yellow zone means his symptoms are getting worse or caution is needed. In this zone, his airways may have begun to constrict (showing about 50 to 80 percent of his personal best reading). Some quick-relief medication may be needed every several hours, or possibly some longer-term medications might be needed.
The red zone means your child's breathing is significantly impaired and the red zone plan for medications must be started to prevent an emergency from occurring. The peak flow reading may be between 0 to 50 percent of his personal best reading. If he has trouble walking or talking and medicines do not appear to be helping, a call to his health care provider is needed. If that person is not available or you cannot contact someone from the child's health care provider's office right away, then a trip to the hospital or call for emergency help may be necessary. If your child is not responding to you or has severe difficulties breathing, blue lips or fingernail beds, or mucus membranes, call 911 right away.
Each child's plan will vary depending on several variables such as severity classifications (intermittent, mild persistent, moderate persistent, and severe persistent). Triggers should be indicated on the action plan, as well as your child's common asthma symptoms.
In addition to keeping your own asthma action plans, these should be distributed to your child's school, sports or physical fitness programs, and daycare program. But this document should not be considered static: It should be updated every few months — reflecting any changes in your child's triggers or medications.
