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Belmontoasis.com.au

Asthma Action Plan For Children
When Well
When Unwell
Danger Signs
every 3 hours
more than
or more often for one or more
every ½ hour, OR
Blue lips, OR
Difficulty speaking or feeding
Frightened OR
Exhausted
What should I do?
What should I do?
What should I do?
What should I do?
Preventer/Combined
Give .……………………………….
Keep giving ……………………….
CALL AN AMBULANCE on 000
Medication:
Up to 3 - 4 hourly as needed:
as needed.
…………………. …. puffs/tablets
(under 6 years old)
Start Oral Steroid if prescribed:
……………………………………….
…… times a day everyday
…………………….… mg (……ml)
(6 years or older)
4 puffs every 4 minutes
Reliever:
And see a doctor or come into
hospital AS SOON AS POSSIBLE
Use a spacer if available
continue same dose as usual, OR
………………………… …. puffs
…………………………. …. puffs
…… times a day until better
Dr name:…………………………………. Ph:…………………. Patient name:……………………………………………………………… Next Dr’s Appointment:…………………………………………………… Take this plan with you when you next visit your doctor
EXTRA MEDICINE TO TAKE AFTER GOING HOME:
FOLLOW-UP (please tick which)
Date:……………………….
GP follow up in ……………. days/weeks
Prednisolone: ………….mg (.ml) once a day for ……………. days
Outpatient Clinic ………. weeks
Asthma Liaison Nurse …. weeks
……………………….……. ……… puffs ……………….… times a day for …………. days
Other: ………………………………………………………………………………………….…….
Consultant rooms ……………. weeks

.
…………………………………………………………………………………………………………….

RETURN to hospital or see a doctor as soon as possible if your child:

• Starts working harder to breath (sucking in around tummy, ribs or neck with breathing) OR
• Starts needing their reliever puffer more than every 3 hours
Call an AMBULANCE if your child has any one of the following:

Needs their reliever puffer more than every ½ hour, OR
Has difficult speaking or feeding due to breathlessness, OR
Is blue at the lips, OR
Is frightened or exhausted
While waiting for the ambulance give your child their Reliever puffer 4 puffs every 4 minutes (use a spacer if available)
IS YOUR CHILDS’ ASTHMA UNDER CONTROL?
Does your child have any of the following symptoms when they seem well?
NIGHT TIME or EARLY MORNING wheeze, chest tightness or cough?

• Wheeze, chest tightness or cough with EXERCISE?
RELIEVER 2 days a week, or more, to relieve asthma symptoms (not including before sport)?

MISSING SCHOOL because of their asthma?
Answer yes, to any one of these? Then your child should see their family doctor, to look at ways to get their asthma under better control.
www.healthnetworks.health.wa.gov.au (08) 9489 2800 [email protected]
Developed by the Acute Respiratory (Paediatric) Working Group of the WA Child and
Youth Health Network and Respiratory Health Network. Dec 2007 REVISION: Dec 2009

Source: http://www.belmontoasis.com.au/uploads/files/asthma_+.pdf

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