The asthma action plan template includes the patient's general information, asthma zones and medications to take to relieve the symptoms of asthma, explains the American Lung Foundation. The action plan also includes information on long-term control of asthma symptoms and details on when to go to the emergency room, according to the U.S. Centers for Disease Control and Prevention.
General information on the action plan includes the patient's name, emergency contact information, contacts of health care providers, asthma triggers and classification of the severity of his asthma attacks, explains the American Lung Foundation.
The action plan template includes information on the three asthma zones: green, yellow and red, explains WebMD. In the green zone, the patient has no symptoms. The yellow zone indicates that the patient should be cautious as he has reduced lung function. His symptoms may be mild to moderate, and he may be unable to go about his daily activities. The red zone is the danger zone. The patient may have severe symptoms such as extreme coughing, wheezing and shortness of breath.
The action plan contains information on the medications that the patient must take daily to control the inflammation of his airways and medications that he should take in case of an asthma attack, reports WebMD. The medications may differ depending on the asthma zone that the patient is in. The action plan template includes information on quick-relief medications to take in each zone, how much to take and when to take them.
The action plan includes measures that the patient or a caregiver should take when in the red zone, according to the American Lung Foundation. The plan should have emergency telephone numbers of doctors, friends, family and emergency transportation providers.