My Asthma Wallet Card

Carry This Card To Help Control Your Asthma



My Asthma Action Plan

Address  
Telephone Number  
Emergency Contact Name  
Hospital/Emergency Department Number  


My Medicine

Long-Term Control Medicines

Name Dose When To Take
     
     
     
     
     

Quick-Relief Medicines

Name Dose When To Take
Short-acting beta2-agonist    
     
     


Warning Signs of an Asthma Attack

Check below any things that you know may warn you of an attack coming on:

  • awakening at night
  • difficulty breathing
  • wheezing
  • coughing, especially at night
  • chest tightness
  • feeling very tired
  • itchy or sore throat
  • itchy nose
  • itchy, watery or glassy eyes
  • need more beta2-agonist
  • than usual
  • other


My Peak Flow

My best peak flow  
Green Zone
(80­100 percent of best peak flow)
 
Yellow Zone
(50­79 percent of best peak flow)
 
Red Zone
(Less than 50 percent of best peak flow)
 


Talk to Your Doctor About:

  • Your asthma treatment goals and how to achieve them
  • Your medications‹what they are for, how much to take, and when and how to take them
  • How to use your inhaler and a peak flow meter, if you have one
  • Your asthma triggers and how to avoid them
  • Warning signs of an asthma attack and what you should do if your symptoms get worse

Ask for a written asthma action plan for responding to worsening symptoms—and make sure you understand it.




NIH Publication No. 07-5245
January 2007

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