Keeping Your Asthma in The Green and not the Red
Asthma action plans
In this entry, I would like to discuss the role of ‘action plans’ in the care of patients with asthma. Since asthma affects so many people, and is cared for by a range of providers, action plans are a way for patients and providers to be able to take the right steps in care when their asthma control changes.
What are asthma action plans?
An action plan is a written document, individualized for each patient, that helps patients identify the signs of worsening asthma control and take appropriate action. There are several key components of action plans:
- key symptoms or other markers of control to look out for
- a complete, detailed list of current asthma medications
- specific steps to take if things get worse.
Most action plans are split into three main ‘zones’ of asthma control - green, yellow, and red.
Green is typically when things are going well for a particular patient** Yellow** when there are early signs of worsening asthma** Red** when things are bad and immediate action is needed.
Action plans are individualized – each asthma patient has different triggers and symptoms when their asthma gets worse, hence different ‘levels’ of symptoms that will put them in yellow or red zones when things are not going well. Finally, since patients have individualized asthma medication regimens, what they should do in terms of changing medications when asthma control deteriorates varies.
Two main types of asthma action plans
There are two main types of action plans - peak-flow based and symptom based.
Peak flow based action plans use a patient’s peak expiratory flow (done at home 2-3 times a day using a peak flow meter) as a key determinant of asthma control. The utility of such an action plan depends on a person’s comfort with performing a peak flow meter reliably. While not very difficult, it takes a certain degree of coordination and some education from your asthma doctor or nurse. Most people who can use a metered dose inhaler (a ‘puffer’) can measure their peak flow. Action plans that are peak flow-based compare a person’s peak flow with their best peak flow, when their asthma is doing great. If their peak flow falls below 80% of this ‘personal best’, the action plan will call for a change in treatment, usually increasing frequency of quick-relief inhaler use and checking peak flow more often to see where things are going. A fall in peak flow of less than 60% of personal best typically puts someone in the ‘red’ zone - their action plan would call for the patient to contact their asthma care provider and likely need a significant change in asthma medication, such as starting a steroid pill (e.g. prednisone).
In symptom-based asthma action plans, the zones are the same. The main difference is that key symptoms are the “triggers” that lead to a change in treatment and/or contacting your asthma care provider instead of peak flow.
I should clarify that peak-flow based asthma action plans also note key symptoms as triggers for action. As peak flow measurement is a more objective marker of narrowing of the breathing tubes, individuals who can measure their peak flow are encouraged to use this type of action plan.
Asthma action plans can be an important component of asthma care for patients and providers. They help patients better keep track of their asthma control by having a written document that reviews symptoms, peak flow (if applicable), and medicine options if they get worse. Most importantly, it gives patients a stronger sense of control over their asthma. If you think an action plan will help you manage your asthma more effectively and take more control, you should discuss this with your asthma provider.
Frederic Little is an Assistant Professor in the Department of Medicine at Boston University. He attends on the Allergy Consultation Service as well as the Medical Intensive Care Unit and Pulmonary Consultation Service at Boston Medical Center. He wrote for HealthCentral as a health professional for Asthma and Allergy.