Understanding an asthma action plan

A clinician prepares it with the patient or caregiver. It should name regular medicines, explain how to recognise a flare, give clear treatment instructions and state when emergency help is needed. RCH commonly refers to the Royal Children's Hospital, but a plan obtained from any source must be completed for the individual rather than followed as a generic form.

Plans often organise care into a stable phase, a worsening phase and an emergency phase. The instructions may use symptoms, reliever use or a personal peak-flow reading. A child's signs can include disturbed sleep, reduced play, cough, wheeze or difficulty speaking comfortably.

Medicine names, device technique and doses need to match the current prescription. The plan also helps parents, school staff and other carers respond consistently instead of deciding from memory during a flare.

Keep an accessible copy at home and provide one to relevant carers or school staff. Check that prescribed inhalers and spacers are available, unexpired and labelled for the person who uses them. Follow the written sequence when symptoms change, and record what happened for the next appointment.

Review the document after a significant flare, a medicine change or any uncertainty about the instructions. Ask a clinician to watch inhaler and spacer technique, because medicine deposited in the mouth cannot work as intended in the airways.

Seek emergency help for severe breathlessness, blue or grey lips, marked drowsiness, confusion, collapse, difficulty speaking more than a few words, or strong pulling-in of the chest or neck with each breath. Use the emergency part of the plan while arranging help, but do not delay care if the reliever is not helping or the person is deteriorating.

Arrange prompt clinical review when symptoms repeatedly wake the person, limit ordinary activity, return soon after reliever treatment or require more reliever than the plan allows.

Ask which symptoms move you between phases, whether peak-flow readings belong in your plan, who should hold copies and when the plan should be updated. Confirm the exact inhaler, spacer and dose for each phase, plus what to do if medicine is vomited, unavailable or appears ineffective.