Also see:
Name ........................................ Personal best peak flow reading is ..........
Doctor / nurse who filled in this form ........................................ Date ..............
If your asthma symptoms are well controlled
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If the following describes you... |
Your action is |
- You are able to work and play normally.
- You do not have any regular symptoms of cough, wheeze, chest tightness or breathlessness (day or night).
- You need your reliever inhaler less than three times per week (not including before doing exercise).
- Your peak flow is above 80% of your personal best - which is above ......
|
Continue with your usual treatment which is:
Preventer:
Reliever:
Other:
See a doctor or nurse at your next routine appointment -
which is on ..........................................
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If your asthma symptoms are troublesome, or may get worse
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If any of the following occur... |
Your action is |
- You start to get a cold or viral cough.
- You have a mild but recurring wheeze, cough, or chest tightness during the day or night.
- You need to use a reliever more than three times per week (not including before doing exercise).
- Your peak flow is reduced to between 50% and 80% of your personal best - which is between
.............. and ..............
|
Increase your treatment to:
Go back to your usual treatment when your asthma symptoms have returned to being well controlled (see section above) for ....... days.
See your doctor or nurse within the next week or so if you have had to increase from your usual medication for a while on two or more occasions since your last routine appointment.
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If your asthma symptoms are getting more severe
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If any of the following occur... |
Your action is |
- If your wheeze, cough or tight chest are getting worse.
- You have difficulty doing your normal activities because of asthma symptoms.
- You are breathless which does not fully ease with a reliever inhaler.
- You need to use a reliever every three hours or more.
- You wake up most nights with wheeze, cough or chest tightness.
- Your peak flow is below 50% of your personal best -
which is below .....................
|
Start taking prednisolone (steroid tablets) at a dose ......
Also, increase your usual treatment to:
See your doctor or nurse within the next 24 hours, or immediately if you get worse. |
If your asthma symptoms are very severe
|
If any of the following occur... |
Your action is |
- You are very breathless.
- You have difficulty speaking because of asthma symptoms.
- Your lips are blue.
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This is an emergency.
Contact a doctor urgently.
If a doctor is not available go straight to hospital accident and emergency. (Call an ambulance if necessary.)
Whilst waiting for help:
- Sit upright and try to stay calm.
- Take from 2 to 10 puffs from a reliever inhaler, preferably via a spacer, inhaling after each single puff. Repeat every 10 to 30 minutes, depending on how severe the symptoms are.
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Note: peak flow readings may not be a good guide of severity for children 12 and under.
Useful phone number 1:
Useful phone number 2: |
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©EMIS and PIP 2004 CHIQ Accredited
