Completing an asthma action plan with your patients

Find out how to complete our asthma action plan with your patients so they can benefit from an effective, safe, and personalised plan.

These guidance notes are for our preventer/reliever action plan, for patients using a preventer inhaler, or a non-MART ICS-LABA inhaler, with a separate SABA reliever inhaler.

If your patient has been prescribed MART (Maintenance and Reliever Therapy) please refer to our MART asthma action plan guidance notes. 

Find all our asthma action plans here.

In between regular asthma reviews, your patients need to know what to do to manage their asthma well.

An asthma action plan tells your patients:

• which medicines they need to take every day
• what to do if their asthma symptoms get worse
• what emergency action to take if they have an asthma attack. 

The National Review of Asthma Deaths (NRAD) published in 2014 showed that lives could have been saved by taking asthma medicines regularly as prescribed, carrying a reliever inhaler and seeking help promptly for worsening symptoms.

An asthma action plan supports patients to take the right actions at the right time and lowers the risk of a potentially fatal asthma attack.

Use our guide to help you complete the Asthma + Lung UK asthma action plan together with your patient and any carers.

Once your patient’s plan is complete and up to date, save a copy to their notes. It’s important to replace any older plans with a newly updated one.

Section 1: Everyday asthma care (green)

Support your patient to stick to their routine medicines so they can avoid asthma symptoms.

Here you can specify the number of puffs of preventer inhaler your patient needs to take every day, and their reliever inhaler if they get symptoms.

When completing this section:

• Highlight the importance of taking their preventer medicine every day, even if they feel well.
• Explain the benefits of using a spacer if they use an MDI inhaler.
• Stress the importance of good inhaler technique. Show them the best way to use their inhaler. Signpost them to the Asthma + Lung UK inhaler videos and tell them their pharmacist can also help.

There is also a box at the bottom of section 1 to list any other medicines and devices your patient uses every day to keep their asthma under control, such as oral medications, peak flow meters, or nebulisers.

If you decide it’s appropriate for your patient to step down to a lower dose, stress the importance of making an urgent appointment if their symptoms flare up again, and explain the best way of getting in touch.

Section 2: When I feel worse (amber)

Support your patient to recognise when their asthma is getting worse and know what to do to manage worsening symptoms.

You can specify extra puffs they can take of their preventer and reliever inhalers to get symptoms back under control.

There is also a box at the bottom of section 2 where you can indicate other medicines they can take if symptoms flare up. For example:

Oral steroids (usually prednisolone)

Occasionally a patient may be prescribed a rescue pack of oral steroids to keep at home. 

Make sure they have clear, written instructions on when to start taking the medicines, at what dose, and for how long. 

Make them aware that they need to see their GP or asthma nurse:

• as soon as possible after starting the course
• urgently if symptoms get worse or their peak flow drops
• if they don’t feel better before the end of the course.

BTS/SIGN Guidelines suggest 40-50mg daily of prednisolone for at least five days or until recovery.

When completing Section 2:

• Stress the importance of acting quickly to avoid symptoms building up into an asthma attack.
• Explain that needing to use their reliever inhaler, or their MART inhaler as a reliever inhaler, three or more times a week is a sign that their asthma is not well controlled, and they should see their GP or asthma nurse.
• Talk to them about the best way to navigate the urgent appointment system at their GP practice, and suitable alternatives, such as A&E or local walk-in centres.

Section 3: In an asthma attack (red)

Make sure your patient, and anyone caring for them, knows what to do in an asthma attack.

This section sets out:

• The signs and symptoms of an asthma attack
• What to do in an asthma attack
• When to call 999
• When to contact their GP after an attack

For more information, signpost your patients to our asthma attack pages.

Note: the asthma attack information on the Asthma + Lung UK asthma action plan does not apply to patients on a MART regime.

If your patient is on the MART regime, add specific details in the box at the end of the section, or provide them with a MART plan and asthma attack advice specific to the licensing of their individual inhaler.

It is essential that you protect your patient by giving them clear instructions about taking extra doses of their MART inhaler and when to seek urgent or emergency clinical help, including:  

• how many puffs to take of their MART inhaler if symptoms flare up
• how long they should wait between puffs
• when to call 999 if there is no improvement
• how many puffs to continue taking while waiting for the ambulance.

Make sure your patient understands that if they are on a MART regime, they need to follow asthma attack advice specific to their individual MART inhaler.

When completing Section 3, emphasise the importance of:

• seeking help urgently if their inhaler is not helping
• getting a same day appointment if they managed an asthma attack at home
• booking a follow up appointment with their GP within 48 hours of being discharged, if they went to hospital with an asthma attack
• a post-asthma attack follow up review to look at what triggered the attack, review their treatment plan and inhaler technique, and discuss ways to reduce the risk of future attacks.

Talk to your patient about the best way to navigate the urgent appointment system at their GP practice, and suitable alternatives, such as A&E or local walk-in centres.

Peak flow – All sections

In all three sections, there is an option to identify your patient’s peak flow scores.

• In section 1 you can note down your patient’s personal best score – the score that is usual for them when they are well. Your patient needs to have kept a peak flow diary for at least two weeks to establish a best score.
• In section 2 note down the peak flow score suggesting worsening symptoms. This is a score that is lower than their personal best score.
• In section 3 note down the peak flow score signalling an asthma attack.

Not all your patients will be using peak flow long term to manage their asthma. Monitoring peak flow at home is most useful at key times, such as after an asthma attack, or if your patient’s treatment plan has changed.

Peak flow is not a substitute for a good clinical history. Do not rely on peak flow in isolation.

If your patient is using peak flow monitoring as part of their asthma management plan, whether that’s in the short or long term, it is important to make them aware that:

• Peak flow scores do not always change when symptoms get worse. It’s important to take action when symptoms worsen, whatever their peak flow score. For example, if they’re having symptoms at night or on waking, they need urgent assessment, even if their peak flow score is the same.
• Peak flow can pick up changes in the airways before they have symptoms. If your patient’s peak flow score is lower than normal, it could be an early sign that their asthma is getting worse, and they should seek help and advice.
• Whatever their peak flow scores, if your patient needs to use their reliever three or more times a week, they should see a healthcare professional for a review.
• Whatever their peak flow scores, if their reliever inhaler does not help, or does not last for at least four hours, they need urgent assessment.

You can signpost your patient to our page on peak flow for more information and advice.

For someone to be well controlled with their asthma, their peak flow should be their personal best score, or a score that is at least 80% of their personal best score.  

A peak flow below 80% of their best score requires action. This could be optimisation of care and self-care.

A peak flow of 50% or below their best score indicates that your patient might be having an asthma attack and they should take urgent action (section 3).

Asthma triggers

Write down any triggers and allergies that you and your patient have identified in the ‘My asthma triggers’ section of the asthma action plan.

Stress the importance of minimising their risk by:

• taking preventer medicine every day
• avoiding triggers when possible, like cigarette smoke, and managing triggers like hay fever
• understanding that if exercise triggers symptoms, it can be a sign of poor control and they should see their GP
• taking extra care with food or other known allergies.

You can signpost your patients to Asthma + Lung UK’s triggers pages for more information and advice about triggers.

Asthma review

In the ‘My asthma review’ section of the plan, there is space for you to write in your patient’s next review date.

When considering the timing and frequency of asthma reviews, consider:

• your patient’s level of asthma control and if they need a review more frequently than once a year
• the pattern of asthma symptoms and when they tend to be worse - for example, in response to seasonal triggers
• your patient’s preferences and ease of attending - for example, if they work, or have children or other dependents to consider.

Your patient’s asthma action plan is designed to be an easy to refer to self-management tool.

To help your patient use their plan effectively, they could:

• Keep a copy of their updated plan on their phone, tablet or laptop. You could email them an electronic version. If this is not possible, they could they take a photo of the plan on their phone. Make sure your patient remembers to replace it.
• Encourage your patient to keep a hard copy on their fridge or somewhere obvious, so it reminds them what they need to do to stay on top of their asthma.
• Suggest your patient shares their asthma action plan with friends, family and colleagues. They could send them the photo on their phone or tell them where a paper version is kept. This could be lifesaving if your patient experiences an asthma attack.
• Bring their plan along to every appointment.

A written asthma action plan is only one part of helping people maintain good control of their asthma.

Pinnock and Taylor explain the application of PRISMS to people with asthma (PDF), which includes:  

• giving patients information about their asthma – for example, signposting them to the Asthma UK website 
• encouraging patients to make the most of a supportive community, such as asthma forums, where they can share experiences and get support from others with asthma.

Find all our asthma action plans, which are available in a range of languages, on our healthcare professionals resources pages. They are free to download or order.