CCAD Hospital

Diseases & Conditions



My personal best peak flow is:__________

My PREVENTER inhaler is:__________

I need to take my preventer inhaler every day, even when I feel well.

I take _________________ puff(s) in the morning, and __________________ puff(s) at night.

My RELIEVER inhaler is: _________________________ __________________________ (Name/ Colour) I need to take my reliever inhaler only if I need to.

I take _______________ puff(s) of my reliever inhaler if

any of the below things happen:

  • I’m wheezing
  • My chest feels tight
  • I’m finding it hard to breathe
  • I’m coughing

Other medications I take for my asthma every day:__________________________________________

My aim is to have no symptoms. If I haven’t had any symptoms or needed to use my reliever inhaler for at least 12 weeks, I will ask a member of my asthma action plan health care team members to review and revise my medication dosages.

If you have allergies, your attacks can be more severe.


My symptoms are coming back (wheeze, chest tightness, breathlessness, cough) I am waking up at night My symptoms are interfering with my usual daily activities (e.g. work or exercising) I am using my reliever inhaler_________________ times a week or more My peak flow drops to below _________________

This is what I can do now to get on top of my asthma:

  1. If I haven’t been using my preventer inhaler, start using it regularly again or: Increase my preventer inhaler dose to __________ puffs __________ times a day until my symptoms have gone and my peak flow is back to normal. Take my reliever inhaler as needed up to __________ puffs every 4 hours. If no improvement in 48 hours make an urgent appointment to see the doctor.
  2. If I have been given prednisolone tablets (steroid tablets) to keep at home: Take _________ mg of prednisolone tablets (which is _______ x 5mg) immediately and again every morning for _______ days or until I’m fully better.

Urgent! Call pulmonary clinic today and let them know I have started taking steroids and make an appointment to be seen within 24 hours.


My reliever inhaler is not helping or I need to increase the dose to be every __________ hours I find it difficult to walk or talk I find it difficult to breathe I’m wheezing a lot or have a very tight chest or I’m coughing a lot My peak flow is below __________

This is an EMERGENCY, take action now

  1. Sit up straight- don’t lie down. Try to keep calm
  2. Take one puff of my reliever inhaler every 30-60 seconds up to a maximum of 10 puffs

a) If I feel worse at any point while I’m using my inhaler (CALL 999 Ambulance takes longer than 15 minutes? Repeat step 2) b) If I don’t feel any better after 10 puffs (CALL 999 Ambulance takes longer than 15 minutes? Repeat step 2)

c) If I feel better make an urgent same day appointment with pulmonary clinic

If I feel better, and have made my urgent same day appointment:

  • Check for rescue prednisolone
  • Take as recommended by your doctor

Please take your asthma action plan to the Emergency Department.


The best way to avoid an asthma flare-up is to make sure your asthma is well controlled. Following an asthma action plan can decrease your need to seek emergency care.

Your asthma action plan is tailored to you and will help you manage your asthma. Once this is set with your health care team members, it will help you to know what to do if you are unwell and help you stay as well as possible.

RESCU rules:

  1. Review my asthma action plan regularly!- you should be reading through your asthma action plan at least once a month and asking yourself how you are getting on with all aspects of your asthma management.
  2. Keep Extra copies At work At school In the car In your handbag/briefcase
  3. Share my asthma action plan with family and friends!- someone who you see regularly so that they can notice any changes in your asthma symptoms and know what to do in an emergency.
  4. Carry this to every healthcare appointment you have including Emergency Department.
  5. Get Used to where it is kept! for example, on the fridge door, near your front door.


Taking my medications and avoiding triggers will help me reduce my flare-ups ___________________________________

My Annual Asthma Action Plan Review:

During my annual asthma action plan review, we will:

  • Update my asthma action plan (if needed)
  • Review my inhaler technique
  • Answer any questions I may have regarding my asthma

My next review date: ___ / ___ / ________

If you have any questions please contact:

My asthma action plan health care team members: Dr._________________________________________ /


© Copyright 2023 Cleveland Clinic Abu Dhabi. All rights reserved.

This information is provided by Cleveland Clinic Abu Dhabi, part of the M42 group, and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition.

We’re here to make managing your healthcare easier.

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