Asthma action plan (template)

Using this handout

Use this template to confirm controller use, rescue steps, and escalation cues. Encourage patients to bring the plan to every visit.

For severe shortness of breath or speaking only in single words, call 911 or emergency services immediately. Use your reliever as directed in your personal asthma plan while help is arranged.

Safety-net wording

Plain-language return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

• Point to the warning signs printed in the handout.
• Confirm follow-up timing and where to go after hours.
• Document that return precautions were reviewed and understood.