When your child has asthma, an asthma action plan can help you respond quickly to symptoms and prevent emergency department visits and hospitalizations. “An asthma action plan … outlines which medications to take, how to recognize early signs of a flare-up, and when to seek medical help. Having this plan helps prevent emergencies, reduce missed school days, and keep your child active and healthy,” says Fariba Rezaee, MD, pediatric pulmonologist at Cleveland Clinic Children's in Ohio.
Asthma action plans are divided into three color-coded zones — green, yellow, and red — to help you know exactly what steps to take when symptoms appear, says Dr. Rezaee. A detailed plan empowers parents, caregivers, and even older siblings to take action when needed.
“Effective asthma management is a partnership with families, school nurses, pediatricians and specialists. Each child’s asthma is unique and requires an individualized medical approach,” says Richard Wong, MD, a pediatric pulmonologist at Phoenix Children's in Arizona. Open communication, following action plan steps consistently, early identification of worsening asthma control, and regular follow-ups are key to helping children with asthma experience minimal disruptions, says Dr. Wong.
Asthma attacks can be deadly, says Purvi Parikh, MD, an allergist and immunologist in New York City and member of the Allergy & Asthma Network’s Medical Advisory Council. “[But] by knowing what to do in a situation, you can stop an asthma flare up from getting worse,” says Dr. Parikh.
In the United States, asthma attacks peak in September, especially in the third week, sometimes called “Asthma Peak Week.” But having a current asthma action plan for children can help them stay safe, active, and breathing well. Below, learn how an asthma action plan works, how often to update it, and when to get urgent help.
An asthma action plan should include several key pieces of information about your child:
Name and age
Healthcare provider’s name and contact information
Emergency contact names and phone numbers
Allergens and triggers to avoid
Best peak flow measurements (PFMs)
Daily medications and dosages
How to identify an asthma attack and what to do based on symptoms
Rescue medication names and dosages
Symptoms or PFMs that signal the need for urgent medical care
“No two children have the exact same asthma triggers or symptoms, so their action plans should be tailored to their specific needs,” says Rezaee. For example, some children have symptoms only during certain seasons or when they exercise, while others may need daily medications to stay in control.
Asthma in the “green zone” means symptoms are controlled. “Asthma is considered controlled when your child can go about their daily activities — like playing, going to school, and sleeping at night — without frequent symptoms,” says Rezaee.
Most asthma action plans say you’re in the green zone if you have all of these:
Breathing easily
No cough or wheeze
Sleeping through the night
Can work and play like normal
In the green zone, your child should only need to use their albuterol or quick relief medication rarely — one or two times a week maximum, says Parikh. Some kids need to take short-acting inhalers like albuterol before exercise, which helps keep their lungs open as they get active. As long as all the other symptoms above apply, a child using a rescue inhaler before physical activity is still considered to be in the green zone, says Rezaee.
Children with asthma may also need to take daily medications to stay in their green zone, even if they have no symptoms. For example, inhaled steroids like budesonide (Pulmicort) or fluticasone (Flovent) help prevent asthma symptoms for hours by reducing excess mucus and airway swelling.
When your child experiences asthma symptoms, they have entered the yellow zone. “This is the warning zone,” says Rezaee.
Your child may be in their yellow zone if they experience the following:
When yellow zone signs and symptoms happen, your action plan should tell you exactly what to do. “Follow the action plan’s instructions to help bring symptoms under control,” says Rezaee.
Treatments in this zone focus on rescue medications to reverse airway tightening, says Wong, and may include quick-relief medicine, like an albuterol inhaler or a combination inhaler with corticosteroids to lessen swelling and mucus.
“Parents should call their child’s doctor if yellow zone symptoms persist despite following the action plan’s medication instructions or if symptoms are worsening,” says Wong. If your child moves into their yellow zone two or more times per week, their treatment plan may need an adjustment, and their provider can help with this.
If your child enters their red zone, it’s an emergency. Red zone symptoms include:
Quickly worsening symptoms
Short-action medicines aren’t working
Chest pain or tightness
Nostril flaring
Fast, hard, or shallow breathing
Difficulty walking or talking from breathlessness
Ribs or stomach moving in and out deeply with breaths
Hunched shoulders (posturing)
Flared nostrils with breaths
Bluish tint to tongue, lips, fingertips, nailbeds, or around the eyes (cyanosis)
Visible ribs when breathing in (retractions)
Your child’s red zone steps will list medications to take, and tell you to call 911 or take your child to the emergency room immediately.
Consider taking your child to the hospital for asthma if they experience any red zone symptoms.
“If your child is having severe symptoms such as difficulty breathing, constant coughing, trouble speaking, or blue lips or fingernails, follow the red zone steps and contact your provider immediately. If symptoms do not improve right away, call 911 or go to the emergency room,” says Rezaee.
Once symptoms are controlled, schedule a follow-up visit with your child’s provider shortly after a visit to the emergency department or a hospitalization.
If your child doesn't have an asthma action plan, make an appointment with their provider to develop one as soon as you can. You should also see their provider to update their plan at least once or twice a year, and sooner if they’re experiencing more symptoms, says Rezaee.
A child’s asthma symptoms can change seasonally, as they grow or pass puberty, or if they experience a change in their home or school environment, says Parikh.
An action plan may need updating if you notice these signs:
Medications don’t work as well as they used to.
Your child needs to use their quick-relief inhaler more often.
Asthma symptoms happen more than twice a week.
Your child wakes up because of asthma more than twice a month.
Oral corticosteroids (like prednisone) are needed more than twice a year.
Wong recommends reviewing your child’s asthma action plan with their medical team whenever there’s a change in therapies and at every asthma checkup — typically every three to six months. “Regular reviews ensure the plan remains current, effective, and reflects any changes in medications and dosages. It is also an opportunity to improve a family’s understanding of asthma and health literacy,” says Wong.
An asthma action plan plays a vital role in keeping any child’s asthma well-controlled.
Asthma action plans tell you if your child is in their green, yellow, or red zone, and what you should do for each.
Your provider can help you keep your child’s asthma action plan updated with each checkup — at least once a year — to prevent asthma attacks and keep them active and healthy.
