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Government of South Australia, SA Health

Asthma Action Plan for Children and Young People


If you require the older version of this form which supports multiple languages (but fewer dosage options) please click here.

This form generates a printed Asthma Action Plan for children and young people. Please complete the mandatory fields below and use other sections as required. Any sections not completed will be omitted from the printed plan. When complete this can be printed for patients, families and caregivers.

This resource is provided as a service to assist medical practitioners and families. However use of this form is at your sole risk. Women’s and Children’s Health Network does not guarantee that the information is correct. It does not constitute medical advice and may not be suitable for all patients or all users. If you use this on-line form and the generated Action Plan you are responsible for ensuring its accuracy, completeness and suitability. Further details of this disclaimer should be accessed here. No liability is accepted.

In order to generate a printed Asthma Action Plan you must use the Generate Action Plan button at the bottom of this form.

Check out the Help page to test your computer's language support, get some printing tips and other helpful hints to get the most out of this generator. For enquiries click here.

Patient Information

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*
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When Well

Reliever

Take only when necessary for relief of wheeze or cough.

*

Please note: Symbicort should only be used as a reliever as part of SMART therapy.

First Preventer

Please note: Singulair 10mg tablet is not PBS listed.

Second Preventer

Please note: Singulair 10mg tablet is not PBS listed.

Before exercise

When Not Well

Reliever

At first sign of a cold or a significant increase in wheeze or cough, take:

*

Please note: Symbicort should only be used as a reliever as part of SMART therapy.

Use up to every 3-6 hours as required


Is prescribed preventer same as above?



First Preventer

*

Please note: Singulair 10mg tablet is not PBS listed.

Second Preventer

Please note: Singulair 10mg tablet is not PBS listed.

Add a Message to 'When Not Well' Plan?


If Symptoms Get Worse - THIS IS AN ACUTE ATTACK

Reliever

Continue any preventer medications usually taken.

* every 3-4 hours as needed.

Prednisolone

immediately then once each morning for 3 - 5 days.

Additional Directions

Please note:These directions will appear on the form exactly as they are written here.
(They will not be translated into other languages.)


Add More Additional Directions: Please note: In English only.












Generate Asthma Action Plan

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Links

Asthma Device Fact Sheets Developed by WCHN

Australian Asthma Guidelines

National Asthma Council

Asthma Australia

Childcare Asthma First Aid Plan

School Health Care Plans (DECS) including Medication Authority

Medication

Lung Foundation Australia

© 2024 SA Health
Developed by Dr Paul Machet (2010), Dept of General Medicine, Women's and Children's Hospital, Nth Adelaide.
and Digital Media, Centre for Education and Training, Women's and Children's Hospital, Nth Adelaide, CET WCHN.
Updated 2018 Kate Roberts-Thomson (Respiratory Disease Management Nurse Consultant) WCHN.

Version: 6.0.1 - March 2018.

Original plan developed by Dr Mike South and the Royal Children's Hospital Melbourne. Adapted with permission.