Tools for Managing Asthma
If you or your child has asthma, you should have a written asthma management plan, also called an Asthma Action Plan.
The Vermont Asthma Action Plan is a detailed form that you can get from your doctor, or you can download and print the form and instructions.
The plan should describe exactly what needs to be done to:
- keep you well by taking your medications
- avoid asthma triggers
- recognize and treat asthma episodes
Your doctor or your child's doctor can help.
The doctor can help explain the Vermont Asthma Action Plan and answer any questions you may have. If the plan is for your child, be sure that you and your doctor both sign it, and send the second page to your child's school nurse. Keep the plan where you can find it quickly in an emergency.
Vermont Asthma Action Plan
Print and complete the Action Plan form:
- Vermont Asthma Action Plan Form (pdf) 255 KB, 2 pgs
- Instructions for Using the Electronic Asthma Action Plan (pdf)
Or Order a Hard Copy:
Contact your local Health Department District Office for a hard copy version of the Plan.
About the Vermont Asthma Action Plan
The Action Plan form was created by the Vermont Asthma Advisory Panel to help improve asthma care statewide through the use of written asthma management plans. When a child is involved, the plan provides a tool to improve asthma management and related communication between health care providers and the child's school nurse.
Developed initially for use with children, the plan can also be used with adults.
The actual Vermont Asthma Action Plan document is a triplicate form with the green, yellow and red zones printed on each page. The physician and parent signatures at the bottom of the page authorize the school nurse or child care provider to exchange information and oversee or administer asthma medications.
- the first page is intended to be kept by the physician
- the second page should be sent to the school nurse or early childcare provider, if a child is involved
- the third page given to the patient or parent
The back of the third page addresses trigger control and medication tips as well as resource contacts. It is designed to aid patient education. A peak flow chart is also provided for those individuals for whom peak flow readings are recommended. The form can be used to manage asthma using either symptoms or peak flow readings.