An asthma action plan converts a vague instruction — watch them, and come back if worried — into something a parent, a grandparent or a school nurse can actually follow at 2am. Children with a written plan that is reviewed and understood do better. The plans that fail are almost always the ones written once, filed, and never revisited.
What an action plan is
It is a short written document, specific to your child, that sets out three things: what to do when they are well, what to do when symptoms start, and what counts as an emergency. It should name your child's actual inhalers and actual doses, not generic categories.
Most plans use a traffic light structure, which works because it is instantly understandable by someone who is frightened and not thinking clearly.
The green zone: well
Your child is playing, sleeping and exercising normally. No night waking, no cough on running, reliever needed no more than twice a week.
- Preventer inhaler taken every day, at the stated dose, even though they feel fine
- Always through a spacer
- Rinse the mouth afterwards if using a steroid inhaler
- Reliever available at home and at school
The commonest failure at this stage is stopping the preventer because the child is well. That is what a working preventer looks like.
The amber zone: symptoms starting
Coughing more, waking at night, needing the reliever more than usual, wheeze with activity, or a cold starting in a child whose asthma always flares with colds.
- Reliever inhaler: the plan should state the number of puffs and how often, typically repeated at defined intervals
- Give each puff separately through the spacer, with several breaths per puff
- Some plans include a step up in preventer treatment at this point — only if your doctor has written it in
- State clearly when to start any rescue oral steroid, if your child has one prescribed
- State when to contact the clinic, and how
The red zone: emergency
This section should be unambiguous, because it will be read in a hurry.
- Is too breathless to complete a sentence, feed, or speak normally
- Has blue or grey lips or fingertips
- Is not improving after the reliever, or improvement lasts less than a few hours
- Is breathing fast, with ribs or the hollow at the neck sucking in
- Is drowsy, floppy or unusually quiet during an attack
- Is agitated or frightened in a way that is out of character
The plan should say exactly what to do on the way: continue giving reliever puffs through the spacer while getting help. A quiet chest is not reassuring — it can mean too little air is moving.
What makes a plan actually work
It names real medicines
"Take your preventer" is useless to a grandparent. The device name, colour, dose and number of puffs should be written out.
Everyone who looks after the child has a copy
School or nursery, both parents if they live separately, grandparents, and anyone who does the school run. Schools generally require a copy before holding a spare reliever.
It is reviewed
At least annually, after any emergency attendance, after any course of oral steroids, and whenever the treatment changes. A plan describing an inhaler your child no longer uses is worse than no plan.
Technique is checked against it
A plan that says four puffs is meaningless if the technique delivers almost nothing to the lungs. Bring the inhaler and spacer to every appointment. See the inhaler and spacer technique guide.
It accounts for the specific triggers
A child whose attacks follow dust events, or who flares every time they start back at school, should have that written in with the pre-emptive action.
Common mistakes I see
- The preventer stopped during the good months. Asthma control is maintained, not restored.
- Reliever overuse treated as normal. Needing it more than twice a week outside exercise means control is inadequate, not that the child needs more reliever.
- No spacer, or a spacer that has never been washed. Spacers should be washed in warm soapy water and left to air dry, not rinsed and towel-dried, which builds static.
- A plan written for a five-year-old still in use at eleven.
- No school copy, so treatment is delayed for the hours that matter most.
Triggers worth writing into a UAE plan
Local plans should name local triggers. Dust and shamal events, which produce clusters of attacks — see dust storms and childhood asthma. House dust mite, sustained year round by air-conditioned sealed buildings. Mould around cooling units. Rapid temperature change between outdoors and heavily cooled interiors. Shisha and tobacco smoke. Where an attack reliably follows a known trigger, the plan can include pre-emptive action rather than waiting for symptoms.
Getting one
An action plan should come out of a consultation, not a template. It needs your child's current medicines, a realistic assessment of how well controlled they are, and a review date. If your child has asthma and does not have a written plan, that is worth raising at the next appointment — and if they have had an emergency attendance or a course of oral steroids in the past year, it should be reviewed regardless of what the plan says.
Clinical references
- Brand PLP, et al. Definition, assessment and treatment of wheezing disorders in preschool children: an evidence-based approach. ERS Task Force. Eur Respir J 2008;32:1096–1110. View source →
- Morice AH, et al. ERS guidelines on the diagnosis and treatment of chronic cough in adults and children. Eur Respir J 2020;55:1901136. View source →
Frequently asked questions
What is a children's asthma action plan?
What are the green, amber and red zones?
How often should an asthma action plan be reviewed?
Should my child's school have a copy of the asthma action plan?
How do I know my child's asthma is not well controlled?
