Name:...................................................

Date:.............................

Best Peak Flow:*:...........

*Not recommended for children under 12 years

WHEN WELL

Preventer:..................................

Dose:....................................

Peak flow above

.................................................

Dose:....................................

Reliever:..................................................................

Dose:....................................

Symptom controller (if prescribed):

..................................................

Dose:....................................

Combination medication (if prescribed):

..................................................

Dose:....................................

WHEN NOT WELL

Preventer:......................................

Dose:....................................

Peak flow between

Reliever:

Dose:....................................

Continue symptom controller

and

Continue combination medication

Continue on this increased dosage for........................................... before returning to the dose you take when well.

IF SYMPTOMS GET WORSE

Start prednisolone/prednisone and contact doctor

Dose:....................................

Peak flow between

• Stay on this dose until your peak flow is above............................on two consecutive mornings

• Reduce prednisolone/prednisone to dose .......................daily for...................days, then cease

and

Extra steps to take...................................................................................................

When your symptoms get better, return to the dose you take when well.

DANGER SIGNS

Peak flow below

WHEN WELL

• be free of regular night–time wheeze or cough or chest tightness
• have no regular wheeze or cough or chest tightness on waking or during the day
• be able to take part in normal physical activity without getting asthma symptoms
• need reliever medication less than 3 times a week (except if it is used before exercise)

WHEN NOT WELL

You will

• have increasing night-time wheeze or cough or chest tightness

• have symptoms regularly in the morning when you wake up

• have a need for extra doses of reliever medication

• have symptoms which interfere with exercise

(You may experience one or more of these) 

IF SYMPTOMS GET WORSE, THIS IS AN ACUTE ATTACK

You will

• have one or more of the following: wheeze, cough, chest tightness or shortness of breath

• need to use your reliever medication at least once every 3 hours or more often 

DANGER SIGNS

• your symptoms get worse very quickly

• wheeze or chest tightness or shortness of breath continue after reliever medication or return within minutes of taking reliever medication

• severe shortness of breath, inability to speak comfortably, blueness of lips

IMMEDIATE ACTION IS NEEDED: CALL AN AMBULANCE