This asthma action plan printable is a free, fillable plan for adults with asthma and for parents of children with asthma. You fill it in with your clinician, then keep it at home and share copies with school, work and caregivers.
An asthma action plan is a written plan you make with your health care provider. It says how to look after your asthma every day and what to do when symptoms change. This one uses green, yellow and red zones, with space for the signs, medicines and instructions your clinician gives you.
Download the Asthma Action Plan Printable
- Fill it in on your phone or computer, or print it
- US Letter and A4
- Includes a filled example
US Letter suits the US and Canada. A4 suits most other countries.
How it helps
Know what to do
Your clinician's signs, medicines and steps for each zone sit on one page, so you do not have to remember them in a hard moment.
Everyone follows the same plan
Family, school staff and caregivers read the same instructions and know who to call.
See how asthma has been
Check-ins and a visit review show how often you were in the yellow or red zone between visits.
How to use it
- Fill in Complete the plan with your clinician at your next visit, and ask them to sign and date it.
- Share Give a copy to family, school and anyone who looks after you.
- Check in On days with symptoms, note your zone and what may have set it off.
- Review Bring it to each visit and update what has changed.
What is inside
- My planYour details, your best peak flow if you use one, and the green, yellow and red zones with signs, medicines and your clinician's instructions. Includes a filled example.
- My supportWhat sets off your asthma, your care team, where your medicines are and who has a copy of your plan.
- My asthma check-insTwo log pages for the date, zone, symptoms, quick relief, peak flow and possible trigger.
- Before my next visitCounts since your last visit, what has changed, how your medicines are going and a card for your next appointment.
See a filled example
The example plan is for Maya Brooks, a child whose plan was made with Dr. Lee on September 8, 2026. Her green zone lists a daily controller inhaler, her yellow zone adds a quick-relief inhaler and a call to Dr. Lee's office, and her red zone ends with the reminder to call 911. Peak flow is ticked as not part of her plan, and Dr. Lee has signed and dated it.
Open the full PDFTips that make it work
- Bring the blank plan to your next visit and fill it in together. Ask your clinician to write each zone in their own words.
- If you need an asthma action plan for school, give a copy to the school nurse and list it on My support, so you know which copies to replace when the plan changes.
- Fill in a check-in only on days with symptoms. If you prefer your phone, the CareClinic app can hold the same notes.
- Write the expiry date of each medicine on My support and check it whenever you review the plan.
Bringing it to your doctor
Bring My plan, your check-ins and Before my next visit to each appointment. The counts on the review page give your clinician a quick picture of how often you were in the yellow or red zone, how many nights asthma woke you and any urgent visits. If your symptoms are getting worse or your medicines do not seem to help as they used to, contact your clinician. For red zone signs, call 911 (or your local emergency number).
Questions
What is an asthma action plan?
An asthma action plan is a written plan you make with your health care provider. It says how to look after your asthma every day and what to do when symptoms change or an attack starts. Many plans, including the one from the NHLBI, group these steps into green, yellow and red zones.
What does an asthma action plan include?
It includes the signs for each zone, the medicines to take with how much and when, and who to call. Some plans also include peak flow numbers if your clinician uses them. This printable adds your triggers, your care team, where your medicines are kept and who has a copy.
What is the yellow zone for asthma?
The yellow zone means your asthma is getting worse. On the NHLBI plan, yellow zone signs include cough, wheeze, chest tightness or shortness of breath, and waking at night because of asthma. Your clinician writes your own yellow zone signs and the medicines to add.
Who can fill out an asthma action plan?
Your doctor, nurse practitioner or other clinician who treats your asthma fills in the zones, medicines and instructions with you. You or a parent can add contacts, triggers and where medicines are kept.
Does an asthma action plan expire?
It can go out of date. A plan is only correct while the medicines and signs on it still match what your clinician wants. Review it at each visit, update the date on the plan and replace every copy when something changes.
Is this asthma action plan free?
Yes. It is free in A4 and US Letter sizes. Fill it in on your phone or computer, or print it and bring it to your next visit.
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References
- National Heart, Lung, and Blood Institute. Asthma Action Plan. https://www.nhlbi.nih.gov/resources/asthma-action-plan-2020