Updated DC Asthma Action Plan Form Now Available
The 2012 revised
DC Asthma Action Plan fill-in-the-blank PDF form is now
available in English and Spanish based on the
National Heart, Lung, and Blood
Guidelines for the Diagnosis and Management of Asthma. The
recommend that ALL children and adults with asthma have a written asthma
action plan, developed jointly with their healthcare provider.
Initially developed in 2007 by community and
government partners through the National Capital Asthma Coalition and piloted at Children's National Medical Center, this
triplicate form includes copies to share with
schools, childcare providers, nursing homes, and other caregivers. It also
fulfills the requirements for the administration of, and/or student self-administration
of, asthma and anaphylaxis medication under DC's
to Treatment Act of 2007 (PDF: 42 KB/6 pages) (D.C.
Law 17-107; D.C. Official Code § 38-651.01 et seq.).
Lisa A. Gilmore, (202)
Download DC Asthma Action Plan Fill-in-the-Blank PDF Forms
to Use an Asthma Action Plan
Plans provide a detailed outline of how to manage asthma on a day-to-day
basis and describes what to do in an emergency. An
Action Plan should be completed by a healthcare provider in partnership with
the patient. Asthma Action Plans come in a number of different formats but
most commonly use a three-color (zone) system like that of a traffic signal:
Green Zone = Go
Yellow Zone = Caution
Red Zone = Danger.
Each zone has
assessment measures and tailored instructions specific to that zone. When
you match the symptoms (and peak flow measurements, if available) to the
correct color section, you will find the steps to take. Most individuals can
benefit from using both symptoms and peak flow measurements to determine
their current asthma zone, but either method is acceptable.
Asthma Action Plan was funded wholly, or in part, by the Government of the
District of Columbia, Department of Health, Community Health Administration,
District of Columbia Control Asthma Now (DC CAN) Program.
The National Capital Asthma Coalition
coordinated the development of the Asthma Action Plan with Children's
National Medical Center, DC's four Medicaid managed care organizations
(AMERIGROUP, DC Chartered Health Plan, Health Right, Inc., and Health
Services for Children with Special Needs, Inc.), DC Department of Health, DC
Public Schools, Mary's Center for Maternal and Child Health, Georgetown KIDS
Mobile Medical Clinic, Howard University Hospital, and other DC healthcare