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New York City Department of Health
Community Asthma Program

Name

 Date
Primary Care Provider

 Medical Record #

Phone Numbers

Clinic: Day || Night/Weekend
Taxi or Friend
Pharmacy

The colors of a traffic light will help you use your asthma medicines.

Green means Go Zone!
Use preventive medicine.

Yellow means Caution Zone!
Add quick-relief medicine.

Red means Stop Zone!
Get help from a doctor.

Personal Best Peak Flow.

GO
ACTION: Use these daily preventive anti-inflammatory medicines:

You have all of these:
  • Breathing is   good
  • No cough or   wheeze
  • Sleep through   the night
  • Can work and   play
Peak Flow from
__________

 to
__________
Medicine
How Much
How Often









CAUTION
ACTION: Continue with your medicine, as above, and ADD:

You have any of these:
  • First signs of a   cold
  • Exposure to   known trigger
  • Cough
  • Mild wheeze
  • Tight chest
  • Coughing at   night
Peak Flow from
__________

 to
__________
Medicine
How Much
How Often









DANGER
ACTION: Take these medicines until you talk to your doctor

Get help from a doctor now! Do not be afraid of causing a fuss.
Your doctor will want to see you right away. It's important!
Your asthma is getting worse fast:
  • Medicine is not   helping
  • Breathing is hard   and fast
  • Nose opens wide
  • Ribs show
  • Can't talk well
Peak Flow
 below

 __________
Medicine
How Much
How Often









If you cannot contact your doctor, go directly to the emergency room.
Do NOT wait. Call an ambulance (911) if necessary.

Make an appointment with your primary care provider within two days of an ER visit or hospitalization.

Additional information: Directions to the Provider can be found here.
Adapted from the NHLBI.

The Asthma Action Line telephone number is 1-877-ASTHMA-0 or 1-877-278-4620.

April 1999