Children’s Health Queensland Hospital and Health Service

Choose an item. (Affix patient identification label here or complete below) URN: FIN: Family name: Given names: Address: Date of birth: Sex: Choose an item. FOR: Date: Click to enter a date Completing Doctor: Treating facility: EVERYDAY MEDICATIONS Reliever medication: Salbutamol Dose: ALWAYS use a spacer (+/- mask) Currently on a preventer? ☐ Yes ☐ No If yes - Type: Choose an item. Dose: DISCHARGE ACTION PLAN – FIRST DAYS AFTER DISCHARGE FROM HOSPITAL Reliever medication: Salbutamol Dose: Choose an item. ALWAYS use a spacer (+/- mask) Day 1 Every 3 hours including overnight Day 2 (if improving) Every 4-6 hours Day 3 and 4 (if continuing to improve) Every 6-8 hours Day 4 and after Return to your Everyday Action Plan below Has a preventer been prescribed? ☐ Yes ☐ No If yes - give as instructed in your Everyday Action Plan above Additional management information? Has an oral steroid been prescribed/given for this episode? ☐ Yes ☐ No If yes - type of oral steroid prescribed/given: Choose an item. Dose: Duration: EVERYDAY ACTION PLAN WHEN WELL No symptoms Always carry the reliever and spacer (and a mask if needed) with you. Continue to use preventer medication (if prescribed). WHEN NOT WELL Cough or wheeze Take the reliever as required up to every 3 hours. Keep a close watch on symptoms. IF SYMPTOMS DO NOT GET BETTER OR SYMPTOMS GET WORSE Needing the reliever more often than every 3 hours, waking at night with wheezing or continuing to need the reliever at least every 3 hours for more than 24 hours. Book an URGENT same day appointment with your GP or take your child to the Emergency Department for review DANGER SIGNS Symptoms get worse very quickly, very hard to breathe or talk, lips look blue. Dial 000 for an ambulance. Continue to take reliever every 5 minutes until the ambulance arrives. Life-threatening attacks are always possible. EXERCISE PLAN ☐ Yes ☐ No If yes - Take reliever 5-10 minutes prior to starting exercise. If symptoms develop, take reliever as required and monitor. FURTHER INFORMATION See fact sheets on Asthma, Pre-school Wheeze and Puffers and Spacers at www.childrens.health.qld.gov.au Adapted from the National Asthma Council of Australia Asthma Action Plan