Asthma and action plan


My asthma has being very up and doctor over the last few months so I have been backwards and forwards to the doctors. My peak flow is like a spike mountain at the moment so before long I think I will start naming them lol. I am under a lot of stress at the moment due to personal issues.

I am on many different medications not just for asthma:

Salbutamol Breath- Actuated Inhaler -2 puffs as required

Fluticasone and Salmeterol Cfc- Free Inhaler 250 - two puffs twice a day

I take this inhaler with a spacer

Montelukast Sodium Tablets 10mg

One to be taken daily

Prednisolone when needed

Epilim Chrono M/R Tablets 500mg

One to be taken at night

Epilim Chrono M/R Tablets 200mg

One to be taken each morning

Fexofenadine HCL 120mg tablets

one to be taken in the morning

Azelastine 0.05% Eye Drops

Put one drop three times a day

]I went to see the asthma nurse at my surgery on the 10th April for my annual review. she asked my about my asthma and me to do a peak flow it was 380 so below my personal best. She asked if I had an asthma action plan, which I don't. She also asked me if I needed any steroids to keep at home and if I did she would speak to the asthma doctor. Later that afternoon the nurse rung and said for me to make an appointment with the doctor in 2 weeks. She said that my asthma was very unpredicable at the moment and asked if I had been in hospital just lately.

I booked to go and see the asthma doctor on 26th April to go through an action plan and to pick up a prescription for some more prednisolone to keep at home for if needed. He listened to my chest and asked my to do my peak flow. I show him my asthma diary that I have been keeping at home. He said my asthma was not fully under controlled so he wants to see me in 2 - 3 months to see how I am getting on.

My action plan:

Zone 1

If you are feeling well and your peak reading is above 380 you should take: 2 puffs of your sere tide inhaler twice a day 1 micrograms of montelukast tablets once a day. Take your blue, reliever inhaler (salbutamol) for unexpected coughing, wheezing or breathlessness.

Zone 2

Zone 3

If you are becoming increasingly breathless and having to use your blue reliever inhaler every 4 to 6 hours or more often or peak flow is between 220 and 380, you should take: 6 prednisolone tablets (5mg strength) immediately and every morning until your symptoms are better and your peak flow is above 380 for two days, then take 3 tablets every morning for the same number of days that it took you to get better and then stop the tablets. Let your doctor or nurse know within 24 to 36 hours that you have started a course of tablets. Also take 2 puffs of your seretide inhaler twice per day.

Zone 4

It is a medical emergency if your symptoms continue to get worse and your peak flow reading have fallen below 220. Get help immediately by telephoning your doctor or calling for an ambulance by dialling 999 or 911. You should take 8 prednisolone (steroid) tablets immediately (5mg strength). Under these circumstances it's fine to use you reliever inhaler every 5 - 10 minutes until you receive medical attention.

I am really nervous about taking my reliever in front of people i don't like people asking me if I am ok and so I try to take it away from people which is not always possible, as I work in a college with students with severe learning difficulties. So my job can be quite challenging at times.

I really hope that I never get to zone 4 as I have a real fear of hospitals.

Sorry for the long post I just hope my asthma get under control soon.


9 Replies

  • Hi Rachel,

    Just wanted to leave you a message so you know your are not alone, I cant really help much I can sympathise so much atm. I also work in a college and find it hard to admit when I need to take inhalers etc as there are always so many people around that it can make you really self conscious but I've been learning the hard way to just suck it up and do it this week as mine has gone out of control too.

    I also recognise the epilim, I dont know why your on it and I wont ask but I do know how frustrating it can be to be taking other meds alongside that too.

    I hope things improve for you soon


  • I am on epilim as I used to have blackouts which are now controlled. I also have hay fever

  • Hi my daughter has had severe uncontrolled asthma for 11 years now she has been under a consultant since age 11 up untill then her asthma was controlled by the usual ble and brown inhalers and seeing the GP or asthma nurse.

    No one knows why her asthma became so severe we have been under some fantastic consultants she has had lung washes x rays and other tests however it remains severely uncontrolled.

    at first when she was around 12/13 her peak flow would drop conciderably low without any warning almost always at night and drop to the red zone of 100 she always ended up in hospital and (luckily thank god) picked up really quickly this went on for a number of years we had open access to the respiratory ward for well over 5-6 years.

    Her medication at this time was blue inhalers as and when monteklast (forgive spelling) a low dose antibiotic , antihistermine 6x5mg predisilone every day this continued with hospital admissions and nebuliser until she transfered to adult are at the age of 17.

    a change of consultant by chance following an admission to hospital with her left kidney failing led to further tests re such long use of oral steroid the consultant took her on (as he is also a chest specialist) and a plan was made to ""manage"" hr asthma.

    This plan is she has open access to his specialist asthma nurse at any time - she is seen every 3 weeks in clinic her kidney function is kept close eye on and she is now trialing the injected steroid alongside a 5mg oral steroid each day with the usual blue inhalers she also has a nebuliser at home to use at night (as this stil remains her worst time) and so far this managment is managing her asthma to a degree where she can function as normally as she can.

    She can't walk far can't do any exercise that raises her heart rate at all as this brings on the inevitable attack but she works part time she has an excellent employer who gives her time off if she needs it anytime and she has a beautiful little girl with her partner the pregnancy actually did not make her asthma any worse and she was seen more regularly and kept a clsoe eye on. Her labour had to be induced early and she had to have an epidural and steriod drips up but she managed really well with only a couple of attacks before baby was born naturally.

    She is still the same as before baby, but obviously more tired as babies make you!!! and her asthma still interrupts her at night. However her partner is self employed and all grandparents and family love helping out so she can rest if need be or is having a bad day.

    She is just waiting to go for a bone scan as bits of bone are starting to stick out on her legs obviously due to the length and anmount of oral steroids

    However her life remains as always positive and as fulfilling as possible

    So please never give up I am sure that the very clever scientists will eventually find a cure for this horrible life threatening condition - which still unfortunately people percieve as ""have a puff on the inhaler and you'll be fine"" and I include professionals such as the police , teachers when I use the term people in this as we know all to well in this 21st century people are still dying from asthma.

  • Just wanted to say I sympathise, hope things improve for you soon


  • Hi everyone,

    How r u all?

    My peak flow is up and down at the moment some days it is my personal best and other day it is well below my best.

    Yesterday I was feeling fine while I was at work but later on in the evening my sinus became very painful, also a painful headache and feeling sick.

    My chest has also become quite tight and it hurts to breath in feeling very worn out at the moment. My peak flow is 360 this evening so I have started on my steroids as my action plan stats.

    So will see how I feel and may have to go back my GP.


  • Hi,

    I have some chest pain when I am breathing in and out what does this mean? My chest also feels tight. I have also being needing my reliver every 4-6 hours.

    I am in zone 3 of my action plan which stats I should 6 pred which I have done and reduced as stated above. It also also says I have to contact my doctor in 24 - 36 hours to say - have started my course of pred and am on zone 3.

    When I ring my surgery will the doctor or nurse want to see me or will their speak to me on the phone?

    This is my first plan so I do not know how everything works and I quite worried about ringing my doctor.

    Has anyone got any answers to my question.

    Thanking you in advance


  • Hi Rachel

    My asthma isn't nearly as difficult as yours clearly is, so i don't feel I can help much there, but i do know from experience that stress can make your asthma worse. Is there any way that you can reduce your personal stress levels at the moment, or someone that you could ask to help you deal with whatever is causing the stress?

    Don't worry about calling your GP - if it's on your action plan it's the right thing to do!

    Hope you're feeling better soon.


  • I would hope if your doctor is good he would want to see you in person as he would need to check oxygen saturation and peak flow and to check how you are, which you can't do over the phone. If you are a frequent flyer at your GP's surgery and see your GP often about your asthma you might get away with a phone call to say you have started pred and to get extra added to your prescription if you need them. Don't worry about contacting them, they are there to help...

  • Hi all,

    Started coughing yesterday at work in the classroom took my reliever feeling a lot better.

    Not feeling to good today so did not go to work today.

    This morning when I did my peak flow I started to cough and have now pulled a muscle in my upper back, really painful.

    Went to see the doctor this morning who has put me on some strong painkiller and have been told to carrying on with my steroids tablet to help improve my asthma.


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