Using the Vermont Asthma Action Plan

You’ll need to make an appointment to fill out this form with your primary care provider. If you are a parent or caregiver, make an appointment to create or update this plan with your child’s provider at the start of every school year.

When making the appointment, ask the provider office if you should bring a copy of this form – some doctors keep them on hand, others do not. If needed, download and print out the Vermont Asthma Action Plan and bring it to the appointment.  

Think about and write down any questions or concerns you have before the appointment. During the appointment, ask the provider to talk through his/her instructions or notes on the plan. If you’re a parent/caregiver of a child with asthma, discuss and decide whether your child is able to carry and take their medications, or if it should be administered by a teacher or nurse. You’ll also need to give permission to any individuals who may speak with the provider or assist your child in taking their asthma medications.

After completing the Asthma Action Plan, make copies and – if possible – scan the document and share it with anyone who cares for your child. An Asthma Action Plan should go everywhere the person with asthma goes. Save a copy and keep it electronically on your phone or computer for easy reference or forwarding. Keep a printed copy at home, in the car, and at work. Email and share a printed copy with your child’s school nurse, teachers, and other staff or professionals who cares for your child. Offer to discuss the plan so they'll be comfortable following it.

If you are the parent or caregiver of a child with asthma, review this plan with your child. If they are old enough, they should know which steps and medications to take themselves and when they should get help from an adult like a nurse or teacher.

Whenever medication types or dosages change, review and revise the plan with your provider – we recommend at least every 6 months, or more often if symptoms become worse or more often than they used to. Any time the action plan is changed, give new copies to anyone who has one.