Asthma Action Plan

Executive Summary

The Partners Pediatric Asthma Action Plan was designed to aid in the documentation of a strategy for managing asthma symptoms as well as to improve adherence to recommendations for assessing asthmatic patients.  This template exists as a form paragraph which is inserted into the patient’s note in his or her electronic medical record.  This allows the provider to modify the paragraph and document the appropriate information for that child.  In its current form, it is meant to be used during a visit to specifically review and/or develop a patient’s ‘action plan’ for managing his/her asthma.  This web site includes a view of the form paragraph and directions for use.    


This template was developed under a grant from the Agency for Healthcare Research and Quality (AHRQ), Improving Pediatric Safety and Quality with Healthcare IT, in collaboration with the Partners HealthCare System Quality Improvement Group, the Massachusetts General Hospital for Children, and Partners HealthCare System Inc. Information Systems.  Listed below are the names of clinicians and experts who contributed to development of the template.  In addition, the LMR Pediatric Content Subcommittee and the main LMR Content Committee reviewed the template, and approved it for use with the Partners Longitudinal Medical Record (LMR).


Timothy Ferris, MD, MPH; Stephen Morgan, MD; Eric Poon, MD, MPH; James Perrin, MD; Shelly Bernstein, MD; Peter Greenspan, MD; John Co, MD, MPH; Mark Mandell, MD. 



Asthma Action Plan Template #1

Provider checks off patient triggers. Provider selects green, yellow, and red zone medications and directions.

Asthma Action Plan Template #2

Asthma Action Plan Template #3

Asthma Action Plan Template #4

Asthma Action Plan Template #5

The asthma action plan appears in the visit note as above. Providers can modify the note as needed.


These tools were created using national, state, and local guidelines, and group consensus regarding best practices. These guidelines, and their interpretation by clinicians at Partners Healthcare System, may not represent the standard of care across all regions or settings, and are not intended to be adopted or applied without independent assessment of their suitability for a particular setting. Moreover, guidelines change over time (for example, the age range for children who should receive influenza vaccinations was recently extended to 59 months). The rules and/or reminders contained within these templates may need the addition or modification of certain items to ensure that they remain consistent with current guidelines. Therefore, the tools included here are intended only as examples or guides for the development of similar templates in other settings. Partners Healthcare System and its affiliates disclaim any and all responsibility or liability associated with the use of the templates displayed here by third parties.