Your Health Care Provider's Name  Your Health Care Provider's Phone: 
Your Predicted Peak Flow:                                                                 Your Personal Best:                     

GREEN ZONE    GO!        BREATHING IS GOOD No cough or wheeze Can play and sleep Peak flow above  CONTROLLER    MEDICATION                STRENGTH           AMOUNT              TIMES / DAY None Needed ADVAIR DISKUS ADVAIR HFA ASMANEX TWISTHALER FLOVENT HFA PULMICORT FLEXHALER PULMICORT RESPULES SYMBICORT HFA QVAR Select Strength - Select Amount - Select 1 2 - times / day Gargle, rinse mouth, and spit after each dose None Needed ACCOLATE SINGULAIR (chewables) SINGULAIR (packet) SINGULAIR (tablets)   Select Strength - Select 1 2 - times / day None Needed FLUTICASONE (Flonase) NASONEX RHINOCORT AQ VERAMYST   Select Amount 1 spray/nostril 2 sprays/nostril - Select 1 - times / day None Needed ASTELIN (Azelastine) CETIRIZINE (Zyrtec) CETIRIZINE SYRUP (Zyrtec) CYPROHEPTADINE CYPROHEPTADINE SYRUP DESLORATADINE SYRUP (Clarinex) DESLORATADINE TABLET (Clarinex) DESLORATADINE REDITAB (Clarinex) DIPHENHYDRAMINE(Benadryl) DIPHENHYDRAMINE SYRUP(Benadryl) FEXOFENADINE(Allegra) FEXOFENADINE SYRUP(Allegra) HYDROXYZINE HYDROXYZINE SYRUP LEVOCETIRIZINE (Xyzal) LEVOCETIRIZINE SYRUP (Xyzal) LORATADINE(Claritin) LORATIDINE SYRUP(Claritin) XYZAL TABLET (Levocetirizine) Select Strength - Select Amount - Select - times / day - Always use a spacer or holding chamber with MDI. Use Reliever 10-15 minutes before exercise   YELLOW ZONE SLOW DOWN!  HAVING TROUBLE  BREATHING Coughing and wheezing Chest tight Wake up at night Peak flow between   and  RELIEVER  MEDICATION                       STRENGTH         AMOUNT           TIMES / DAY  None Needed ALBUTEROL HFA (ProAir, Proventil, Ventolin) XOPENEX HFA Select Amount 2 puffs 4 puffs 6 puffs - Select Dose - OR None Needed ALBUTEROL SOLUTION XOPENEX SOLUTION Select Strength - Select Dose - - Recheck symptoms 15 minutes after taking reliever. Advance to red zone if not improving.  CONTINUE YOUR CONTROLLER None Needed ADVAIR DISKUS ADVAIR HFA ASMANEX TWISTHALER FLOVENT HFA PULMICORT FLEXHALER PULMICORT RESPULES SYMBICORT HFA QVAR   Select Strength - Select Amount - Select 1 2 - times / day Gargle, rinse mouth, and spit after each dose None Needed ACCOLATE SINGULAIR (chewables) SINGULAIR (packet) SINGULAIR (tablets)   Select Strength - Select 1 2 - times / day None Needed FLUTICASONE (Flonase) NASONEX RHINOCORT AQ VERAMYST   Select Amount 1 spray/nostril 2 sprays/nostril - Select 1 - times / day None Needed ASTELIN (Azelastine) CETIRIZINE (Zyrtec) CETIRIZINE SYRUP (Zyrtec) CYPROHEPTADINE CYPROHEPTADINE SYRUP DESLORATADINE SYRUP (Clarinex) DESLORATADINE TABLET (Clarinex) DESLORATADINE REDITAB (Clarinex) DIPHENHYDRAMINE (Benadryl) DIPHENHYDRAMINE SYRUP (Benadryl) FEXOFENADINE (Allegra) FEXOFENADINE SYRUP (Allegra) HYDROXYZINE HYDROXYZINE SYRUP LEVOCETIRIZINE (Xyzal) LEVOCETIRIZINE SYRUP (Xyzal) LORATADINE (Claritin) LORATIDINE SYRUP (Claritin) XYZAL TABLET (Levocetirizine) Select Strength - Select Amount - Select - times / day  - If not back in the Green Zone in 48 hours, call your Health Care Provider.  - No outside activities on high ozone days.    RED ZONE     STOP!!!     ASTHMA IS OUT OF  CONTROL Increased yellow zone symptoms Reliever medicine isn't working Breathing hard and fast Can't walk or talk well Can't sleep Peak flow below  RELIEVER  MEDICATION                       STRENGTH          AMOUNT           TIMES / DAY None Needed ALBUTEROL HFA (ProAir, Proventil, Ventolin) XOPENEX HFA Select Amount 2 puffs 4 puffs 6 puffs - Select Dose - OR None Needed ALBUTEROL SOLUTION XOPENEX SOLUTION Select Strength - Select Dose - - While taking your reliever medicine, call your Health Care Provider for advice or go to the Emergency Room. DANGER! Follow these steps:  - *For skin color changes or blue lips, call 911.  - *If still in the Red Zone after 3 treatments or if not better, call 911.   - *Call your Health Care Provider whenever taking Red Zone Medicines.

CHILDREN'S MEDICAL CENTER DALLAS 1935 Medical District Drive - Dallas, Texas 75235 (214) 456-7000