Asthma Is Getting Worse First Add: quick-relief medicine–and keep taking your GREEN ZONE medicine. Cough, wheeze, chest tightness, or puffs, 4every 20 minutes for up to 1 hour shortness of breath, or onceNebulizer,
Waking at night due to asthma, or If applicable, remove yourself from the thing that made your asthma worse.
Can do some, but not all, usual activities Second If your symptoms (and peak flow, if used) return to GREEN ZONE after 1 hour of above treatment: monitoring to be sure you stay in the green zone. ContinuePeak flow: to -Or(50 to 79 percent of my best peak flow) If your symptoms (and peak flow, if used) do not return to GREEN ZONE after 1 hour of above treatment: Take:
Add: mg per day.  For  (3–10) days (oral corticosteroid) the doctor hours after taking the oral corticosteroid.(phone)
Medical Alert! Take this medicine:
Very short of breath, or
Nebulizer Quick-relief medicines have not helped, or (short-acting beta2-agonist) Cannot do usual activities, or mg Symptoms are same or get worse after (oral corticosteroid) 24 hours in Yellow Zone.
Then call your doctor NOW. Go to the hospital or call an ambulance if
You are still in the red zone after 15 minutes AND
Peak flow: less than
You have not reached your doctor.
(50 percent of my best peak flow)
Trouble walking and talking due to shortness of breath puffs of your quick-relief medicine 6AND Lips or fingernails are blue
Go to the hospital or call for an ambulance                                  NOW!
Allergy Atopic dermatitis Allergic rhinitis Elevated total serum IgE levels (first year of life) Peripheral blood eosinophilia >4% (2–3 yr of age) Food and inhalant allergen sensitization
Girls Asthma associated with obesity and early-onset puberty Triad asthma (adulthood)
Lower respiratory tract infection Respiratory syncytial virus, parainfluenza Severe bronchiolitis (e.g., requiring hospitalization) Pneumonia
From Liu A, Martinez FD, Taussig LM: Natural history of allergic diseases and asthma. In Leung DYM, Sampson HA, Geha RS, et al, editors: Pediatric
Allergy: Principles and Practice. St Louis, 2003, Mosby, p 15.
to severe asthma, or have a history of severe exacerbations. Peak flow monitoring also can be useful in children who are still learning to recognize asthma symptoms.
To use a peak flow meter, a child should be standing with the indicator placed at the bottom of the scale. The child must inhale deeply, place the device in the mouth, seal the lips around the mouthpiece, and blow out forcefully and rapidly. The indicator moves up the numeric scale. The PEFR is the highest number achieved. The test is repeated three times to obtain the best possible effort. Peak flow meters are available as low range (<300 L/sec) and high range (<700 L/sec). It is important to provide the appropriate range meter so that accurate measurements can be obtained and children do not become discouraged because their exhalations barely move the indicator.