7-CAPE—4/2017

Asthma discharge plan

CHICAGO Plan

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Child’s name

Date

Doctor’s signature

Date

Take your asthma medicine

Things to know about oral steroids: • is another powerful “rescue” medicine • if you were given these in the emergency room, it is very important that you finish them! Things to know about rescue medicine: • should be used only if your child is having symptoms during an asthma attack/ with symptoms • is typically albuterol with a name like: Proventil, Pro-Air, Ventolin, Xopenex Things to know about controller medicine: • should be used every day, even if your child has no symptoms • examples include Pulmicort, Flovent, Azmacort, Advair • may be an allergy medication, such as Singulair and Accolate

Your oral steroid is:

1 st dose time/date Howmuch How often For how long It is very important you complete the dosage

Pills

Liquid

Your “rescue” medicine is:

Mark your meds at the pharmacy:

1 st dose time/date Number of puffs How often For how long After that, use ONLY when symptoms occur

red sticker for “rescue” medicine

Inhaler

Spacer

Mask

Nebulizer

Your “controller” medicine is:

Mark your meds at the pharmacy:

1 st dose time/date Number of puffs How often

green sticker for “controller” medicine

Inhaler

Spacer

Take every day EVEN IF no visible symptoms

Mask

Nebulizer

Other:

See your child’s doctor within 3 days of your ER visit

Doctor’s name

Clinic telephone number

Your appointment date and time

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