(Last Updated On: July 11, 2023)

What is an Asthma Action Plan and the 4:4:4 Rule?

Asthma is a chronic respiratory disease that affects millions of people worldwide. It causes inflammation and narrowing of the airways, making it difficult to breathe. Asthma can be triggered by various factors such as allergens, exercise, stress, or pollution and can cause wheezing, coughing, chest tightness, and shortness of breath. To manage the condition, it’s helpful to have an asthma action plan.

Older man suffering with Asthma in a doctors appointment

Asthma Action Plan

An asthma action plan is a written document that outlines the steps patients should take when asthma symptoms worsen. The plan includes information on daily management, symptom recognition, medication use, and emergency response. An effective asthma action plan should be personalized to each individual’s needs and preferences.

Creating a personalized asthma action plan involves working closely with a healthcare provider who understands your specific needs and triggers. The plan should be updated regularly to reflect any changes in your condition or treatment.

Having an asthma action plan provides the following benefits:

  • Improved asthma control: Patients who follow an asthma action plan consistently can achieve better control of their symptoms and stay on top of their condition.
  • Reduced emergency room visits: When patients know how to manage worsening symptoms at home, they may not need to visit the emergency room as often.
  • Better communication with healthcare providers: An up-to-date copy of an asthma action plan ensures that healthcare providers are aware of your current condition, treatment plans, and medication doses.

Asthma Action Plan Zones

An asthma action plan is divided into three zones: green, yellow, and red. In the green zone, patients with persistent asthma and good asthma control have good lung function with no or minimal symptoms. Patients are advised to continue their asthma care by taking their usual medication at the dose prescribed by their doctor.

In the yellow zone, patients with persistent asthma have mild-to-moderate symptoms with reduced lung function. Patients are advised to increase their medication dosage to a medium dose according to the instructions provided in the fact sheet to improve their asthma control.

In the red zone, patients with persistent asthma and poor asthma control have severe symptoms with low lung function. Patients are advised to take immediate action by following emergency procedures such as using an inhaler or seeking medical attention.

The medications used in each zone include bronchodilators such as salbutamol and corticosteroids such as beclomethasone. These medications are essential for achieving optimal asthma control and preventing exacerbations. Theophylline and zileuton are also used in combination with these medications to manage symptoms effectively.

4:4:4 Rule for Asthma Emergencies

The 4:4:4 rule describes the steps to take in an asthma-related emergency. Research shows the rule is effective for improving asthma control and reducing hospital admissions. The steps are as follows:

Step 1: Sit Upright and Stay Calm

Experiencing an asthma attack can be frightening. The first step in the 4:4:4 rule is to sit upright and stay calm. Sitting up straight allows you to expand your lungs more fully and reduces pressure on the chest, making it easier to breathe. Staying calm is equally important since anxiety can exacerbate symptoms by causing rapid breathing and increased heart rate.

Step 2: Shake the Inhaler and Take Four Puffs

Shake your inhaler well before use. Then hold it upright with one hand while removing the cap with the other. Breathe out slowly away from your inhaler before placing the mouthpiece between your teeth and closing your lips around it. Then inhale deeply through your mouth while pressing down on the canister to release the medication into your lungs. Hold your breath for about 10 seconds after inhaling to allow time for the medication to deposit deep within lung tissue where it can be most effective.

Step 3: Wait Four Minutes and Take Four More Puffs if Needed

Wait four minutes after puffing the inhaler to allow the medication to reach its full potential. If symptoms persist, take another four puffs of the inhaler. Waiting four minutes before taking more medication can be challenging while experiencing severe asthma symptoms, but following this step ensures that you take the appropriate dose of therapy and don’t overuse your inhaler.

Step 4: If Symptoms Persist, Call an Ambulance

If symptoms remain severe, calling an ambulance is the best option to prevent further complications. The effects of severe asthma can be life-threatening, and it is crucial for patients to seek medical service as soon as possible.

When calling an ambulance, provide all necessary information about your condition. You might provide details on how long you have been experiencing symptoms, whether you have taken any medication or not, and if you have any underlying conditions or allergies.

If discharge from the emergency department is not an option, admission to the hospital may be necessary to manage the condition. Severe asthma attacks can cause damage to lung function that needs ongoing monitoring and treatment, so make sure you follow up with your healthcare provider after receiving emergency care.

Common Mistakes to Avoid During Asthma First Aid

Delaying first aid can lead to severe consequences. The longer one waits to administer first aid, the more severe the symptoms become, making it harder to manage them effectively. Therefore, it’s crucial to act promptly when someone is experiencing an asthma attack.

Using expired or unfamiliar medication during first aid can worsen the situation. Always check the expiry dates on medications before using them and ensure you know how to use them correctly.

Giving too much medication may cause adverse side effects like increased heart rate or blood pressure in some people with pre-existing conditions. Therefore, always follow prescribed dosage instructions carefully when administering medication during first aid.

Ignoring signs of worsening asthma symptoms can be dangerous and lead to a life-threatening situation. If you notice any changes in your breathing pattern or if you start to feel dizzy or lightheaded, seek immediate medical attention.


Having an asthma action plan in place is vital, as it helps you stay prepared and respond promptly during an attack. If an emergency occurs, knowing the 4:4:4 rule can save lives. Remember to sit upright and stay calm, shake the inhaler and take four puffs, wait for four minutes before taking another four puffs if needed, and call an ambulance if symptoms persist.

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