🚨ZONE WATCH — The Asthma Action Plan in Plain Language
Every person with asthma should have a written Asthma Action Plan from their clinician. Green / Yellow / Red zones tell you exactly what to do at each level. Track your peak flow (PEF) at home with a $20 meter to find your personal best, then use the zones below. If you're using a rescue inhaler more than twice a week, your asthma is not controlled — that's a fixable problem.
🎯Three Phases · One Force Field
Every square belongs to one of three phases of mastery. Inside each square's detail panel, the four sections — Concepts · Skills · Actions · Plan — are the building blocks of these phases.
📘 Learn It Tier 1 · Aware
Identity earned: Self-Advocate. The "know" — what asthma is (chronic airway inflammation + reversible bronchoconstriction), how severity is classified (mild intermittent → severe persistent), the T2-high vs non-T2 phenotypes that drive treatment choice, the goal-state framing (zero daytime symptoms / zero rescue use / zero ED visits / full activity), and the honest framing that asthma is one of the most controllable chronic conditions in medicine.
🛠 Live It Tier 2 · Active
Identity earned: Care-Team Member. The "do" — daily skills (SMART regimen adherence, correct inhaler technique with spacer, trigger control, Green/Yellow/Red zone Action Plan, peak flow + ACT tracking, vaccinations) and this-week actions that turn skills into habits — including building the family / school / employer Ambassador partnership.
📣 Share It Tier 3 · Certified
Identity earned: Ambassador. The "carry forward" — handle asthma identity honestly, mentor a newly-diagnosed person via AAFA, navigate the AA mortality disparity and Puerto Rican / Indigenous / rural / pediatric gaps, advocate for clean indoor air at school + workplace + home, and bridge to the biologic-revolution conversation for severe T2-high.
🛡️Your Force Field — 16 Squares
Click any square to open its detail panel. Each square is a tile in your shield. Keep clicking, learning, and acting — your Force Field gets stronger every step.
What Is Asthma?
A chronic disease of airway inflammation + reversible bronchoconstriction. Inflammation is the underlying state; bronchoconstriction is the episodic narrowing that produces symptoms (cough, wheeze, chest tightness, shortness of breath). ~25 million Americans (~1 in 12), including ~1 in 11 children. One of the most controllable chronic conditions in medicine — goal is zero symptoms, zero rescue use, zero ED visits, full activity.
Primer360 Human Anatomy
Airway, T2 Inflammation, Smooth Muscle
The lower airways (bronchi → bronchioles) are lined with epithelium + smooth muscle + mucus glands. In asthma: airway smooth muscle contracts (bronchoconstriction); epithelium activates type-2 (T2) inflammation via TSLP / IL-33 / IL-25 → Th2 cells / ILC2s → IL-4 / IL-5 / IL-13 → eosinophils + IgE + mucus + airway hyperresponsiveness + remodeling. Biologics target this cascade: anti-IgE (omalizumab), anti-IL-5 (mepolizumab / reslizumab / benralizumab), anti-IL-4Rα (dupilumab), anti-TSLP (tezepelumab).
AnatomyWho Gets It? — Phenotypes
T2-high (allergic): high eosinophils, high FeNO, high IgE, atopic history (eczema, allergic rhinitis), often childhood-onset — biologic candidates. T2-high (eosinophilic late-onset): adult-onset, high eos, often non-allergic. Non-T2 (neutrophilic, paucigranulocytic): smoking-related, obesity-related, older-onset, less responsive to inhaled steroids. Exercise-induced. Occupational (bakers, hairdressers, healthcare workers, agricultural). Aspirin-exacerbated respiratory disease (AERD): nasal polyps + asthma + NSAID sensitivity. Pediatric: 1 in 11 US children; viral triggers dominant.
PrimerThe Numbers — PEF, FEV1, ACT, FeNO, Eos
~25M Americans with asthma; ~1 in 12 adults; ~1 in 11 children. ~10 deaths/day in the US (~3,500/year — mostly preventable). Peak Expiratory Flow (PEF) — daily home; personal best drives zones. FEV1 spirometry — <80% predicted = poor control. FEV1/FVC ratio <0.7 = obstruction. ACT (Asthma Control Test) — 5-question 25-point survey; <20 = not controlled. FeNO (fractional exhaled nitric oxide) — >25 ppb = T2 inflammation. Blood eosinophils ≥300/μL — biologic eligibility threshold for many T2-targeted agents.
PrimerRecognize Symptoms + Triggers
Symptoms: cough (often worse at night or with exercise), wheeze, chest tightness, shortness of breath. Triggers: viral URIs (the #1 trigger of exacerbations), allergens (dust mite, cockroach, mouse, mold, pollen, pet dander), tobacco / wood smoke / vaping / air pollution, exercise, cold air, strong emotions / stress, GERD, occupational exposures, NSAIDs (AERD), beta-blockers (relative). Variable airflow — symptoms come and go. Spirometry reversibility with bronchodilator confirms diagnosis.
Learn ItDiagnostic Workup + Wellness
Spirometry (pre + post bronchodilator) is the diagnostic gold standard — looks for obstruction (FEV1/FVC <0.7) and reversibility (FEV1 improves ≥12% + ≥200 mL after bronchodilator). Bronchoprovocation (methacholine challenge) for normal spirometry with suspicious history. FeNO, blood eosinophils, serum IgE, allergen-specific IgE identify T2-high phenotype + biologic eligibility. CBC, allergy testing (skin prick or specific IgE). Chest X-ray if atypical. Vaccinations: annual flu, COVID, RSV (adults 60+; pregnant; infants), pneumococcal (PCV20 or PPSV23 per age + risk). Vitamin D adequacy.
Learn ItKnow My Numbers
PEF daily + personal best · FEV1 + FEV1/FVC at each spirometry · ACT score monthly (<20 = re-evaluate) · FeNO + blood eos for phenotyping + biologic eligibility · serum total IgE if biologic considered · rescue inhaler use / month (more than 2× / week = not controlled) · oral steroid bursts / year (any = severe; ≥2 = consider biologic referral) · ED visits / hospitalizations / year · missed school or work days · nighttime awakenings. Bring a one-page numbers card.
Learn ItLifestyle Force Field — Trigger Control + Adherence
Trigger reduction: dust-mite-proof bedding + HEPA filtration where applicable; integrated pest management for cockroach / mouse; mold remediation; pet dander mitigation; complete smoking cessation (passive + active + vaping); indoor air quality (no candles / incense / open-flame cooking without ventilation); avoid air-pollution-high outdoor activity. Annual flu + COVID + RSV + pneumococcal vaccines (viral URI is the #1 exacerbation trigger). Weight management (obesity worsens asthma). Allergen immunotherapy (SCIT or SLIT) for allergic asthma — disease-modifying. Exercise (with pre-treatment if EIB).
Learn ItMedications + Inhaler Technique
SMART regimen (GINA 2024): ICS-formoterol (budesonide-formoterol or beclomethasone-formoterol) as BOTH daily controller AND reliever — replaces SABA-only (which is no longer recommended). Controllers: low/medium/high-dose ICS; ICS-LABA; LAMA add-on (tiotropium) for moderate-severe; LTRAs (montelukast — black-box warning for neuropsychiatric effects); biologics for severe T2-high. Biologics: omalizumab (anti-IgE), mepolizumab / reslizumab / benralizumab (anti-IL-5), dupilumab (anti-IL-4Rα), tezepelumab (anti-TSLP). Oral steroids for exacerbations only — chronic use indicates severe disease + biologic referral. Inhaler technique is high-leverage — most patients use inhalers wrong; use a spacer with MDIs; pharmacist teach-back essential.
Live ItCare Team Members
PCP (most uncomplicated asthma) · Pulmonology (moderate-severe, frequent exacerbations, atypical) · Allergy/Immunology (allergic asthma, immunotherapy, biologic management) · Pediatric Pulmonology / Allergy if child · Pharmacist (inhaler technique, adherence, polypharmacy) · ENT (chronic rhinosinusitis / nasal polyps; AERD) · Behavioral Health (mood; 30–40% prevalence in moderate-severe asthma; 988 surfaced) · Dietitian if obesity / GERD · Smoking-cessation counselor / Quitline 1-800-QUIT-NOW · School nurse with Action Plan on file · Employer / HR if occupational · AAFA peer mentor · Family Ambassador.
Live ItTelemedicine & Tech
Telehealth well-suited for asthma follow-up + adherence support. Peak flow meters (mechanical $20; digital $50) + smartphone apps (AsthmaMD, Propeller). Smart inhalers (Propeller, Hailie) — track adherence + technique, sync with care team. Air-quality apps (AirNow, IQAir) for exposure avoidance on high-pollution days. Asthma Action Plan apps (AAFA, NHLBI templates). FeNO home devices (NIOX, emerging). Spirometry-at-home (consumer-grade emerging). Video inhaler-technique check — pharmacist or AAFA video library. Allergy app for pollen counts. Apple Health / Google Health integration for trend tracking.
TechInsurance, Treatment Cost & Help
Generic ICS + ICS-LABA + SABA are typically inexpensive ($10–60/month with insurance). Brand-name ICS-formoterol (Symbicort, Dulera) has generics now. Biologics are expensive ($30,000–60,000+/year) but typically covered with prior authorization for severe T2-high asthma; manufacturer copay programs cover most patients (Xolair Co-Pay, Nucala Connect, Dupixent MyWay, etc.). AAFA Helpline 1-800-7-ASTHMA. NHLBI patient education. Stock-inhaler programs at schools (passed in many states). Medicare Part D for outpatient meds. Medicaid covers most asthma care. NeedyMeds + RxAssist for patient assistance.
Live ItEquity, Access & Cultural Competence
AA Americans have ~2–3× higher asthma mortality than white Americans. Puerto Rican children have the highest US asthma prevalence and mortality. Indigenous communities face under-studied gaps. Drivers: urban air pollution (highway/industrial proximity from historical redlining), indoor allergens (substandard housing — cockroach, mouse, mold), tobacco smoke exposure, access to specialty care (Pulm + Allergy gaps), biologic-prescribing gaps (severe T2-high AA patients are biologic-eligible but under-referred), insurance gaps, language barriers, school resource gaps. Rural patients: access gaps + agricultural occupational exposures. Don't be preachy — be specific.
Share ItTalk to Kids, Partner, School, Employer
Kids (about their asthma OR a parent's): "Asthma is when the tubes that bring air to your lungs get tight and swollen. Your inhalers open them up and keep them calm. With your plan, you can do everything other kids do." Always send a written Asthma Action Plan to school with the school nurse + classroom teacher. Partner: Inhaler-technique coach, Action Plan keeper, trigger watcher, ED-rule reminder. Employer: ADA covers asthma; reasonable accommodations (work-from-home on bad air-quality days; trigger reduction; time for visits; biologic infusion / injection scheduling); occupational asthma is a workers'-comp issue.
Share ItMentor & Share Insights
AAFA peer mentor + support groups + community Wall of Hope. American Lung Association (ALA) — Open Airways for Schools curriculum. Allergy & Asthma Network — patient advocacy + Trusted Messengers program. World Asthma Day first Tuesday of May. National Asthma Awareness Month May. The newly-diagnosed person who hears 'my ACT was 12, I'm on dupilumab, my ACT is now 24, I haven't had an ED visit in 18 months, I run again' gets a different orientation than statistics. The Ambassador role for under-referred AA / Puerto Rican / Indigenous severe asthma patients — get them to Pulm or Allergy for biologic evaluation — is real public-health work.
Share ItJoin the ROI Study (PHIT)
PHIT — Population Health Impact Tracking. Pairs asthma-specific outcome tracking with cost data — ACT score trend, exacerbation rate, oral-steroid bursts/year, ED visits, hospitalizations, biologic uptake in eligible patients, missed school/work days, vaccinations completed, AA / Puerto Rican / Indigenous specialty-care access rates, badge progress, self-reported QoL. Aggregate & anonymous. Cross-references the CDC BRFSS asthma surveillance and SEARCH pediatric registry.
Study🩺 Hand-off to my Asthma Team
Print and bring to your next visit. This page tells your team what you have prepared for, what you want to focus on, and how you would like to participate as an active member of your own care team.
- I am a Prepared Patient in training for asthma. I have reviewed all 16 squares of this Force Field Fact Sheet.
- I have started building my Health Passport, my PEF / personal-best log, my ACT score, my rescue-use count, my oral-steroid burst log, my trigger map, my vaccination record, my inhaler-technique check date, my written Asthma Action Plan, and my biologic-eligibility audit (FeNO + blood eos + total IgE if T2-high) to bring to every visit.
- I want to teach back what I have learned and have you correct anything I have misunderstood — especially around my SMART regimen, inhaler technique with spacer, my Green/Yellow/Red zones, when to call vs go to ED (severe dyspnea, tripoding, silent chest, drowsiness, cyanosis, can't speak full sentences), and whether I'm a biologic candidate.
What helps my visit
Two minutes for me to teach back. One question I prepared. My PEF log + ACT score + rescue-use count + oral-steroid bursts/year. My Action Plan on file. Inhaler-technique video review. Confirm my severity classification, phenotype, and biologic eligibility on the chart. Don't normalize daily rescue use.
What I am working on
SMART regimen adherence · correct inhaler technique with spacer · trigger reduction (allergens, smoke, air quality) · annual vaccines (flu, COVID, RSV, pneumococcal) · daily peak flow · monthly ACT · written Action Plan · AAFA peer connection · school Action Plan if child · biologic eligibility audit if not controlled.
How I want to participate
Shared decisions. Honest conversation about controller step-up, biologic eligibility if severe T2-high, immunotherapy candidacy. AHRQ SHARE Approach. Pulmonology / Allergy referral if not controlled. Coordinate with school + employer for Action Plan. Don't normalize daily rescue inhaler use — that's not control.
🔬 Help Prove This Works — Join the FFH ROI & PHIT Study
The Prepared Patient program is being studied to see whether better preparation actually improves outcomes — more controlled asthma (ACT ≥20), fewer rescue inhaler uses, fewer oral-steroid bursts, fewer ED visits, more written Action Plans, more biologic referrals for eligible severe T2-high patients, more equitable specialty access for AA / Puerto Rican / Indigenous / rural patients, more vaccinations — for asthma patients and families. Your participation is voluntary, your data is aggregated and anonymized, and you can withdraw at any time.
➕ Add-On Force Field Card · Asthma Skill Mastery
If your care plan adds a specific skill or device, bolt on a 5-step Add-On Card. For asthma common bolt-ons include: inhaler-technique-with-spacer routine, peak flow + personal best baseline routine, ACT monthly routine, SMART regimen daily routine (ICS-formoterol controller + reliever per GINA), written Asthma Action Plan completion (Green / Yellow / Red zones), allergen immunotherapy (SCIT or SLIT) adherence routine, biologic SC injection technique (omalizumab, mepolizumab, dupilumab, tezepelumab), smart-inhaler (Propeller / Hailie) setup, trigger-reduction sweep (allergen, smoke, air-quality), annual vaccinations (flu / COVID / RSV / pneumococcal), school Action Plan partnership with school nurse, occupational asthma triggers + workers'-comp navigation, pregnancy asthma management (continue ICS + LABA + SABA — uncontrolled asthma is worse than meds).
Introduce
What it is, why it matters, what it does
Coach
Watch a demo + walk-through
Practice
Do it with a coach watching
Train
Use it daily with a check-in
Test
Demonstrate competence + earn badge
Ready to go deeper?
The Prepared Patient · Asthma course turns this fact sheet into a guided journey: pre/post knowledge checks, the airway-inflammation-and-bronchoconstriction-mental-model module, severity classification + phenotype (T2-high vs non-T2) literacy, the SMART regimen (GINA-compliant), inhaler-technique-with-spacer training, the biologic revolution for severe T2-high (omalizumab, mepolizumab, dupilumab, tezepelumab), the Green/Yellow/Red Asthma Action Plan, the AA mortality disparity story, pediatric + pregnancy + occupational considerations, and your printable Health Passport. Earn Aware → Active → Certified.