Colorado School Asthma Care Plan

This document is also called “Colorado Asthma Care Plan and 

Medication Order for School and Childcare settings”

Colorado School Asthma Care Plan

What is it?

Step-by-step asthma management plan developed by your family and your provider to guide school nurse in managing your child’s asthma in the school setting.

Who gets this form?

The school nurse needs to review and sign the completed form, and distribute the form to school personnel who may need it.

Why is it important?

This form completed by parents and providers is the basis for a child’s asthma management at school.

As part of this plan, families should provide a quick relief inhaler to the school for use at the school.


Make sure the form is SIGNED by parents/guardians and provider.

If you have questions, ask your school nurse.



Similar to the Home Asthma Action Plan, this School Asthma Asthma Care Plans uses zones to help manage asthma symptoms.

There are green, yellow and red zones, which are categorized by symptoms and sometimes peak flow readings. This information helps your child’s healthcare provider determine how bad your child’s asthma is at that time. The school care plan may include exercise/activity pre-treatment in the green zone to prevent symptoms.

Green Zone: No Symptoms Pretreat •No current symptoms •Strenuous activity planned PRETREATMENT FOR STRENUOUS ACTIVITY, please choose ONE: ☐Not required OR ☐ Student/Parent request OR ☐ Routinely Give QUICK RELIEF MED 10-15 minutes before activity: ☐ 2 puffs ☐ 4 puffs Repeat in 4 hours, if needed for additional physical activity. If child is currently experiencing symptoms, follow YELLOW or RED ZONE. If the child is in the YELLOW ZONE they have Mild symptoms •Trouble breathing •Wheezing •Frequent cough •Chest tightness •Not able to do activities 1.Give QUICK RELIEF MED: ☐ 2 puffs ☐ 4 puffs 2.Stay with child/youth and maintain sitting position. 3.REPEAT QUICK RELIEF MED if not improving in 15 minutes: ☐ 2 puffs ☐ 4 puffs 4.Child/youth may go back to normal activities, once symptoms are relieved. 5.Notify parents/guardians and school nurse. If symptoms do not improve or worsen, follow RED ZONE. If a child is in the RED ZONE: this is an emergenty/ EMERGENCY Severe Symptoms •Coughs constantly •Struggles to breathe •Trouble talking (only speaks 3-5 words) •Skin of chest and/or neck pull in with breathing •Lips/fingernails gray/blue 1.Give QUICK RELIEF MED: ☐ 2 puffs ☐ 4 puffs Refer to the anaphylaxis care plan if the student has a life threatening allergy. If there is no anaphylaxis care plan follow emergency guidelines for anaphylaxis. 2.Call 911 and inform EMS the reason for the call. 3.REPEAT QUICK RELIEF MED if not improving: ☐ 2 puffs ☐ 4 puffs Can repeat every 5-15 minutes until EMS arrives. 4.Stay with child/youth. Remain calm, encouraging slower, deeper breaths. 5.Notify parents/guardians and school nurse.

Families can learn more about helping kids with asthma: 

Common Asthma Terms

Types of Asthma Medication