Know how to help a child when asthma flares

Learn about the Green, Yellow, and Red Zones, and when to help with medication* or to call for help.

If your child has an asthma action plan, please refer to that instead, but these are strong general guidelines.

    THE GREEN ZONE: All is good – go play!

    A child in the “Green Zone”

    • Does not need “reliever” medicine, OR uses it only 1 or 2 times a week
    • Does not cough or wheeze during the day or night
    • Sleeps soundly most nights
    • Wakes up at night no more than 2 times a month from asthma

    Each Day:  Use “controller” or maintenance medicine, even if the child shows no breathing problems.

    Before Exercise:  Use “reliever” medicine 5 to 15 minutes before exercise.

      YELLOW ZONE: Use Reliever Medication

      If your child shows ANY of these signs, use reliever medicine right away. Keep using the “controller” medicine, too.

      Yellow Zone Signs:

      • Wheezing or whistling when breathing – hard time breathing
      • Chest feels tight
      • Coughing and breathing problems make it hard to sleep

      CALL YOUR CHILD’S CLINIC and ask to talk to a doctor or nurse if:

      • Breathing problems last for more than 1 day
      • You need reliever medicine 3 or more times in 1 day
      • Breathing does not get better 20 minutes after using reliever medicine
      • Child is using reliever medication for symptoms more than 2 days/week.

      RED ZONE: Get medical help!

      If a child has even one of these RED ZONE signs

      • Help them use 2-4 puffs of reliever medicine every 5 minutes


      • Get to the nearest hospital.

      Red Zone Signs:

      • Ribs show when breathing
      • Hard time walking
      • Hard time saying a full sentence without a breath
      • Hard time breathing even when sitting
      • Breathing gets worse within 20 minutes of taking reliever medicine

      Call 911

      • Lips or fingernails are gray or blue
      • Breathing so hard that the child is drowsy or sleepy

      There are three types of medications for asthma: controllers, relievers, and combination medications.

      Controllers and relievers each treat a different part of a child’s asthma.
      *Reliever medications also sometimes called “rescue” and “quick relief” medication

      1. Reliever medications are taken to relax and open up the airways when a child is experiencing symptoms. Quick relief medication typically starts working within a few minutes. (example: Albuterol, levalbuterol)

      2. Controller medications are usually taken every day, and they reduce the swelling in the airways and control symptoms to prevent asthma attacks.They are the most effective medication for controlling symptoms and preventing asthma attacks. They may take up to 4 weeks to be fully effective. (example: Fluticasone, Budesonide, Mometasone)

      3. Medications that are both reliever and controllers
      Example: Mometasone/Formoterol, Budesonide/Formoterol, budesonide/albuterol

      Learn more about Asthma Medications

      Attribution: This page was adapted from work by Dr. Bruce Bender in development with the Navajo Nation community. Funding source: National Institutes of Heart, Lung and Blood Institute (NHLBI U34HL130762 and U01 HL138689).

      Reference Doc:


      Key Community Partners
      Children’s Hospital Colorado Breathing Institute
      • ACCORDS – Adult and Child Center for Outcomes Research and Delivery Science
      • State and Community Advisory Boards
      • Scientific Advisory Board
      • Colorado Department of Public Health and Environment
      • Denver Public School District School Nurses
      Acclaro Design, Inc.
      Trailhead Institute
      National Association of School Nurses
      Colorado Department of Education Nursing Services

      The information on this website, including but not limited to text, graphics, videos, images and other material, are for health informational purposes and to support a tailored asthma care plan developed by a student’s team of asthma health care professionals. No material on this site is intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of a physician or other qualified health care provider with any questions you may have regarding a student’s asthma care, and never disregard professional medical advice or delay in seeking it because of something you have read on this website