My Asthma Action Plan For Single Inhaler Maintenance and Reliever Therapy (SMART) - with budesonide/formoterol

Sep 23, 2026

Upload by McQueen

SMART asthma action plan for single-inhaler maintenance and reliever therapy using budesonide/formoterol. Includes fields for patient name, date, usual best PEF, usual maintenance dosing by morning and evening, and instructions to use 1 inhalation as needed for symptom relief. Defines stability criteria, flare-up steps over 2–3 days (add 1 as-needed dose, consider prednisolone, contact doctor), and emergency triggers. Provides maximum daily inhalations requiring same-day medical care, emergency signs, ambulance instructions, and first-aid actions with prednisolone guidance.

LanguageEnglish

CategoryForms

FormatPDF

Pages1

AccessFree to download

Normal mode

My Regular Treatment Every Day

Reliever

My asthma is stable if

Other Instructions

Asthma Flare-up (If over a Period of 2-3 Days)

Asthma Emergency

First aid while waiting for an ambulance

(Example of action plan template for budesonide/formoterol. A similar action plan could be constructed for other ICS/formoterol formulations, eg, mometasone/formoterol) Normal mode My SMART Asthma Treatment is: ☐ budesonide/formoterol 160/4 .5 (12 years or older) ☐ budesonide/formoterol 80/4 .5 (4-11 years) My Regular Treatment Every Day: (Write in or circle the number of doses prescribed for this patient) Take [1, 2] inhalation(s) in the morning and [0, 1, 2] inhalation(s) in the evening, every day Reliever Use 1 inhalation of budesonide/formoterol whenever needed for relief of my asthma symptoms I should always carry my budesonide/formoterol inhaler My asthma is stable if: • I can take part in normal physical activity without asthma symptoms AND • I do not wake up at night or in the morning because of asthma Other Instructions ______________________________________ ______________________________________ Asthma Flare-up Asthma Emergency My Asthma Action Plan For Single Inhaler Maintenance and Reliever Therapy (SMART) with budesonide/formoterol Name: Date: Usual best PEF: L/min (if used) Action plan provided by: Doctor: ____________________________ Doctor’s phone: If over a Period of 2-3 Days: • My asthma symptoms are getting worse OR NOT improving OR • I am using more than 6 budesonide/formoterol reliever inhalations a day (if aged 12 years or older) or more than 4 inhalations a day (if aged 4-11 years) I should: ☒Continue to use my regular everyday treatment PLUS 1 inhalation budesonide/formoterol whenever needed to relieve symptoms ☐ Start a course of prednisolone ☐ Contact my doctor Course of Prednisolone Tablets: Take mg prednisolone tablets per day for days OR ___________________________________ ___________________________________ If I need more than 12 budesonide/formoterol inhalations (total) in any day (or more than 8 inhalations forchildren 4-11 years), I MUST see my doctor or go to the hospital the same day. Signs of an Asthma Emergency: • Symptoms getting worse quickly • Extreme difficulty breathing or speaking • Little or no improvement from my budesonide/formoterol reliever inhalations If I have any of the above danger signs, I should dial for an ambulance and say I am having a severe asthma attack. While I am waiting for the ambulance start my asthma first aid plan: • Sit upright and stay calm. • Take 1 inhalation of budesonide/formoterol. Wait 1-3 minutes. If there is no improvement, take another inhalation of budesonide/formoterol (up to a maximum of 6 inhalations on a single occasion) . • If only albuterol is available, take 4 puffs as often as needed until help arrives. • Start a course of prednisolone tablets (as directed) while waiting for the ambulance. • Even if my symptoms appear to settle quickly, I should see my doctor immediately after a serious attack. Modified from Australian action plan with permission from National Asthma Council Australia and AstraZeneca Australia

FAQs

What should I write in the Normal mode dosing section?

Record the prescribed budesonide/formoterol inhalation numbers for the morning and evening every day, and circle the appropriate strength and age range in the SMART plan.

What do I do if symptoms worsen over 2–3 days?

Continue regular everyday treatment and add 1 budesonide/formoterol inhalation whenever needed for relief. If symptoms are not improving, consider starting prednisolone and/or contact your doctor as indicated.

When is an asthma emergency and what should I do immediately?

Seek emergency help if symptoms worsen quickly, breathing or speaking becomes extremely difficult, or there is little/no improvement after reliever inhalations. Dial for an ambulance and follow the first-aid steps: sit upright, take inhalations as instructed, use albuterol puffs if available, and start prednisolone while waiting.

Sep 23, 2026

Upload by McQueen