University Hospitals Emergency Department

Asthma Discharge Contract

Take your prescribed medicines as directed, dont wait!
Asthma attacks like this one can be prevented with a long-term treatment plan.
Even when you feel well, you may need daily medicine to keep your asthma under
good control and to prevent attacks
Visit your doctor or other health care provider as soon as you can to discuss how to
control you asthma and develop your own action plan.
You have a follow up appointment with ______________________ on _______
Their phone number is __________________
Your medicine for this asthma attack is:
Oral Steroid (Prednisone) _________ mg.
Take _____ pill(s) a day, all at once just after waking up. Even if you feel better,
take all the prescribed medicine.
Albuterol EFC.
Take _______ puffs every 4-6 hours if you have symptoms. This is also your
rescue inhaler
Your daily medicine for long-term control and prevention is:
Inhaled corticosteroid: _______________
Take _________ puffs _________ times a day
Singulair tablets, _________ mg
Your quick-relief medicine when you have symptoms (rescue inhaler) is:
Albuterol EFC.
Take _______ puffs every 4-6 hours if you have symptoms. This is also your
rescue inhaler
As yourself 2-3 times a day, every day, for at least 1 week:
How is my asthma compared to when I left the hospital?
If you feel much better take your daily long-term control medicine
If you feel better but still need your rescue inhaler take your daily long-term control
medicine; see your doctor in the next 2 days
If you feel about the same: Use your rescue inhaler take your daily long-term control
medicine; see your doctor in the next 2 days

If you feel worse: take your daily long-term control medicine; call 911 and go directly to
the emergency department
Your asthma is under control when you can:
Be active daily and sleep through he night
Need fewer than 4 doses of rescue inhaler per week
Are free of shortness of breath, wheezing or cough
When your peak flow is above _____________ (discuss with your doctor)