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My Asthma Symptom Diary

Keep track of symptoms with the chart below. (Make some copies first.) Show your records to your health care provider at your visits. As your asthma control improves you should have fewer episodes of symptoms to record.

 

Date

Symptoms

Possible triggers

Action taken

Results

Did symptoms interfere with your sleep? Yes or No?

 

3/3

Example:

Wheezing, peak flow 75%

 

Cold air

 

2 puffs albuterol, went inside

 

Symptoms gone in 20 min.

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Online Medical Reviewer: Berry, Judith, PhD, APRN
Online Medical Reviewer: Hanrahan, Maura, MD
Last Review Date: 11/21/2012
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