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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 healthcare provider at your visits. As your asthma control gets better you should have fewer episodes of symptoms to record.

Asthma symptom diary

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: Alan J Blaivas DO
Online Medical Reviewer: Daphne Pierce-Smith RN MSN CCRC
Online Medical Reviewer: Paula Goode RN BSN MSN
Date Last Reviewed: 8/1/2018
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