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Asthma Diary

A Tool for Tracking Symptoms

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Updated: February 11, 2007

Here is a tool you can use to track your asthma symptoms. You can also record and identify your asthma triggers, which are the things that set off asthma symptoms or asthma attacks.

You can use this page as a reference for the types of information you can keep track of in your own asthma diary or notebook. Or, if you prefer, print our PDF version and make copies you can write on each week.

Asthma Diary Template

Date AM PEF PM PEF Triggers Rate Symptoms* Medicine Taken & Response
        __ Cough
__ Wheeze
__ Short of breath
__ Tightness
__ Other:
 
 
        __ Cough
__ Wheeze
__ Short of breath
__ Tightness
__ Other:
 
 
        __ Cough
__ Wheeze
__ Short of breath
__ Tightness
__ Other:
 
 
        __ Cough
__ Wheeze
__ Short of breath
__ Tightness
__ Other:
 
 
        __ Cough
__ Wheeze
__ Short of breath
__ Tightness
__ Other:
  
 
        __ Cough
__ Wheeze
__ Short of breath
__ Tightness
__ Other:
 
 
        __ Cough
__ Wheeze
__ Short of breath
__ Tightness
__ Other:
 
 

*Use this scale to rate your symptoms:
0=None; 1=Mild; 2=Moderate; 3=Severe; 4=Emergency

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