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
