My Asthma Symptom Diary

Use the chart below to keep track of symptoms. (Make some copies first.) Bring your Asthma Action Plan and this symptom diary to every visit with your healthcare provider. Show your records to your provider. Also ask any question you have. You should have fewer items on your chart as your asthma control gets better.

Asthma symptom diary

Date

Symptoms

Possible triggers

Action taken

Results

Did symptoms make it hard for you to sleep? Yes or No?

3/3

Example:

Wheezing, peak flow 75%

Cold air

2 puffs albuterol, went inside

Symptoms gone in 20 minutes

No

 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 
 

 

 

 

 

 

 

 

 

 

 
Online Medical Reviewer: Allen J Blaivas DO
Online Medical Reviewer: Daphne Pierce-Smith RN MSN
Online Medical Reviewer: Marianne Fraser MSN RN
Date Last Reviewed: 11/1/2021
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