Asthma Diary
Use this diary to keep track of daily asthma symptoms, number of doses of rescue medication and peak flow values. Rank the intensity of your symptoms using the scale below:
| 0 | None | 1 | Mild | 2 | Moderate | 3 | Severe |
Week starting _______________
| Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | ||
| Cough | ||||||||
| Wheezing | ||||||||
| Shortness of breath | ||||||||
| Breathing problems at night | ||||||||
| Interferes with activities | ||||||||
| Number of doses of rescue medication: | ||||||||
| Peak expiratory flow value | morning: | |||||||
| night: | ||||||||
Week starting _______________
| Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | ||
| Cough | ||||||||
| Wheezing | ||||||||
| Shortness of breath | ||||||||
| Breathing problems at night | ||||||||
| Interferes with activities | ||||||||
| Number of doses of rescue medication: | ||||||||
| Peak expiratory flow value | morning: | |||||||
| night: | ||||||||
Week starting _______________
| Monday | Tuesday | Wednesday | Thursday | Friday | Saturday | Sunday | ||
| Cough | ||||||||
| Wheezing | ||||||||
| Shortness of breath | ||||||||
| Breathing problems at night | ||||||||
| Interferes with activities | ||||||||
| Number of doses of rescue medication: | ||||||||
| Peak expiratory flow value | morning: | |||||||
| night: | ||||||||
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The patient information leaflets are provided by Vigilance Santé Inc. This content is for information purposes only and does not in any manner whatsoever replace the opinion or advice of your health care professional. Always consult a health care professional before making a decision about your medication or treatment.