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    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: Chris Southard RN
    Online Medical Reviewer: Rajadurai Samnishanth Researcher
    Online Medical Reviewer: Rita Sather RN
    Date Last Reviewed: 3/1/2024
    © 2000-2024 The StayWell Company, LLC. All rights reserved. This information is not intended as a substitute for professional medical care. Always follow your healthcare professional's instructions.
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    Southern New Mexico
    Surgery Center

    2301 Indian Wells Rd. Suite B
    Alamogordo, NM 88310
    www.snmsc.org

    Phone: 575.437.0890
    Fax: 575.437.0905
    Email: info@snmsc.org

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