Asthma /

Asthma Diary

01 Clinicians Tools and Resources

Daily asthma symptoms diary

Name: .....................................................................................................................

Every evening (for each symptom below) record the number (0.1, 2, or 3) that best matches how you/your child felt in the last 24 hours.

SYMPTOMS 

  Monday Tuesday Wednesday Thursday Friday Saturday Sunday
Date              
Sleep disturbance due to asthma              
Slept well last night (no asthma) Score 0              
Slept well but tended to wheeze or cough Score 1              
Woke up twice or more with wheeze cough Score 2              
Bad night, mostly awake with asthma Score 3              
Cough              
None Score  0              
Occasional Score 1              
Frequent Score 2              
Most of the time Score 3              
Wheeze              
None Score 0              
Mild Score 1              
Moderate Score 2              
Severe Score 3              
Breathlessness on exertion              
None Score 0              
Mild Score 1              
Moderate Score 2              
Severe Score 3              
Medications              
Ventolin              
Prednisolone              
Preventer              
The information published here has been reviewed by Flourish Paediatrics and represents the available published literature at the time of review.
The information is not intended to take the place of medical advice.
Please seek advice from a qualified healthcare professional.
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Last updated: 15/07/2012