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Use of asthma diaries: Simplified for children

Patient Education
Dec 22, 2011

Figure 3
Asthma Diary for _________________________________
Complete diary by checking the correct box or filling in the requested value

   Month __________ Day              
Last night Good night              
Slept well but a little wheeze or cough              
Woke once or twice              
Bad night, awake a lot              
Morning Peak Flow (best of 3 efforts)              
Activity No problem              
Can run a little bit              
Can't run at all              
Had to rest all day              
Wheeze No              
Yes, 2 times or less              
Yes, more than 2 times              
Yes, all the time              
Cough No              
Yes, a little              
Yes, keeps me from doing some things              
Yes, bothers me a lot              
Evening Peak Flow (best of 3 efforts)              
Intervention Inhaled bronchodilator (no. of treatments)              
Oral Corticosteroid (dose)