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)
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