Below is a sample of what an Asthma Symptom Diary looks like. Patient: __________________________________  Month: ________________________

Date Asthma Action Plan Followed: Yes or No Symptoms: cough, wheeze, shortness of breath  Medicines Taken Response:  improved, need to re-medicate, or go to ER Possible Trigger

 

 

 

           

           

           

           

           

           

           

           

           

           

           

Below is a sample of what an Asthma Symptom Diary looks like. Patient: __________________________________  Month: ________________________

Date Asthma Action Plan Followed: Yes or No Symptoms: cough, wheeze, shortness of breath  Medicines Taken Response:  improved, need to re-medicate, or go to ER Possible Trigger

 

 

 

           

           

           

           

           

           

           

           

           

           

           

Below is a sample of what an Asthma Symptom Diary looks like. Patient: __________________________________  Month: ________________________

Date Asthma Action Plan Followed: Yes or No Symptoms: cough, wheeze, shortness of breath  Medicines Taken Response:  improved, need to re-medicate, or go to ER Possible Trigger

 

 

 

           

           

           

           

           

           

           

           

           

           

           

Below is a sample of what an Asthma Symptom Diary looks like.

Patient: __________________________________  Month: ________________________