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Asthma Diary Template

Topic Overview

Week of ________________________

If I use a peak flow meter:

My personal best peak expiratory flow (PEF) is ________ .

  • My PEF for green zone is ___________ liters per second (80% to 100% of my personal best*).
  • My PEF for yellow zone is ___________ liters per second (50% to less than 80% of my personal best*).
  • My PEF for red zone is less than ________liters per second (less than 50% of my personal best*).

* To figure out 80% of personal best peak flow, multiply your personal best by 0.80. To figure out 50% of personal best peak flow, multiply your personal best by 0.50.

If your peak flow is lower than normal, check your asthma action plan or call your doctor.

My current controller medicines are _______________________________________.

Date

AM/PM peak expiratory flow (if I use a peak flow meter)

Trigger

Symptoms

Quick-relief medicine and response

Red zone visit to doctor or hospital?

Green

Yellow

Red

             
             
             
             
             
             

Credits

Current as of: June 8, 2019

Author: Healthwise Staff
Medical Review: E. Gregory Thompson, MD - Internal Medicine
Adam Husney, MD - Family Medicine
Rohit K. Katial, MD - Allergy and Immunology

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