1. Peak Flow
Predicted:
Personal Best:
Green Zone: Good (80% – 100% of your personal best) :
______
Yellow Zone: Caution (50% – 80% of your personal best): ______
Red Zone: Emergency (less than 50% of your personal best): ______
Symptom/Peak Flow Diary
Fill in this chart using the keys below. Be sure to bring this sheet, along with your questions, to your next doctor’s appointment.
Date
Wheeze
Cough
Activity
Sleep
Peak Flows
a.m.
↓
p.m.
↓
Use of
Quick relief
Inhaler
Use of
Controller
a.m.
↓
Comments
p.m.
↓
KEY
Wheeze
None = 0
Some = 1
Medium = 2
Severe = 3
Cough
None = 0
Occasional = 1
Frequent = 2
Continuous = 3
Activity
Normal = 0
Can run short distance = 1
Can walk only = 2
Missed school/stayed indoors = 3
Sleep
Fine = 0
Slept well, slight wheeze or cough = 1
Awake 2-3 times, wheeze or cough = 2
Bad night, awake most of the time = 3
1/03, 4/08