Iowa Pediatric Asthma & Allergy
Iowa Pediatric Asthma & Allergy
Iowa Pediatric Asthma & Allergy
Iowa Pediatric Asthma & Allergy

Asthma Diaries

As you well know, symptoms of asthma fluctuate and may not be present at all when you see your doctor.  Asthma diaries are designed to help you keep track of the symptoms your child experiences over a period of time.  These forms will provide your physician and staff with invaluable firsthand information regarding your child's asthma.This, in turn, results in better medical decisions. (Please see below to download diary form.)

 

This forms take only a few moments to fill out each day. There are 4 main questions:

  • How was the night?
  • How was activity?
  • Any wheezing?
  • Any coughing?

 

Please check the box (only one) for each question that best fits the answer.

 

The questions regarding asthma symptoms “last night” are best filled out upon awakening in the morning. The subsequent questions are completed at bedtime and ask about symptoms during the day.

 

Keeping the diary and a pencil near the bedside and completing it at bedtime and on arising is probably the easiest way of not forgetting. Space is provided for tracking medication use for acute symptoms (reliever medicines such as albuterol or oral steroids). There is also space for marking down remarks or questions on the back.

 

The questions asking for “peak flow measurements” are only filled out by those instructed to use regular peak flow meters. Then the best of 3 efforts should be recorded. Directions on how to use a peak flow meter are given on a separate sheet for those using them.

 

REMEMBER TO BRING YOUR ASTHMA DIARIES TO ANY
APPOINTMENTS WITH DR. SHEETS.

Asthma Diary for Children
Asthma Diary.09.10.16.docx
Microsoft Word document [25.6 KB]
Asthma Diary for Infants and Young Children
Infant diaries.09.10.16.doc
Microsoft Word document [120.5 KB]

Our Location

IPAA - Dr Scott Sheets

7029 Vista Drive

West Des Moines, IA  50266

DIRECTIONS

 

(O)  515-868-0220

(F)  515-223-3022

EMAIL

 

Office hours are 8-4:30pm M-F

Please call to make an appointment

PATIENT FORMS

Click here to print patient information forms out, complete  them, and email them back to us prior to your visit.

Information for Parents

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© 2016 Iowa Pediatric Asthma & Allergy