Asthma Symptoms Diary

The Asthma Symptoms Diary is a clinical tool that allows the day-to-day recording of symptoms, medication use, trigger exposure, and, if indicated, daily peak flow readings by children (and/or their caregivers) over a 31-day period. The novelty resides in the addition of a guide for the overall interpretation of the level of asthma control achieved by the child.

• To standardise the recording of symptoms, medication use, exposure to triggers, and peak flow values and provide guidelines for their interpretation & classification as “controlled” or “not controlled” days.
• To facilitate the self-assessment of asthma control for enacting the Written Action Plan for Asthma.

The need for an Asthma Symptoms Diary was highlighted by 85% of children and their parents who participated in the development of the Written Action Plan for Asthma; they specifically requested a calendar that matched the Written Action Plan for Asthma to facilitate its application. Many parents indicated that they meant to use it when needed, that is, only during periods of symptoms to better report them to the health care professionals.

The Asthma Symptoms Diary was developed using the standard Kirshner and Guaytt's approach for instrument development. The item generation was conducted by an extensive literature review. The item reduction was based on the product of endorsement and importance of each item rated by 15 health care professionals considered experts in childhood asthma. Scaling, layout, format, language, colors and graphics of the Asthma Symptoms Diary were inspired from a previously validated Written Action Plan for Asthma. Testing for clarity was conducted in 37 children and adolescents and their parents, using cognitive interviews where participants were asked to read aloud each question and response option, and were prompted to “think aloud” while choosing their answer. Their answers were then challenged to ensure correct understanding of the questions and accurate responses. The versions were repeatedly modified until 85% clarity was achieved. Using the back-translation technique, we simultaneously designed and tested the French and English versions.

The Asthma Symptoms Diary is a 31-day diary (1 page per month) intended to be completed daily or when needed to facilitate the self-monitoring and self-assessment of asthma control. It has 5 sections focusing on:

• A self-assessment tool based on the clinical criteria 'specified' the Canadian consensus statement, namely, day and night time symptoms, use of rescue medication, exercise limitation, absenteeism, and exacerbation.
• Integration of the Canadian asthma control criteria into self-assessment criteria to recognise 'under-controlled', 'not-well-controlled', or 'out-of-control' days.
• Recording of regular and rescue asthma medication use as well as other medications to treat co-morbidities.
• Recording of triggers or other symptoms.
• Recording of peak expiratory flow measurements.

In line with the 6 asthma criteria endorsed by the Canadian Asthma Consensus statement and 'utilised' by the Asthma Quiz for Kidz, two or more of the following criteria signal a loss of asthma control:

1. Four or more days/week with asthma symptoms;
2. Night time symptoms one night or more/week;
3. Use of rescue ?2 agonist four times or more/week;
4. Reduced physical activity due to asthma symptoms in the past week;
5. School absenteeism due to asthma symptoms within 30 days, or;
6. An exacerbation requiring an unscheduled medical visit within 30 days.

The Asthma Symptoms Diary is available and used to assess asthma control in several paediatric asthma clinics and athma education centres in the province of Quebec

Contact Person: Patricia Côté, Réseau québécois de l’enseignement sur l’asthme et la MPOC [Quebec Network for asthma and COPD education]: www.rqam.ca.

• Canadian French
• Canadian English