COPD Daily Symptom Tracker
Date
Name
Breathlessness (1–5)
1 (None)
2 (Mild)
3 (Moderate)
4 (Severe)
5 (Very Severe)
Cough (1–5)
1 (None)
2 (Mild)
3 (Moderate)
4 (Severe)
5 (Very Severe)
Sputum (Thickness or Color)
Wheezing (Yes/No)
Yes
No
Chest Tightness (1–5)
1 (None)
2 (Mild)
3 (Moderate)
4 (Severe)
5 (Very Severe)
Fatigue (1–5)
1 (None)
2 (Mild)
3 (Moderate)
4 (Severe)
5 (Very Severe)
Notes