ASTHMA CONTROL TEST

1. In the past 4 weeks, how often did your asthma keep you from getting as much done at work, school or at home?

All of
the time Most of
the time Some of
the time A little
of the time None of
the time

2. During the past 4 weeks how often have you had shortness of breath?

More than
once a day Once
a day 3 to 6 times
a week Once or
twice a week Not at all

3. In the last 4 weeks, how often did your asthma symptoms (wheezing, coughing, and shortness of breath) wake you up at night?

4 or more
nights a week 2-3 nights
a week Once
a week Less than
once a week Not at all

4. During the past 4 weeks, how often have you used your inhaler or nebulizer medication (such as albuterol)?

3 or more
times per day 1 or 2 times
per day 2 or 3 times
per week Once a
week or less Not at all

5. How would you rate asthma control during the last 4 weeks?

Not controlled
Poorly
controlled Somewhat
controlled Well
controlled Completely
controlled

6. In the past 12 months, have you ever had to go to the emergency room because of asthma symptoms?

Yes No

7. In the past 12 months, have you ever been admitted to the hospital overnight because of asthma?

Yes
No

8. In the past 12 months, how many days of school or work have you missed because of asthma symptoms?

10 days
or more 6-9
days 3-5
days 1-2
days no days