8/19/2019 Asma Control Test

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1. In the past 4 weeks, how much of the time did your asthma keep you fromgetting as much done at work, school or at home?

All ofthe time

Most ofthe time

Some of the time

A little

of thetime

 None ofthe time

2. uring the past 4 weeks, how often ha!e you had shortness of "reath?

Morethan

once a

day

#nce a

day

$ to %times a

week 

#nce ortwice a

week 

 Not at

all

$. uring the past 4 weeks, how often did your asthma symptoms &whee'ing,

coughing, shortness of "reath, chest tightness or pain( wake you up at night or

earlier than usualin the morning?

) ormore

nights a

week 

2 or $nights a

week 

#nce a

week 

#nce or

twice

 Not at

all

). uring the past 4 weeks, how often ha!e you used your rescue inhaler or

ne"uli'er medication &such as al"uterol(?

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$ or

more

times per day

1 or 2

times per day

2 or $

times

 perweek 

#nce a

week orless

 Not at

all

*. +ow would you rate your asthma control during the past 4 weeks?

 Not

controlledat all

oorlycontrolled

Somewhatcontrolled

-ellcontrolled

ompletelycontrolled

Step 1: /et your child

respond to the first four

questions (1 to 4). If your child needs help

in reading or understanding

the 0uestion, you mayhelp, "ut let your child

select the response.

omplete the remaining

three questions (5 to 7)

on your own and without

letting your childs

responses influence youranswers. here are no

right or wrong answers.

Step 2: lick an answer

 "utton for each 0uestion.

3ou will see a num"er

score populate thecolumn to the right.

Step 3: -hen all se!en0uestions ha!e "een

answered, press the 4S55

3#67 S#754 "utton to

!iew your score.

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Step 4: ake a printout

of the test results to the

doctor to talk a"out yourchilds total score.

Have your hi!" omp!ete these questions.

1. +ow is your asthma today? Score

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8ery 9ad 9ad :ood 8ery :ood

2. +ow much of a pro"lem is your asthma when you run, e;ercise or play sports?

Its a "ig pro"lem,I cant do what I

want to do.

Its a pro"lem and

I dont like it.

Its a

little pro"lem "ut its okay.

Its not a pro"lem.

$. o you cough "ecause of your asthma?

3es, all of 

the time.3es, most of

the time.

3es, some of

the time.

 No, none of

the time.

). o you wake up during the night "ecause of your asthma?

3es, all of 

the time.3es, most of

the time.3es, some of

the time. No, none of

the time.

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#!ease omp!ete these questions on your own.

*. uring the last ) weeks, how many days did your child ha!e any

  daytime asthma symptoms?

 Not at all 1<$ days )<1= days 11<1> days 1<2) days 5!eryday

%. uring the last ) weeks, how many days did your child whee'e during

  the day "ecause of asthma?

 Not at all 1<$ days )<1= days 11<1> days 1<2) days 5!eryday

@. uring the last ) weeks, how many days did your child wake up during  the night "ecause of asthma?

 Not at all 1<$ days )<1= days 11<1> days 1<2) days 5!eryday