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ADULT
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PEDIATRIC
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In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?
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How is your asthma today?
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During the past 4 weeks, how often have you had shortness of breath?
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How much of a problem is your asthma when you run, exercise or play sports?
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In the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, SOB, chest tightness or pain) wake you up at night?
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Do you cough because of your asthma?
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During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?
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Do you wake up at night because of your asthma?
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How would you rate your asthma control during the past 4 weeks?
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During the last 4 weeks, how many days did your child wheeze during the day because of asthma?
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ACT Score
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In the last 4 weeks, how many days did your child have any asthma symptoms during the day (Cough, Wheeze, SOB, Chest tightness)?
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During the last 4 weeks, how many days did your child wake up during the night because of asthma?
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ACT Score
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How many times have you been to Emergency Department AND required hospitalization DUE TO ASTHMA in last 12 months
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Use of Controller Medications
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What percentage of days have you used the controller medications in last one year
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