Asthma Reviews

4th Nov 2021

Asthma Questionnaire


The Asthma control test is a way to quickly assess your asthma control, giving you a simple score out of 25. Please read each question carefully and select you answer. Add up each of the 5 scores and enter it in the box below the questions. Then use the score guide below to learn how well you are controlling your asthma.


Q1. During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home?


All of the time - Score 1


Most of the time - Score 2


Some of the time - Score 3


A little of the time - Score 4


None of the time - Score 5


Q2. During the past 4 weeks, how often have you had shortness of breath?


2+ times / day - Score 1


Once a day - Score 2


3-6 times / week - Score 3


1-2 times / week - Score 4


Not at all - Score 5


Q3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, chest tightness, shortness of breath) wake you at night or earlier than usual?


4+ times/week - Score 1


2-3 Nights/Week - Score 2


Once a week - Score 3


Once or twice - Score 4


Not at all - Score 5


Q4. During the past 4 weeks, how often have you used your reliever inhaler (usually blue)?


3+ times/day - Score 1


1-2 times/day - Score 2


2-3 times/week - Score 3


Once a week or less - Score 4


Not at all - Score 5


Q5. How would you rate your Asthma control during the past 4 weeks?


Not controlled - Score 1


Poorly controlled - Score 2


Somewhat controlled - Score 3


Well controlled - Score 4


Totally controlled - Score 5


What was your total score out of 25?

What does your score mean?

19 or less: We ought to see you as your asthma may not be very well controlled and we may be able to help. We strongly recommend you make an appointment with one of our respiratory nurses for a review.


20 or more: Your asthma appears to be reasonably well controlled. Ideally we would like to see you for a review but if you would prefer not to attend the surgery please complete the rest of the questionnaire and return it to the surgery.




What number of exacerbations have you had in the last year?  


Asthma Care Plan


Do you already have an asthma care plan?


Peak Flows

Do you measure your peak flow? If you do please record a typical reading

It is a good idea to have a peak flow meter and to check your measurements occasionally. If the measurement varies a lot it’s a sign your asthma is not well controlled and you might be at risk from an attack. In particular if your early morning readings are consistently lower than your evening readings your asthma may be inadequately controlled.


Inhaler Technique

Do you have any problems taking you inhaler?

Things people often forget with MDI inhalers (snorkel shaped one press):- Shake the inhaler before each puff; press inhaler as you breath, NOT before or afterwards; hold your breath for 10 seconds.


Smoking Status


If you are a smoker no doubt you are aware smoking is bad for your health, especially if you are asthmatic. Apart from making your asthma potentially more difficult to control, it increases your chances of developing irreversible lung disease in the future.


Would you like help giving up smoking please let refer to the NHS website NHS stop smoking services help you quit