Answer seven short questions and find out whether your asthma is well-controlled. Download your result and use it as a guide to talk to your healthcare provider about your asthma treatment options and how to improve control.
1. In the past 4 weeks, how much of the time did your asthma keep you from being effective 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. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?
4 OR MORE NIGHTS A WEEK
TWO NIGHTS A WEEK
ONCE A WEEK
ONCE OR TWICE
NOT AT ALL
During the past 4 weeks, how often did you need a pump (such as Ventolin TM) or an inhaler to relieve symptoms?
3 OR MORE TIMES A DAY
1- 2 TIMES A DAY
2 OR 3 TIMES A WEEK
ONCE A WEEK OR LESS
NOT ONCE
5. How would you rate your asthma control during the past 4 weeks?
NOT CONTROLLED AT ALL
POORLY CONTROLLED
SOMEWHAT CONTROLLED
WELL-CONTROLLED
COMPLETELY CONTROLLED
I have had a period of asthma exacerbation requiring an emergency room visit or hospitalisation in the past year.
YES
NO
I have had two or more exacerbations of my asthma requiring treatment with oral corticosteroids in the past year.
YES
NO
Is my asthma controlled?
Self-evaluation points (explanation):
Answers to the questions (refers to questions 1-5) are scored with points from 1 to 5. Each question has 5 answers, where the first answer is always worth 1 point, the second 2 points and so on. By adding up the points of the answers to the first 5 questions, we arrive at the final score:
0-5 – Not controlled
6-10 – Poorly controlled
11-15 – Somewhat controlled
16-20 – Well-controlled
21-25 – Completely controlled
Total number of points:
Self-evaluation points (explanation):
Answers to the questions (refers to questions 1-5) are scored with points from 1 to 5. Each question has 5 answers, where the first answer is always worth 1 point, the second 2 points and so on. By adding up the points of the answers to the first 5 questions, we arrive at the final score:
0-5 – Not controlled
6-10 – Poorly controlled
11-15 – Somewhat controlled
16-20 – Well-controlled
21-25 – Completely controlled
