In the last week:
In the last week, how many times have you used your reliever inhaler (usually blue)?
0
1
2
3
4
5
6
7
8
9
10+
Please answer this question
Thinking about the last 7 days
How many days has asthma interfered with your normal activities (e.g. sport, school, work/housework)?
0
1
2
3
4
5
6
7
Please answer this question
How many nights have you been affected/woken by asthma symptoms (including cough)?
0
1
2
3
4
5
6
7
Please answer this question
How many days have you experienced asthma symptoms?
0
1
2
3
4
5
6
7
Please answer this question
In the past 4 weeks, did you:
Miss any work, school, or normal daily activity because of your asthma?
Yes
No
Unsure
Please answer this question
Wake up at night because of your asthma?
Yes
No
Unsure
Please answer this question
Believe that your asthma was well controlled?
Yes
No
Unsure
Please answer this question
In general, do you use an inhaler for quick relief from your asthma symptoms?
Yes
No
Unsure
Please answer this question