1. In the past four weeks, how much of the time did your asthma keep you from getting as much done at work, school or home?
All of the time (+1)
Most of the time (+2)
Some of the time (+3)
A little of the time (+4)
None of the time (+5)
2. During the past four weeks, how often have you had shortness of breath?
More than once a day (+1)
Once a day (+2)
2 to 6 times a week (+3)
Once or twice a week (+4)
Not at all (+5)
3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness, or pain) wake you at night or earlier than usual in the morning?
4 or more nights a week (+1)
2 or 3 nights a week (+2)
Once a week (+3)
Once or twice (+4)
Not at all (+5)
4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)?
3 or more times per day (+1)
1 or 2 times per day (+2)
2 or 3 times per week (+3)
Once a week or less (+4)
Not at all (+5)
5. How would you rate your asthma control during the past 4 weeks?
Not controlled at all (+1)
Poorly controlled (+2)
Somewhat controlled (+3)
Well controlled (+4)
Completely controlled (+5)
Add your answers and determine your total score. If your score is 19 or less, your asthma may not be controlled as well as it could be. Bring this test to our office to discuss your results.
