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Childhood asthma control test

Childhood (4-11) Asthma Control Test
Who are you completing this form for?
For example, on behalf of a child or dependent
What is your name?
What is your date of birth?
For example, 31 3 1980
What is your sex?
As recorded on your medical record
The one used to register with your GP
Anyone else with access to your email account may see responses sent to you

How to answer the childhood asthma control form

Let your child answer the first 4 questions. You may help your child understand the question but let them select the response.

Complete the remaining 3 questions on your own without letting your child’s response influence your answers.

Your score will automatically calculate and go through to the surgery for review. If your child’s score is less than 19, it may be a sign that their asthma is not as controlled as it could be.

Asthma Control

Ask your child to complete these questions:

How is your asthma today? Required
How much of a problem is your asthma when you run, exercise or play sports? Required
Do you cough because of your asthma? Required
Do you wake up during the night because of your asthma? Required

Please complete the following questions on your own:

During the last 4 weeks, how may days did your child have any daytime asthma symptoms? Required
During the last 4 weeks, how may days did your child wheeze during the day because of asthma? Required
During the last 4 weeks, how may days did your child wake up during the night because of asthma? Required

Additional Questions

Do you have a personalised asthma action plan?
Since your child’s last review, have they needed to see a doctor as an emergency or attend the A&E department of a hospital as a result of their asthma?
Since your child’s last review, have they needed a course of steroid tablets to get their asthma under control?
Is your child ever exposed to cigarette smoke?

Inhalers

Please select the types of inhalers that you use: