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Asthma Review

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What is an Asthma Review?

What does it involve?

There are 5 questions relating to different situations.
Once you have scored each question the values are added together to give an indication of how you are managing.
On reviewing your submission, a nurse may want to speak to you or arrange an appointment, please ensure we have the correct contact number for you so we can contact you as required.

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All questions marked with a * are mandatory

Personal Details

Please double check you've entered the correct email address

May be used to identify you

Children must be aged 4 or over to take the Asthma Control Test.

This form is not suitable for those under 4 years so you cannot continue: *

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Asthma Questions

Have you been told you are on a MART or AIR regime for your asthma?:

Do you have a blue inhaler?: *

Have you been given a printed / written asthma management plan?: *

Do you feel confident with your inhaler technique?: *

In the last month has your sleep been disturbed by your asthma?: *

For example, waking up coughing during the night

Do you have asthma symptoms every day?: *

(Cough / wheeze)

Does your asthma interfere with your day to day activities?: *

Have you had any time over the last year you have taken steroids and/or antibiotics for your asthma?: *

Do you smoke?: *

Did you find this form easy to complete?: *

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Privacy Consent

This form collects personal and medical information about you and we use this information to allow the practice team to contact you.
Please read our Privacy Policy to discover how we protect and manage your submitted data.

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If the error persists please contact us.