Asthma Review

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Asthma Review

Asthma Review 

What is an Asthma Review?

  • It is intended to measure and assess well you are managing your condition.

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.

Once received it can take up to 1 week to review your answers

  • If you are in need of urgent advice/treatment call the surgery or call 111
  • Call 999 in life threatening situations
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All questions marked with a * are mandatory

Personal Details
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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 given a printed / written asthma management plan?: *
Have you been told you are on a MART or AIR regime for your asthma?:
Do you feel confident with your inhaler technique?: *
 
During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home? : *
During the past 4 weeks, how often have you had shortness of breath?: *
During the past 4 weeks, how often did your asthma symptoms ( wheezing, coughing, chest tightness, shortness of breath) wake you up at night or earlier than usual in the morning?: *
During the past 4 weeks, how often have you used your reliever inhaler : *
How would you rate your asthma control during the past 4 weeks? : *
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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Contact

Strathesk Medical Practice
Bonnyrigg Health Centre
109/111 High Street
Bonnyrigg
Midlothian
EH19 2ET

Telephone: 0131 322 9333

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