Asthma Control Test The Asthma Control Test provides a score to help you and your healthcare provider determine if your asthma symptoms are well controlled. Please tell us which practice you are registered with---Haigh Hall Medical PracticeShipley Medical PracticeSunnybank and Cowgill PracticeThornton and Denholme Medical PracticeThe Willows Medical Practice Full name NHS Number Date of Birth Email address Phone How often does your asthma prevent you from getting as much done at work/school/home? All of the timeMost of the timeSome of the timeA little of the timeNone of the time How often have you had shortness of breath? More than once a dayOnce a day3-6 times a week1-2 times a weekNone at all How often did your asthma symptoms wake you up at night or early in the morning? 4 or more times a week2-3 nights a weekOnce a weekOnce or twiceNot at all How often have you used your reliever inhaler (usually blue)? 3 or more times a day1-2 times a day2-3 times a weekOnce a week or lessNot at all How would you rate your asthma control? Not controlledPoorly controlledSomewhat controlledWell controlledCompletely controlled
