ARFP

Autumn Road Family Practice

904 Autumn Road, #200

Little Rock, AR 72211

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Asthma Control Test

Do you have asthma? Is it well controlled? Mark your answer to these questions to find out.

1. In the past 4 weeks, how much of the time did your asthma keep you from getting as much done at work, school or at home?

All of the timeMost of the timeSome of the timeA little of the timeNone of the time

2. During the past 4 weeks, how often have you had shortness of breath?

More than once a dayOnce a day3 to 6 times a weekOnce or twice a weekNot at all

3. During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, shortness of breath, chest tightness or pain) wake you up at night or earlier than usual in the morning?

4 or more nights a week2 or 3 nights a weekOnce a weekOnce or twiceNot at all

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 day1 or 2 times per day2 or 3 times per weekOnce a week or lessNot at all

5. How would you rate your asthma control during the past 4 weeks?

Not controlled at allPoorly controlledSomewhat controlledWell controlledCompletely controlled

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