Bryngwyn Surgery

4-6 Bryngwyn Road, Newport, NP20 4JS

Telephone: 01633 263463

enquiries.w93046@wales.nhs.uk

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Asthma Control Test

Asthma Control Test

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Name(Required)

Date of Birth(Required)

DD slash MM slash YYYY

During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home?(Required)

All of the time

Most of the time

Some of the time

A little of the time

None of the time

During the past 4 weeks, how often have you had shortness of breath?(Required)

More than once a day

Once a day

3-6 times a week

1-2 times a week

Not at all

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?(Required)

4 or more times a week

2-3 nights a week

Once a week

Once or twice

Not at all

During the past 4 weeks, how often have you used your reliever inhaler (usually blue)?(Required)

3 or more times a day

1-2 times a day

2-3 times a week

Once a week or less

Not at all

How would you rate your asthma control during the past 4 weeks?(Required)

Not controlled

Poorly controlled

Somewhat controlled

Well controlled

Completely controlled

Finally, how many exacerbations have you had in the last year?(Required)

Opening Times

Monday
08:00am to 06:30pm
Tuesday
08:00am to 06:30pm
Wednesday
08:00am to 06:30pm
Thursday
08:00am to 06:30pm
Friday
08:00am to 06:30pm
Saturday
CLOSED
Sunday
CLOSED

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