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

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)

Phone

This field is for validation purposes and should be left unchanged.

87218

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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42353

Prescriptions

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If there are any problems with issuing your prescription, we may call you to let you know.
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90778

Make an Enquiry

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885

Submit your blood pressure readings

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79240

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