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 time Most of
the time Some of
the time A little
of the time None of
the time

2. During the past 4 weeks, how often have you had shortness of breath?
More than
once a day Once
a day 3 to 6 times
a week Once or
twice a week Not 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 week 2 or 3 nights
a week Once
a week Once
or twice Not 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 day 1 or 2 times
per day 2 or 3 times
per week Once a
week or less Not at all

5. How would you rate your asthma control during the past 4 weeks?
Not controlled
at all Poorly
controlled Somewhat
controlled Well
controlled Completely
controlled

Asthma Control TestTM

Asthma Control Test^TM