Asthma Control Test™

Please check

ONE

answer for each of the five questions below. Be sure to review your results with your healthcare professional.

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

   • none of the time
   • some of the time
   • a little of the time
   • most of the time
   • all of the time

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

   • not at all
   • 3 to 6 times a week
   • once or twice a week
   • once a day
   • more than once a day

3. During the past four 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?

   • not at all
   • once a week
   • once or twice
   • 2 to 3 nights a week
   • 4 or more nights a week

4. During the past four weeks, how often have used your rescue inhaler or nebulizer medication (such as albuterol)?

   • not at all
   • a few times a week
   • once a week or less
   • 1 or 2 times per day
   • 3 or more times per day

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

   • completely controlled
   • somewhat controlled
   • well controlled
   • poorly controlled
   • not controlled at all

If you mark any answers on the right-hand side, your asthma may not be well-controlled. Be sure to talk to your healthcare professional about your asthma treatment plan.

Copyright 2002, by QualityMetric Incorporated
Asthma Control Test is a trademark of QualityMetric Incorporated