Asthma review (adults)

Section

Which surgery are you registered at?

In the last month

How often does your asthma cause symptoms at night? *
How often does your asthma cause symptoms during the day? *
How often does asthma limit your activities? *

Asthma control test

During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home? *
During the past 4 weeks, how often have you had shortness of breath? *
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? *
During the past 4 weeks, how often have you used your reliever inhaler (usually blue)? *
How would you rate your asthma control during the past 4 weeks? *

Since your last review, have you needed to see a doctor as an emergency or attend the A&E department of a hospital as a result of your asthma? *
Since your last review, have you needed a course of steroid tablets to get your asthma under control? *

Smoking

Smoking status: *

Smoker

What do you mainly smoke?
How many cigarettes do you smoke in a day? *
How many cigars do you smoke in a day? *
Would you like to give up smoking? *

If you would like help or advice to stop smoking, please visit NHS Quit Smoking.

Ex Smoker

What did you mainly smoke?
How many cigarettes did you smoke in a day? *
How many cigars did you smoke in a day? *
Are you currently exposed to second hand smoke at home? *

Further questions

Did you have a flu vaccination last flu season? *
Do you have a personalised asthma care plan? *
Please select the types of inhalers that you use:

Inhalers can help:

  • relieve symptoms when they occur (reliever inhalers)
  • stop symptoms developing (preventer inhalers)

Some people need an inhaler that does both (combination inhalers).

Watch a short video from Asthma UK to learn how to use your inhaler properly (opens in new tab)

Please let us know that you have watched and understood the video(s):
Terms and conditions *