Asthma Review Questionnaire

 

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Your Information
Asthma Review
Inhaler Technique

It is essential to have a good inhaler technique to ensure that your medication gets to the part of your lungs that need it. Please watch the specific inhaler video below to check that you are using your inhalers correctly:

Asthma UK Inhaler Videos: https://www.asthma.org.uk/advice/inhaler-videos/

Lifestyle - Alcohol
For more information please see: https://www.drinkaware.co.uk/understand-your-drinking/unit-calculator
Lifestyle - Smoking
 
Asthma Control Test Score

The Asthma Control Test provides a score to help you and your healthcare provider determine if your asthma symptoms are well controlled.
If you are 12 years or older, please complete the questions below.

Further Questions

Please see the following links for further information on asthma that you may find useful:

NHS - http://www.nhs.uk/conditions/asthma/Pages/Introduction.aspx

Patient.Info - http://patient.info/health/asthma-leaflet

Asthma UK - https://www.asthma.org.uk

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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