Asthma Control Test

Name

The Asthma Control Test™ provides a numerical score to help you and your healthcare provider determine if your asthma symptoms are well controlled.

Take this test if you are 12 years or older. Share the score with your healthcare provider. text

Step 1: Write the number of each answer in the score box provided.

Step 2: Add up each score box for the total.

Step 3: Take the completed test to your healthcare provider to talk about your score

IF YOUR SCORE IS 19 OR LESS, Your asthma symptoms may not be as well controlled as they could be. No matter what the score, bring this test to your healthcare provider to talk about the results.

NOTE: If your score is 15 or less, your asthma may be very poorly controlled. Please contact your healthcare provider right away. There may be more you and your healthcare provider could do to help control your asthma symptoms.

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 [1] Most of the time [2] Some of the time [3] All of the time [4] None of the time [5]

Score

2. During the past 4 weeks, how often have you had shortness of breath?

More than once a day [1] Once a day [2] 3 to 6 times a week [3] Once or twice a week [4] Not at all [5]

Score

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 [1] 2 to 3 nights a week [2] Once a week [3] Once or twice [4] Not at all [5]

Score

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

3 or more time per day [1] 1 to 2 times per day [2] 2 or 3 times per week [3] Once a week or less [4] Not at all [5]

Score

5. How would you rate your asthma control during the past 4 weeks?

Not Controlled at all [1] Poorly controlled [2] Somewhat controlled [3] Well controlled [4] Completely controlled [5]

Score

TOTAL:

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