Asthma Control Test™ (ACT) for people 12 yrs and older

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FOR PATIENTS:
Take the Asthma Control Test™ (ACT) for people 12 yrs and older.
Know your score. Share your results with your doctor.

Step 1 Select the number of each answer.
Step 2 Add the score for your total score.
Step 3 Take the test to the doctor to talk about your score.

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?

1 - All of the time 2 - Most of the time 3 - Some of the time 4 - A little of the time 5 - None of the time

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

1 - More than once a day 2 - Once a day 3 - 3 to 6 times a week 4 - Once or twice a week 5 - 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?

1 - 4 or more nights a week 2 - 2 or 3 nights a week 3 - Once a week 4 - Once or twice 5 - Not at all

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

1 - 3 or more times per day 2 - 1 or 2 times per day 3 - 2 or 3 times per week 4 - Once a week or less 5 - Not at all

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

1 - Not controlled at all 2 - Poorly controlled 3 - Somewhat controlled 4 - Well controlled 5 - Completely controlled

Total Score:

If your score is 19 or less, your asthma may not be controlled as well as it could be. Talk to your doctor.

FOR PHYSICIANS:

The ACT is:
• A simple, 5-question tool that is self-administered by the patient
• Clinically validated by specialist assessment and spirometry
• Recognized by the National Institutes of Health

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