Childhood Asthma Control Test for children 4 to 11 years

Northwest Suburban Pediatrics

Please correct the errors described below.

This test will provide a score that may help the doctor determine if your child's asthma treatment plan is working or if it might be time for a change.

How to take the Childhood Asthma Control Test

Step 1 Let your child respond to the first four questions (1 to 4). If your child needs help reading or understanding the question, you may help, but let your child select the response. Complete the remaining three questions (5 to 7) on your own and without letting your child's response influence your answers. There are no right or wrong answers.

Step 2 Select the number of each answer.

Step 3 Add up each score for the total.

Step 4 Take the test to the doctor to talk about your child's total score.

19 or less - If your child's score is 19 or less, it may be a sign that your child's asthma is not controlled as well as it could be. Bring this test to the doctor to talk about the results.

Have your child complete these questions:

Please complete the following questions on your own.

Your information will be encrypted.

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