Childhood Asthma Control Test for children 4 to 11 years old.
Know the Score.
Please correct the errors described below.
This test will provide a score that may help your 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 1-4)
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 seled 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.
Write the number of each answer in the score.
Add up each score box for the total.
Take the test to the doctor to talk about your child's total score.
Have your child complete these questions.
Please complete the following questions on your own.
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. No matter what the score, bring this test to your doctor to talk about your child's result.
Your information will be encrypted.
Your browser does not support capabilities required for electronic signatures.