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ASTHMA CONTROL TEST

This Asthma Control Test™ (ACT) is for people 12 yrs. and older. This questionnaire can help both you and your physician determine whether your asthma is properly controlled. Know your score and share your results with your doctor.

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 timeMost of the timeSome of the timeA little of the timeNone of the time

During the past 4 weeks, how often have you had shortness of breath? *More than once a dayOnce a day3 to 6 times a weekOnce or twice a weekNot at all

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 week2 or 3 nights a weekOnce a weekOnce or twiceNot at all

During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as albuterol)? *3 or more times per day1 or 2 times per day2 or 3 times per weekOnce a week or lessNot at all

How would you rate your asthma control during the past 4 weeks? *Not controlled at allPoorly controlledSomewhat controlledWell controlledCompletely controlled

From a scale from 5 to 25, you have scored:

Lung Sleep Institute Medical Disclaimer *

I acknowledge the Screener is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on the Screener.

CONTACT US FOR QUESTIONS OR APPOINTMENTS

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Contact Us

239-315-7123

239-315-7122 (fax)

6376 Pine Ridge Rd. Unit 440
Naples, Florida 34119

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