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Asthma review (adults)

Adult Asthma Review
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About You

Please use this date format: DD/MM/YYYY. Your date of birth is required to verify your identity.
This email address will be used for all correspondence relating to this request. Please be aware that if anyone else has access to this email address that they may see responses sent to you.

In the last month…

How often does your asthma cause symptoms at night? Required
How often does your asthma cause symptoms during the day? Required
How often does asthma limit your activities? Required

Asthma Control Score

During the past 4 weeks, how often did your asthma prevent you from getting as much done at work, school or home? Required
During the past 4 weeks, how often have you had shortness of breath? Required
During the past 4 weeks, how often did your asthma symptoms (wheezing, coughing, chest tightness, shortness of breath) wake you up at night or earlier than usual in the morning? Required
During the past 4 weeks, how often have you used your reliever inhaler (usually blue)? Required
How would you rate your asthma control during the past 4 weeks? Required