Asthma Control Test (ACT)
A quick test that provides a numerical score to assess asthma control.
Recognized by the National Institutes of Health (NIH) in its 2007 asthma guidelines
Clinically validated against spirometry and specialist assessment.
PATIENTS:
Answer each question by marking the circle that best describes your answer.
Your score will automatically be calculated for you.
Hit the submit button to send to your providers office or if unable to do that you can download and print to bring to your next appointment with your provider.
Name
First Name
Last Name
Date
-
Month
-
Day
Year
Date
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?
All of the time
Most of the time
Some of the time
A little of the time
None of the time
Calculation
2. During the past 4 weeks, how often have you had shortness of breath?
More than once a day
Once a day
3-6 times a week
Once or twice a week
Not at all
Calculation
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?
4 or more nights a week
2 or 3 nights a week
Once a week
Once or twice
Not at all
Calculation
4. During the past 4 weeks, how often have you used your rescue inhaler or nebulizer medication (such as Albuterol)?
3 or more times per day
2 or 3 nights per week
Once a week
Once or twice
Not at all
Calculation
5. How would you rate your asthma control during the past 4 weeks?
Not controlled at all
Poorly controlled
Somewhat controlled
Well controlled
Completely controlled
Calculation
Total Score
If your score is 19 or less, your asthma may not be under control.
Submit
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