Childhood Asthma Control Test for children 4 to 11 years old.

Childhood Asthma Control Test for children 4 to 11 years old.
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

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.
Name

First NameLast Name
Date of Birth

MonthDayYear
Date
Today's Date

MonthDayYear
Date
In the past 12 months, has your son/daughter been seen in the emergency department for asthma?

YesNo
In the past 12 months, has your son/daughter been hospitalized due to asthma?

YesNo
1. How is your asthma today?

Very badBadGoodVery good
2. How much of a problem is your asthma when you run, exercise or play sports?

It's a big problem, I can't do what I wantIt's a problem and I don't like itIt's a little problem but it's okayIt's not a problem
3. Do you cough because of your asthma?

Yes, all of the timeYes, most of the timeYes, some of the timeNo, none of the time
4. Do you wake up during the night because of the asthma?

Yes, all of the timeYes, most of the timeYes, some of the timeNo, none of the time
Parents please complete the following questions on your own
5. During the last 4 weeks, on average, how many days per month did your child have any daytime asthma symptoms?

Not at all1-3 days4-10 days11-18 days19-24 daysEveryday
6. During the last 4 weeks, on average, how many days per month did your child wheeze during the day because of asthma

Not at all1-3 days4-10 days11-18 days19-24 daysEveryday
7. During the last 4 weeks, on average, how many days per month did your child wake up during the night because of asthma

Not at all1-3 days4-10 days11-18 days19-24 daysEveryday
Should be Empty: