Asthma Control Test (Ages 4-11)

Asthma Control Test (Ages 4-11)

Standard online form based on the PDF. Complete the patient information and answer the asthma control questions for the applicable age section. Scores are calculated by summing the selected answers, with interpretation notes shown in each section.
Instructions:

For questions 1-4, ask your child to answer.
for questions 5-7, parent answers without child's input.
1. How is your asthma today?
2. How much of a problem is your asthma when you run, exercise or play sports?
3. Do you cough because of your asthma?
4. Do you wake up during the night because of your asthma?
5. During the last 4 weeks, on average, how many days per month did your child have any daytime asthma symptoms? (0 = Every day. 1=19-24 days/mo. 2=11-18days/mo. 3=4-10 days/mo. 4=1-3 days/mo. 5= Not at all.)

0

1

2

3

4

5

0 is Everyday, 5 is Not at all
6. During the last 4 weeks, on average, how many days per month did your child wheeze during the day because of asthma? (0 = Every day. 1=19-24 days/mo. 2=11-18days/mo. 3=4-10 days/mo. 4=1-3 days/mo. 5= Not at all.)

0

1

2

3

4

5

0 is Everyday, 5 is Not at all
7. During the last 4 weeks, on average, how many days per month did your child wake up during the night because of asthma? (0 = Every day. 1=19-24 days/mo. 2=11-18days/mo. 3=4-10 days/mo. 4=1-3 days/mo. 5= Not at all.)

0

1

2

3

4

5

0 is Everyday, 5 is Not at all
Total score
If your score is 19 or less, your asthma may not be under control.

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