Asthma Control Test (4-11 Years)

This is a quick test that provides a numerical score to assess asthma control. Please answer each question, note your total score, and discuss your results with your doctor.

Patient Name*

First NameLast Name

Date of Birth*

Date

1. How is your asthma today?*

0 - Very Bad1 - Bad2 - Good3 - Very Good

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

0 - It's a big problem, I can't do what I want to do1 - It's a little problem but it's okay2 - Once or twice a week3 - It's not a problem

3. Do you cough because of your asthma?*

0 - Yes, all of the time1 - Yes, most of the time2 - Yes, some of the time3 - No, none of the time

4. Do you wake up during the night because of your asthma?*

0 - Yes, all of the time1 - Yes, most of the time2 - Yes, some of the time3 - No, none of the time

Asthma Control Test

Have your child complete these questions.

Please complete the following questions on your own.