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Asthma review (adults)

Asthma Review

Patient Details

Please use date format: DD/MM/YYYY

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? *
During the past 4 weeks, how often have you had shortness of breath? *
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? *
During the past 4 weeks, how often have you used your reliever inhaler (usually blue)? *
How would you rate your asthma control during the past 4 weeks? *

If you are using your blue inhaler 3 times per week or more, it can mean that your asthma is not well controlled. Therefore, please contact Orchard Surgery to book a face-to-face appointment with the asthma nurse.

If your asthma score is below 20, this could also indicate that your asthma is not well controlled, therefore please book a face-to-face appointment.

Additional Questions

Do you smoke?
Would you like to stop smoking?
Would you like us to contact you about stopping?
Are you happy with your inhaler technique?
Do you have a written asthma care plan?
*