In the last 4 weeks, how much has your asthma kept you from doing as much as you’d like at work, school or home?*
In the last 4 weeks, how often have you had shortness of breath?*
In the last 4 weeks, how often have your Asthma symptoms made you wake up at night or earlier than usual in the morning?*
In the last 4 weeks, how often have you used your reliever inhaler (usually the blue one) or nebuliser medication, such as Salbutamol?*
How would you rate your Asthma control in the last 4 weeks?*
In the last year, have you had time off work or school because of your Asthma?*
Is there anything else you’d like us to know about your Asthma?*
Do you have a personalised Asthma Action Plan?*
Do you smoke, or have you ever smoked regularly?*
Does anyone else in your household smoke?*
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