Children's Asthma Review

 

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Please complete our online form for children aged 4 to 11 years.

Asthma Review for those aged 12 and over

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Personal Details of the Adult
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Personal Details of the Child
 
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This test will provide a score that may help the 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

Step 1

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  emaining 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.

Step 2

Write the number of each answer in the score box provided.

Step 3

Add up each score box for the total.

Step 4

Take the test to the doctor to talk about your child’s total score.

Asthma Control Score

Have your child complete these questions.

Please complete the following questions on your own.

Your Score

Off Target

You scored 

This may be a sign that your child’s asthma is not controlled as well as it could be. Book an appointment with a doctor to talk about the results.

On Target

You scored 

Your asthma appears to have been reasonably well controlled during the past 4 weeks.
However, if you are experiencing symptoms your Doctor or Nurse may be able to help you, please let a Doctor or Nurse know.

Well Done

You scored 

Your asthma appears to have been under control over the last 4 weeks.
However, if you are experiencing symptoms your Doctor or Nurse may be able to help you, please add these into the comments box at the end of this form.

 
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Additional Questions

Additional Questions

Please complete the additional questions below and then press submit to send your review to your Doctor.

 

How to get an asthma action plan

If you’re not using an asthma action plan yet, it’s easy to get started:

  1. Download an asthma action plan here. If you can, print out a copy to take to your GP or asthma nurse.
  2. Book an asthma appointment with your GP or asthma nurse.
  3. At the appointment, talk through the plan with your GP or asthma nurse and fill it in together. You can do this by telephone or video call too if your appointment isn’t in the surgery. Ask them to save a copy onto your notes and send it to you on email, SMS or WhatsApp.

Inhaler technique demonstration videos can be found by clicking here

Privacy Consent

This form collects personal and medical information about you. We use this information to allow the practice team to contact you. Please read our Privacy Policy to discover how we protect and manage your submitted data.

 
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